37. Becoming a Principal


	MANY DOCTORS are non-principals whilst they look for a suitable partnership. This chapter briefly details how to look for a principal post. Readers are strongly advised to read further on this subject (see below for sources). Defining your ideal practice. Decide what sort of doctor you are. The Curriculum Vitae. Looking For Vacancies. Practice Profiles. Visits and Interviews. Practice Agreements. The Accounts. Further Reading. Defining your ideal practice If you feel the need to settle down, to get some stability and commitment in your life, it could be time to become a principal. Before rushing out to every local practice that has been advertising for months, think about the ideal place you would like to work in. Decide which of the following you would prefer. Which factors represent hard criteria i.e. 'must have' and which are soft criteria that you could compromise on? Consider the chart below: You should now have an ‘ideal’ practice but there are more things to consider. Before formally applying, these are some of the areas you may want to know about: structure of the GP’s day; when do the partners see each other? the attached staff - nurses and professions allied to medicine and administrative; who leads the practice? any non-principal staff? does the practice manager manage or just administer? does he or she get a profit share? number of appointments per day and average number of visits; arrangements for extras and emergencies - is there a duty doctor rota? when will you be expected to buy in and what are the likely costs of this? what is the access to secondary care like? Are there any GP beds nearby? what innovations have the practice made? Are there any local innovations in secondary care? what’s the deal on money and when will you reach parity? Decide what sort of doctor you are Do you thrive best in a busy, dynamic, demanding environment or are you more suited to a quiet, stress-free existence with little change. Most of us would prefer elements of both. How critical is income to you? Although the average net taxable earnings are around £45K, practices vary a lot and you’ll need to consider this seriously if you want foreign holidays, new cars and private education for the kids. What are your clinical and management interests? Are you interested in computers, practice nursing, staff appraisal, audit, research, finance, secondary care, GP politics, training...? If you've never thought of them, do so now - you'll need to know whether they complement or duplicate those of the other partners. The Curriculum Vitae (CV) Before you start applying, get your CV up-to-date and virtually ready. It really should be adapted for each practice you apply for. Ensure that you can amend it easily and quickly. Your CV creates the first impression. It has to be good. Only high quality printing on good quality paper will do. There must be no spelling mistakes or other ‘typos’. The formatting must be consistent throughout. Choose a font which is kind to the eye (this is Times New Roman). Arial is often used but is rather bland. Courier looks like old lecture notes. Anything jazzy is right out -you will not be WANTED! Use your CV to promote yourself and show others what sort of person you are. Demonstrate enthusiasm for your work and your leisure. Areas to include: front page with your name (not qualifications - have some modesty); summary sheet containing a brief promotional résumé and why they should appoint you; personal details include partner’s name and job and your children’s names and ages; education, secondary, undergraduate, postgraduate, eligibility for subsidiary lists; posts held - a list; experience gained - clinical and administrative; research and audit - work you have been involved with; publications if any - most people have none; leisure interests; career aims/why you are applying for this job; referees - never quote without asking first. Whether to bind your CV or present it in a nice plastic wallet might depend on how many you need to provide. It may leave your hands in perfect order but it may not stay that way at the other end. A clear cover will prevent inadvertent marks tarnishing that essential first impression. Career Breaks Many doctors (especially specialists) get rather hung up about career breaks. Fortunately, generalists are more human and realise that people have families, desires to travel and find other ways to spend life without a traditional ‘job’. If there are breaks in your CV, and as a non- principal there are likely to be some, you should consider yourself a better candidate than those without. How long will that doc who has worked constantly from A-levels to becoming a principal survive in a pressurised practice? Be able to describe what you did during the so-called ‘breaks’ and justify them. If the prospective partners are unimpressed, you probably wouldn’t have got on together anyway. Looking for Vacancies Scan the: BMJ classified adverts; GP press classified adverts; Ask around at the: · local postgraduate centre; health authority; LMC office; local non-principal group. In popular areas, practices don’t need to advertise. Word of mouth often finds them a candidate who fits the bill and will jump at the offer. You will need to have ‘connections’ and to put the word out that you are available to be in with a chance in such areas. Don’t despair though, the recruitment crisis is upon us. There are fewer such areas than in the past. Practice Profiles The content of these vary enormously. Some look like brochures for a luxury new home (wasting money or commercially astute?) Others merely send a practice leaflet! Send off for one or two, particularly if their adverts sound good, and use them as a benchmark. A good profile will include most of the information you need. If there is information missing, phone the practice manager and ask. Be prepared to be put through to a partner so don't call about trivial points and avoid traditional surgery hours. First impressions count. Ask locally about the practice. Other practices that you work for are likely to know the partners there and receptionists will know other practices’ reputations - they may be registered there themselves. Ex-registrars can be very useful although their views may be coloured by the way they were treated. (If so, do you want to work here?) Other non-principals are likely to know the practice, but you may want to keep your interest quiet - finding out that good friends and colleagues are applying unsettles many people. Visits and Interviews An informal look around the building is essential if it’s not too far away. Practices should be prepared to do this. It’ll help you to decide whether the area and the practice are for you. If you are invited to look around, this is likely to form part of an informal interview. Be smart, be on time, be