ASSISTANTS are formally defined as practitioners either employed by a principal with the consent of the health authority or working within a partnership but not as a partner. They usually work regularly for one or more practices. They may be full or part-time. There are four types:

• Some assistant posts are formally approved by the health authority;
• Others are known to the practice as an employed assistant but do not have formal health authority approval;
• Others are those taken on by a practice usually for a fixed term with a view to partnership. The BMA discourages such arrangements recommending that other provision be made for such time when both parties are assessing each other;
• Others are locums who have worked for a practice for more than three months and who should be regarded as employed assistants. It is cheaper for practices not to do this because it is more bureaucratic to employ staff formally and because employed staff are entitled to join the NHS superannuation scheme and the practice has to pay the employers contribution for national insurance. Locums may feel happy with such an arrangement, believing that the self-employed tax status they retain as locums is advantageous. The trouble with these arrangements is that joining the NHS superannuation scheme is probably worth more than setting expenses against tax and that the Inland Revenue may regard you as an employee anyway and so prevent you doing so - but too late for you to join the Pension Scheme.

All assistants should have a formal written contract. The BMA produce a standard one which is available from local offices.

The advantage of being an ‘approved’ assistant is that the practice qualifies for an assistant’s allowance. To get the maximum assistant's allowance, practices must have:

• 3000 or more patients if single handed (less in rural practices); or
• 3000 patients for the first partner and 2500 patients for subsequent partners;
• engage the doctor for at least three months;
• ensure at least half the assistant’s salary arises from treating NHS patients.

The assistant’s allowance in 1997/8 is £6515 - £9,120 in practices in a designated area. (A designated area is one in which there are too few doctors and the average list size is over 2,500). When the official statistics count assistants they only include approved assistants. There are no national data on the numbers of other assistants.

Assistant work can be a good halfway house between locuming and partnership. There is often the ability to arrange work around other commitments (e.g. children or other work); there is no financial commitment (and so it is easy to leave if you have to move); there is limited requirement to partake in non-clinical issues; there is continuity of care for patients; there is usually no on-call and there is ‘protection’ within employment law (maternity rights, statutory sick pay) and the ability to join the NHS pension scheme.

Assistantships may be bad for general practice and patients though. Female GPs may be attracted to such posts but in doing so reduce female input into service management and planning. The pay for such posts is not standardised and is often low with no profit share. There is often no financial support for CME.

Under the LIZEI scheme a number of posts called Academic Assistants were created for recently qualified GPs. These doctors were employed by the Department of General Practice at St George’s, Tooting, to work seven sessions in two or three local practices and spend two sessions with the department for other personal, professional and academic work. The programme was developed to support existing principals and to respond to GP Registrars’ concerns about entering inner city practice. Initially the scheme was LIZEI-funded but some fund-holding practices bought into it and there are hopes that it will continue when the LIZEI money runs out.

Further Reading:

ELLIS NORMAN & CHISHOLM JOHN: Making Sense of the Red Book (Radcliffe Medical Press 1997)

The BMA produce an excellent membership guidance note (a booklet for members) on Assistants In General Practice. It contains useful information on a written contract and the framework this should be based on.