ASSOCIATES were introduced as part of the 1990 GP Contract specifically to end GPs’ isolation in sparsely populated areas. Such single handed GPs found it difficult to get away from the continuous on-call commitment and hence take holiday or study leave. Associates are usually employed by two (or three) single handed practices in which the list size is insufficient to warrant another partner. Associates are salaried and tend to be notionally full-time but increasing numbers are taking up part time posts attached to just one practice. Single handed doctors are permitted an allowance to employ an associate to relieve the continuous on call commitment if they:

• receive rural practice payments; or are sole practitioners on an island; and if they
• receive inducement payments (paid to ensure medical cover in unpopular areas); or
• work more than 10 miles from their nearest neighbouring practice and district general hospital.

There are a number of financial inducements for the principals and associates, see box.

Such inducements may seem very attractive but as isolated rural doctors associates have to face challenges that most GPs avoid; they are likely to be the first on the scene at an accident and referral to hospital has to be considered more carefully when the hospital is 50 miles away. Associates will face long periods of continuous on call, (that’s what they’re employed for) and if the practices they work for are some distance apart, have to have two bases. Being salaried means that associates can’t get the same tax perks that other non-principals can.

Although originally targeted at doctors finishing their GP training, most associates are older than 35 and two-thirds are female. Increasingly principals are becoming associates. The advantage, like other non-principal work, is that it provides time to gain additional experience without the commitment or paperwork of being a principal. Associates are able to concentrate on clinical skills with some continuity of care. Patients also get the opportunity to consult a different doctor.

Posts are advertised in the BMJ and GP Press. Further information and advice about associate posts can be obtained from the National Society of Associates, c/o Fiona Fraser, Postgraduate Centre, Inverness. Telephone 01463 704347/704348.

In 1996 there were 44 associates, all but two in Scotland. There are other ‘associates’ elsewhere but many of these are unique posts created for the locality in which they are based and which may not have the same terms and conditions as set out in the Red Book ^{Note 1}. One scheme (reported in GP 28/2/97) has been set up in two single handed practices on the Shropshire Powys border where an associate is working one day per week at each practice, ten weekends per year and providing holiday cover.

North West Regional Primary Care Initiative - Primary Care Associate Physicians

In Liverpool a unique scheme was established in 1993 in which vocationally trained GPs were recruited to work in deprived areas of the city, in small busy practices. The doctors formally known as Primary Care Associate Physicians but nicknamed Parachuting Doctors were intended to support hard pressed principals and act as catalysts for change. Practices which felt they were ‘under-achieving’ were invited to bid for an associate.

The Associates were employed for a three year term, full time in the first year and part-time in the second and third years enabling time for funded higher degree courses. Sixteen doctors were taken on initially. By the third year, some nine had left the scheme but six of these were continuing to work in deprived areas.

The initial full time salary was £31,827 topped up with a car allowance, reimbursement of medical defence organisation subscriptions and funding for approved postgraduate courses. Associates were also able to join the NHS Pension Scheme. One session per week was based out of the practice with other associates on the scheme.

Although the scheme comes to an end in April 1998, health authorities in the region are funding 9 Associate Physicians to undertake similar work. These doctors will also attend small group support sessions. There is potential for similar schemes to continue as pilots under the 1997 NHS (Primary Care) Act or through the White Paper ‘Delivering the Future’, which allows health authorities to support the employment of salaried GPs in hard pressed practices. Negotiations over the details of this are in progress between the Department of Health and the GMSC. Schemes like this provide increasingly wanted (and needed) experience for newly qualified GPs. Sadly they are few and far between.

Further details on the North West Regional Primary Care Initiative can be obtained from Dr Roy Woodward, GP Coordinator, at Liverpool Health Authority. Telephone 0151 236 4747.

Lambeth, Southwark and Lewisham ‘Associates’
Lambeth, Southwark and Lewisham scheme. This is a year-long scheme launched in October 1994 where associates work three sessions a week in one practice, four sessions in another practice, and spend one session per week on group research and two sessions per week on professional and personal development. This scheme is funded with LIZEI money.

Note 1
The Red Book (Statement of Fees and Allowances) Paragraph 19.