polite, slightly enthusiastic and have some questions to ask. An informal visit should take about half an hour. Use it to observe the scene in reception whilst you are still unknown. You may never get another chance. What are the doctors’ rooms like, and the waiting room? Are the premises adequate? What’s the general feel of the practice? Do the partners say ‘Hello’? Are the staff relaxed or stressed? A call for an interview is a sign that you are over the first hurdle of short-listing. Be pleased about this and allow it to boost your confidence. Before the interview be sure that you think this is the right practice for you. Find out as much as you can from wherever you can. Any unanswered questions will have to be saved for the interview. Make sure they are important. On the day the partners will probably feel as uncomfortable as you. They will want to ensure they pick someone who will fit and settle in quickly. Selecting replacements is not an easy task. Again, be smart, be on time, be polite, slightly enthusiastic and have some questions to ask. Don’t turn down the opportunity to look around again. You’ll be given a different commentary and will get a better idea of the adequacy of the building on a second visit. The style of the actual interview will vary enormously. Partners are likely to take it in turns to ask the questions and in good practices will ask each candidate the same questions. Expect several, if not all, the partners to be there - this is an important decision for them. If you get dry during the interview, be bold enough to ask for some water. Don’t be too serious - questions are often phrased awkwardly on purpose, but you don’t have to fall into the trap of giving the MRCGP answer. Show how human and down-to-earth you are. At the end have a good idea on whether you could work with these individuals. They may offer you a job in the next few days. You’ll need to accept quickly if you are not going to get a reputation for mucking people about. Similarly, if after the interview, you decide it’s not for you, sleep on it and phone the practice manager the next morning to withdraw. Don’t wait for the glory of being offered a job. If you haven’t heard within a week, it may suggest they are having trouble making their minds up - or they are negotiating with their first choice. Politely enquire at this stage. You may yet be called to undergo a trial by dinner party. This, fortunately, is becoming a rare event. Although the meal and small talk may be very false and trying, it needn’t be. Use it to get to know the partners. Are they like-minded? Are they utter snobs? Could you work with them? Trials by dinner party will enable your partner to judge them too - one advantage of having them. There is not likely to be more than one other candidate at this stage. Try not to be overly nervous - enjoy the occasion and wait the result with dignity. Before you confirm your acceptance, ensure you see the practice agreement and the accounts of the last year or two. Accept, giving the rider that you will seek a professional opinion on each. The Partnership Agreement Whole books have been written on this alone and still the GP press report partnerships that have dissolved because a dispute could not be settled (and there wasn’t a partnership agreement). Ask the local office of the BMA (or a solicitor experienced in GP partnerships) to review the document for you. BMA staff will do this for free for members. The GMSC have produced guidance on this, as has the BMA. It is worth getting a copy of these from your local office: Partnership Agreements - Guidance for GPs - GMSC July 1996 Medical Partnerships under the NHS - BMA August 1995 The Accounts These will show the profit trends and efficiency of the business. Beware of practices that are reluctant to show them. Ask your ex-trainer and an accountant (who is familiar with GP accounts) to go over them. Medeconomics provides figures for GP pay and national fee comparisons per patient. Find out the answers to these questions: How are profits divided? · When will you reach parity? Consider negotiating if the traditional three years seems too long, and if new partners are thin on the ground. Find out what income is pooled? Does it include seniority awards, PGEA, and Clinical Assistant earnings? How is provision for tax liabilities made? How does the manager calculate how much partners can draw each month? Does the practice manager do cash flow forecasting? BMA Professional Services will check practice accounts for a fixed fee. Call them free on 0500 262829. Further information GP Handbook 1997-98 - BMA free to members Ellis Norman and Stanton Tony (Editors) 1994: Making Sense of Partnerships Radcliffe Medical Press RCGP booklet 1996: What's new in General Practice - an excellent quick read of six topics aimed at young principals. Gallen, D, Coulson, W, and Buckle, G 1994: First Steps in General Practice Blackwell Although the start of this book is about training there are large parts on looking for, applying for and surviving in practice. I can't recommend it enough. Astra reps were offering it for free in 1997 but if you haven’t seen an Astra rep recently, just buy it! M Pringle, M, Hayden, J and Procter, A. A Guide for New Principals An easy-to-read, informative book, with an excellent first chapter on the history of general practice (and the 1990 contract) and lots of good advice for survival in the job. BMJ Career Focus Articles These all appeared in the Classified Advertisements supplement and are available on the BMJ website at Craft Naomi: Making the short-list BMJ 7066 Volume 313. Crawley, Helen: Building a Career Portfolio in General Practice BMJ 7065 Volume 313. Chambers, Ruth: Career Counselling in General Practice BMJ 7062 Volume 313. Sudlow, Mark and Toghill, Peter: How to be interviewed BMJ 7059 Volume 313. Hutton-Taylor, Sonia:Do it Yourself Careers Guidance, BMJ 7053 Volume 313. Snowise, Neil: Changing partnership BMJ 7086 Volume 314. BMA New Principals’ courses cover employment and partnership law and issues around property, parity and the sale of goodwill and the future of general practice. Delegates receive one of the BMA’s New Principal’s packs consisting of an executive briefcase, the new complete file of GMSC’s Guidelines (including a version on disc with all the NHS regulations governing general practice), the BMA's new GP Handbook and other BMA publications and goodies. The courses are held in quality hotels and are good value for money. The editor (having attended one) recommends them! Details from Jacquie Newman, course administrator on 0171-383 6105. Want to job share? The BMA has recently centralized its job sharing register. Contact Janet Jordan on 0121 456 1402 for an application form for the register. BMJ Classified’s Noticeboard section offers free ads to individual readers seeking a job share partner.