Career Options in GP

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Career Options in GP

• June 2004

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Freelance GP
Post VTS
Salaried GP
Portfolio GP
Profit Sharing Partner
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Freelance GP.

• Advantages/disadvantages
• Getting work
• Finance
• Pay
• Resources and support

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Advantages and Disadvantages.

• Disadvantages.
• Unpredictable income.
• Holidays, sick and maternity leave.
• No paid study leave (initiatives to fund
  education for non-principals).
• Practices may cancel bookings at very short
  notice.
• Locums may be seen as second best or as a new
  opportunity to get a second opinion on!
• Continuity of care difficult.
• Different practices will different systems and
  procedures, e.G computers.

• Advantages
• Flexibility and freedom of working
• Exposure and experience of different practices
• Top-up your income
• Try before you buy
• Local knowledge about prospective posts
• Increased profile
• Workload is less stressful than being a principal
  in GP

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Requirements to Work As a FGP

• Supplementary list
• VT certificate
• GMC
• Medical defence
• CV
• Details of previous employment
• References

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Getting Work.

• Start early
• Circulate your CV to local practices and LHBs
• Register with LHBs locum list
• Mention to drug reps that you are looking for
  locums
• Advertise in local postgraduate centre
• Contact local co-operatives and deputising
  services if you want "out-of-hours" work
• Locum agency

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Communication

• Mobile phone
• Answering machine
• Email
• Fax at home
• Check and respond even if not able to do work

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Agreeing to Work

• Make sure you know exactly what you are expected
  to do!
• Surgery, calls, on call, emergency appointments
• Agree a fee
• BMA rates? Travelling costs
• When will you get paid
• Weekly rate versus daily rate
• Invoice, copy for practice and keep a copy for
  accountant

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The Accountant

• You get the following note from your accountant.
• Dear Dr
• Please can you provide me with details of your
  income and expenditure for the last financial
  year so that I can prepare your practice and
  personal accounts.
• What do you do?
• What information does he need

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Finance

• Being self employed doctors requires you
• Keep records of all your income and work related
  expenses
• To pay your own national insurance contributions
• To collect the income tax that you have to pay to
  the inland revenue at the end of the tax year
• Keep 1/3rd income for tax.

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Finance

• Personal.
• Meet the accountant.
• Income and expenditure.
• Check what the accountant wants from you and how
  he wants it presented.
• National Insurance

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Personal Expenses

• Motoring
• Petrol and oil
• Repairs and servicing
• Road Tax
• Insurance
• Breakdown
• Car parking/washing
• Mileage log 3 months, watch out for this!

• Other
• Books magazines and journals
• Home study
• Clothing allowance
• Drugs and equipment
• Courses
• Telephone
• Home Computer
• Locum payments
• Locum insurance
• Subscriptions

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National Insurance Contributions

• Self employed people are liable to pay two
  classes of contributions
• Class 2 contributions.
• Flat rate, direct debit, set this up ASAP.
• Penalties for late payment.
• Class 4 contributions which are paid on profits
  at or above a certain level.
• Calculated by accountant.

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NHS Superannuation.

• If you are a 'freelance' GP locum performing GP
  locum work and work for a GMS, PMS or a PMS GP
  or GP practice, you will be able to pay NHS
  pension scheme contributions on the gross pay you
  receive (less expenses of 10).
• Any NHS GMS, PMS or PMS work can be pensionable,
  provided there is a clear and direct transaction
  for the work, between yourself and the employing
  GP practice or absent GP.
• You will be able to claim tax relief at your
  usual rate in your annual tax return on the
  contributions you pay.

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Pensionable Pay.

• Examples of GP locum work that WILL be
  pensionable.
• 'Out of hours' cover based on a direct
  transaction between the GP locum and a named GP,
  e.G. One who is unable to do their scheduled
  shift will be pensionable.
• Additional work performed for a specific GP
  practice will also be pensionable.
• Examples of GP locum work that WILL NOT be
  pensionable.
• GP locum work that has been arranged and paid
  through a third party, such as a commercial
  deputising firm, a commercial agency or a
  co-operative itself, is not pensionable under the
  NHS pension scheme.

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Remember

• Appraisal and revalidation
• Professional development
• Local NP facilitator
• Holidays
• Sickness
• Insurance
• Critical illness

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Resources

• NANP
• NP Network Wales
• BMA
• NHS pension
• National Insurance Contributions

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Salaried GP

• Options for working as a salaried
• GP Salaried v partnership
• Who pays your salary? Does it matter?
• Salaried contract what to look for?

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Options

• Who can you work for as a salaried GP?
• Department of PG medicine
• GP assistant scheme
• Research fellow with sessions in practice
• Primary care organisation e.g.LHB
• Individual practices
• Deputising and private firms
• Others, armed forces

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Salary or Partnership

• Advantages
• Introduction to life as a G.P. without the
  business worries
• Flexibility no long term commitment, and working
  hours can be easily negotiated to suit family or
  outside work interests(?)
• Less paperwork and administration than partners
• Guaranteed income
• Superannuation scheme is maintained
• No equity to bring or financial risk involved

• Disadvantages
• Usually lower income than peers who go into
  partnership
• May be viewed by some as "lower" status than
  partnership
• Short term contract
• Full maternity and sick pay may have to be
  negotiated)

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Who Pays Your Salary?

