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How to... find a good salaried GP job

Salaried GPs need to ensure they agree terms and conditions clearly with practices, reports Fiona Barr.

Statistics from the BMA's GP opinion survey published last month paint a mixed picture of life as a salaried GP. Almost one in 10 GPs works as a salaried doctor.

Compared to colleagues who are partners, they are more likely to have high morale, less likely to expect a drop in income in the next year and less likely to say that work impinges on their quality of life.

However, almost half would like to become a partner in the next five years, suggesting that salaried life has its drawbacks.

Model contract
Practices on GMS contracts must use the salaried model contract for doctors taken on since 1 April 2004. The GPC recommends that those on PMS and alternative provider medical services (APMS) contracts also use the model. Primary care organisations (PCOs) are obliged to offer at least the model contract.

It includes details, hours of work, continuity of employment, agreements for outside activities and private practice, practice meetings, termination of employment, sick leave, maternity leave and holidays. The model contract also includes a minimum salary range recommended by the Doctors and Dentists Review Body. This is £51,332-£77,462 for 2007/8.

Agreeing a salary
Negotiations over pay are always going to be tricky. Dr Vicki Weeks, chairwoman of the GPC's sessional GPs sub-committee describes the job market for salaried GPs as 'pretty dire'. She says it is currently a buyer's market.

But Dr Vik Mohan, a salaried GP in Exeter (see case study), encourages partners to be open about the premium they put on partnership.

'Partners have greater responsibility and do more work, that is not in question,' he says. 'But there needs to be a decent dialogue about what that added work is worth financially.'

Dr Mohan suggests 80 per cent of a full-time partners' earnings at a particular practice is a reasonable starting point for pay negotiations for a full-time salaried GP.

Map out the job
The model contract states that a job plan must be attached to the GP's terms and conditions. This should cover normal duties, workload and non-clinical roles. The employer should set out, for example, how many hours is included in a session, how many patients the doctor are expected to have seen in that time, including extras, and what administrative time is included.

Dr Weeks advises salaried GPs to be clear about their own and the practice's expectations: 'Consider whether the practice knows what it actually wants. Often you see posts advertised for a full-time salaried GP when what is really needed is a mini-partner.'

Employee entitlements
Newly revised guidance 'Focus on Salaried GPs' from the GPC sets out the statutory and model contract requirements for maternity and sick leave and includes advice on continuity of NHS service. The Focus also states that salaried GPs (regardless of the model contract) can join the NHS Pension Scheme as 'assistant practitioners' (or type 2 practitioners).

Career development
Dr Weeks advises applicants to think in terms of how a potential job will develop their skills. They should find out, for example, how much continuing professional development the practice will support and whether the salaried GP will be included in the teams' meetings.

'You don't want to find yourself just treading water,' she says.

Tap into outside expertise
Find out as much as you can about practices' reputations. If possible do some locum work at practices you apply to and get a real feel for how the practice operates.

Tap into local sessional GP networks, join the National Association of Sessional GPs and the BMA and seek the LMC's support.

The BMA offers a contract-checking service to review your offer letter and terms and conditions.


Case study: avoiding unfair terms

Being treated fairly is a subject close to Dr Vik Mohan's heart. As a half-time salaried GP with the St Thomas Medical Group in Exeter, Dr Mohan says he is lucky to work for a supportive partnership that offers him good terms and conditions. However, as a former chairman of the Exeter Sessional GP Group and as a GP appraiser, Dr Mohan says he has too often come across less fortunate salaried GPs.

'It's fantastic that GPs are now in a position where we have a number of career options,' he says. 'But my concern is that it is creating a two-tier system. In my area we have large numbers of GPs chasing a small number of jobs and being under pressure to accept unfair terms and conditions.'

His advice is to follow a three-step process when applying for salaried GP. First, insist that practices use the BMA model contract. Second, make sure you have a clear job plan setting out exactly what is expected and finally have a full and frank discussion about pay including the minimum you will accept and review dates for both inflation and seniority.

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