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READ codes, living wills and taxation

NHS RULES

Q: In view of the emphasis being put these days on recording ethnicity, does anybody know which READ codes are going to be the ones used?

A: As of 1 April 2006, the DoH has advised that the '16+1 codes' be used (where the '+1' is 'not stated') based on the five ethnic bands. A copy of these can be found at: www.dh.gov. uk/assetRoot/04/11/68/43/ 04116843.pdf

Tim Kimber

NHS RULES

Q: We have lately had two requests to hold living wills with patients' records. Does anyone have a protocol for dealing with this? Do you charge? I know we can code for a living will being available, but who should hold the documents? I also wondered how the information is made known to the out-of-hours cover? Will they accept the information?

A: There is nothing to charge for and there is no reason why everyone who might need a copy cannot have a copy.

My out-of-hours organisation accepts them.

Tim Kimber

ACCOUNTANCY

Q: I qualified in 1993, have been in general practice since 1998/9 and I work as a salaried GP with an annual salary of £68,000 for eight sessions. I am currently doing seven sessions. I pay for my own courses, defence union and insurance. I have not been paid for last year's appraisal and am unlikely to be paid for this year.

I am in the process of renegotiating my annual contract and I want to ask for a pay increase, as well as remuneration for medical reports and letters that I write, and any private patients that I am asked to see.

I have been with the practice since May 2003 and although my pay was increased last year it was only because I am no longer paid petrol allowance, or defence union and insurance fees, which had previously been paid. Is it reasonable to ask for an extra £500 per session per year?

A: Your question is difficult to answer in that there will have to be local circumstances that affect any salary package.

You suggest that you might ask for an extra £500 per session per year, which equates to just short of 6 per cent. If you are asking to be paid in respect of medical reports and other non-GMS activities for the first time, this makes the increase much larger, although to what extent you did not specify.

The difficulty is that GPs, after significant increases in some respects due to the new contract, are now facing a period of uncertainty; this makes it difficult to comment on specifics.

Stuart Williamson

PENSIONS

Q: I am having to retire from general practice, at the age of 57 due to ill health, and my application has been accepted by the NHS Pension Agency.

With the approval of my partners I am planning to retire at the end of March 2006. Could you please advise me whether it would be to my advantage, with regard to calculation or payment of my pension, to retire on any particular date, such as 31 March, 1 April or 6 April?

A: As NHS Pension scheme dynamisation factors are calculated on a monthly basis, it does not make much of a difference in which month a GP decides to retire. However, it is advisable to retire at the start of a month to obtain the full dynamisation for that month.

Kevin Quinn

TAXATION

Q: When is a locum 'self-employed' and when are they 'employed'? I am unclear about the distinction and do not want to fall foul of HM Revenue and Customs nor the Pensions Agency.

A: The question of whether someone should be employed or self employed is very much a grey area because there is no statutory definition of employment.

When HM Revenue and Customs is trying to establish a person's status it will look at the 'badges of trade'. These include looking at whether a person is working personally under the control of someone else, the basis of payments made or benefits such as holiday/sick pay.

For a locum to be treated as self employed, they will normally cover a doctor's place during illness or holiday and it will be on an ad hoc basis when cover is needed.

A self-employed locum would be able to choose what work they did, and when they wanted to work, they would not be paid holiday, sick leave and should be working for many practices.

This way the locum can be self employed and would be paid on receipt on an invoice.

GPs who describe themselves as a locum might be engaged as an additional doctor in the practice and should be treated as an employee and put on the payroll.

It is also advisable that a maternity locum covering more than six months' leave be treated as an employee.

Jenny Stone

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