• Does it matter?
• May determine how much you get but also
  additional benefits and security.

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Contracted to Whom?

• Trust
• 1 or more practices
• Full holiday, study leave, maternity and sickness
  (Whitley)
• Difficult to change contract and working
  conditions

• Individual Practice
• Single practice
• May need to negotiate leave entitlements
• Negotiate car, defence subs
• Easier to change working conditions
• ? Salary higher

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GPC and RCGP Recommendations for Salaried GP
Contract

• Paid, protected time for educational activities
  of 30 hours per year.
• Financial support towards continuing education
  activities when undertaken in support of the
  employing authority's objectives.
• Payment for bank holidays, adjusted pro rata for
  part-time employees.
• A minimum of six weeks paid annual leave.
• Financial recognition of the costs incurred in
  securing childcare where necessary.
• Car allowance, where the provision of transport
  is a necessary requirement to discharge the
  responsibilities of the contract.

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GPC and RCGP Recommendations for Salaried GP
Contract

• Telephone allowance, where telephone access at
  home is a necessary requirement of the contract
  and which should include recognition of the costs
  of mobile phone provision where necessary to
  fulfil in hours or out of hours obligations under
  the contract of employment.
• Maternity leave in full compliance with current
  statutory provisions.
• Full compliance with statutory provisions on
  parental leave and dependants leave.
• An undertaking to treat the employee with freedom
  from discrimination on the grounds of race,
  religion, gender, sexual orientation, disability
  or contractual status.

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Profit Sharing Partnership

• Why?
• Choosing a practice?
• What to look for?

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Advantages of Partnership

• Higher income?
• Ownership.
• Own boss with equal say.
• Ability to develop skills.
• Clinical.
• Non clinical.
• Security.
• New contract.
• Pension opportunities.

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Pitfalls of Partnership

• Pitfalls are many and varied and, although not
  all can be predicted, they tend to concern the
  five Ps
• Profits, ? parity
• Property, fixtures, capital account, buying in to
  property
• Patients, registration rules
• Performance, who does what?
• Personalities, mutual assessment

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Choosing a Practice

• Before looking for a practice you will need a
  checklist of essentials and desirables for your
  ideal practice.
• Many factors that you need to consider when
  looking for a practice.
• Geography.
• Do you want to work in a particular part of the
  country?
• Do you want to work in an urban or rural
  practice?
• Where do you want to live?
• What sort of schools out of hours.
• Work commitments.
• Partnership size and characteristics.
• Buildings.
• There may be other major factors. At the end
  prioritize how important each of the factors are
  to you and your family.

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What to look for?

• The partners
• What are their interests?
• Outside commitments?
• Approach to PHCT?, RCGP
• Practice Agreement
• Is there one?
• Study leave
• Holidays
• Practice meetings
• Maternity leave
• Sabbaticals
• On call

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What to Look for?

• Income
• What goes into the pot
• What sort of income should one aim for
• How is the income distributed and what will be
  your share
• What about parity
• Is there a mutual assessment period
• Buying in. What share will you be expected to buy
  and when
• How is tax dealt with, do you have to manage your
  own tax
• Private income and its distribution
• Will you be expected to have an outside
  appointment
• Are targets met
• How are the drawings decided
• Accounts
• When will you be able to see an set of the
  practice accounts

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At the End of the Day Ask Yourself?

• Does the practice suit me as a doctor?
• Do the existing partners share my professional
  values?
• Am I going to get a fair deal?
• Is this a practice I want to call my own?
• Do I need to take advice?

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Portfolio Medical Career

• General practitioners have opportunities to
  control both their career development and the
  shape of their working week
• Flexible working, with a variety of hours and
  posts, is increasingly becoming accepted
• Interests and areas of expertise from your
  hospital training can be brought with you into
  general practice in the form of clinical
  assistantships
• Education, research, and medical writing are
  examples of non-clinical "add ons" to clinical
  life
• Sessional posts, such as community health, lend
  themselves to being mixed with part time general
  practice

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C.A
Trainer
C.O
GPSI
Hospital
UG
GPR
CMO
Education
GMS
Medical Advisor
CPD
App
Research
Forensic
LHB
DSS
OTHERS!!
Medical Politics
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Advantages

• Motivation
• Reduce burnout
• Continuous development
• Change with time and needs
• Income generation
• Meet new people

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But Watch Out for

• Time management
• Allow plenty of time for family and self
• Often work more than your salary
• May cause resentment
• Patients
• Partners
• Relatives

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Options

• Clinical Assistant
• GP SI
• Retainer