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LMCConf | Salaried GP contract threatened

#LMCConf42 AGENDA COMMITTEE to be proposed by DERBYSHIRE: That conference, with respect to the standard model contract for salaried GPs:

  1. insists that the concept is professionally beneficial
  2. demands that terms no less favourable are offered by all employers of GPs
  3. believes that it is now not fit for purpose
  4. believes that it generates unrealistic and unaffordable burdens concerning annual leave entitlements and study leave entitlements
  5. instructs the GPC to negotiate changes.

43 DORSET: That conference believes that the BMA model contract for sessional doctors is bad for all GPs and bad for general practice and demands that GPC have its obligatory use removed from the general practice contract. (Will fall if Motion 42 part (ii) is passed).

NASGP view

Not quite sure what's going on here, which is probably the point, and good luck to anyone on the day in following the heated debate that's bound to go with this one. So, the salaried model contract is good for the profession; all employed GPs should have a contract with at least its terms, whilst at the same time being unaffordable and not fit for purpose. And that the GPC needs to make changes? Changes? What changes?

We suspect the Agenda Committee will recommend that 3. and 4. are thrown out, but there's no guarantee. If this motion gets in the wrong hands - and the fact that as it has come this far suggests that it could - employment conditions for salaried GPs could become a right royal pain in the arse, hasten a greater decline in recruitment and retention and just explode in practices faces. Don't do it, guys.

And if you're a GP thinking of working as a salaried GP in Dorset, you might want to make sure your contract is up to scratch.

LMC Conference 2015

See also

Salaried GPs

As an employee, probably not; it's not usual practise in any employment to charge for mileage to and from work. However, there may be an allowance in your contract for use of your car for visits, or if your practice requires you to travel to certain meetings to represent the practice.

Locum GPs

If you're a locum GP then you can charge for mileage to and from your place of work and for visits too if you want to - some locums do, some don't. When you charge for mileage, it's not just the fuel you're charging for - think of the tax, insurance, oil, servicing bills, wear-and-tear, tyres and the time taken to physically get there etc. What you [successfully] charge is entirely up to your negotiations with your employing practice.

A decision on whether or not to charge depends on how much it's actually costing you vs both the hassle of working it all out plus the 'perceived pettiness' by the practices that may ultimately lead them to booking someone else.

See also

Locum GP claims will depend on the pattern of their work. If they are ‘itinerant workers’ – so that they work at different places from day-to-day with no discernible pattern, then it should be possible to argue that the main place of work is home – the base from which the business is run. This should make all journeys to surgeries allowable.

If however there is a pattern claims will be restricted. For example:

  • Dr L is a freelance locum. He has a number of regular jobs. He covers at surgery A on Mondays, does 2 days a week at surgery B and the 4th and 5th days are totally variable. It is likely that surgery A and surgery B become ‘workplaces’ so that home to each of those premises will be a personal journey. The 4th and 5th days should fall within the itinerant rules so that home to surgery will be deductible.

Sometimes the pattern will not be obvious in advance. A short spell of locum work may develop into something more regular (at this stage there is a risk that the locum is no longer freelance in respect of that placement and may need to become salaried, but that is beyond the scope of this article).

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

Recently we have seen examples of HMRC asking to see locum mileage logs and refusing claims without them. So please try to keep a mileage log of all practice related journeys. It is much easier to take out what turns out not to be deductible, than to try to recreate information that wasn’t retained in the first place.

A mileage log can be a notebook kept in the car; a spreadsheet or a phone app that calculates journeys that you can annotate.

What if you have not kept a log?

For home to GP surgeries, it is easy enough to ‘google’ journeys to find the mileage. Visits are much harder if you haven’t retained records. Some surgeries’ computer systems can produce a printout of visits by doctor, from which you can then work out the mileage. This might work for salaried doctors, but the practices are likely to be less enthusiastic hunting out the information for irregular locums.

Don’t forget to include other travel in the course of work – such as for training courses. If they are not local, that can be a noticeable amount. Salaried doctors will not be able to claim it themselves; they will need to try to get reimbursement from the practice.

If the pattern of work has not changed then a sample period might be sufficient but this is only likely to work for salaried doctors’ visits – and if HMRC want to do it by the book, it still may not be enough. Locum work is unlikely to ever be settled enough for a sample period of mileage log to be representative – so doctors in that position need to get into the habit of keeping a regular log.

Self-employed doctors may usually claim a mileage rate similar to salaried GPs, but if their turnover exceeds £81k (for 2014-15) they should claim a proportion of total car running costs.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

Salaried GPs may claim for journeys undertaken wholly in the performance of their duties. Where the practice reimburses a doctor for visits (pretty rare!), then salaried GP mileage reimbursements up to 45p per mile (assuming less than 10k miles pa) are tax free. Payments in excess of that (sometimes seen in payments by hospital trusts) will be treated as taxable benefits and should be shown on form P11d at the end of the year, and must be recorded on the employment pages of the tax return.

If the practice reimburses less than 45p per mile, the difference can be claimed as an expense of employment. If there is no reimbursement at all, the then full 45p per mile can be claimed as an expense of employment. Where miles exceed 10k p.a. then the reimbursement rate drops to 25p.

The above rates relate to car travel; motorcycles can be reimbursed/claimed at 24p; cycles at 20p.

Allowable journeys for salaried doctors would include patient visits, meetings (necessary ones as part of the employment), and travel between different sites, but see the caveat below.

Home to work journeys are not allowable.

Additional mileage may be claimed in restricted circumstances such as:

  • Dr D is employed by multi-site practice A to work at surgery X. If Dr D is asked to work at surgery Y for a limited time (perhaps to cover a maternity leave), then temporary travel from home to another place of work for an intended period of less than 2 years will be treated as allowable.

Note on the other hand that if Dr E was employed on a temporary basis for the maternity leave mentioned above, home to work mileage would not be allowed because surgery Y would be his main (and indeed only) workplace.

Travel between sites cannot be claimed in the following circumstance:

  • Dr D is still employed by practice A at surgery X. He lives close to surgery Y and pops in each day on his way to work to pick up post. This does not make the journey between the two surgeries a business journey.
  • Dr D is still employed by practice A. He works Mondays and Tuesday at surgery X and Wednesday and Thursday at surgery Y. These are two separate places of employment and travel between them or from home to work for either of them is not deductible.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

Claiming for GP travel expenses

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

Salaried GPs may claim for journeys undertaken wholly in the performance of their duties. Where the practice reimburses a doctor for visits (pretty rare!), then salaried GP mileage reimbursements up to 45p per mile (assuming less than 10k miles pa) are tax free. Payments in excess of that (sometimes seen in payments by hospital trusts) will be treated as taxable benefits and should be shown on form P11d at the end of the year, and must be recorded on the employment pages of the tax return.

If the practice reimburses less than 45p per mile, the difference can be claimed as an expense of employment. If there is no reimbursement at all, the then full 45p per mile can be claimed as an expense of employment. Where miles exceed 10k p.a. then the reimbursement rate drops to 25p.

The above rates relate to car travel; motorcycles can be reimbursed/claimed at 24p; cycles at 20p.

Allowable journeys for salaried doctors would include patient visits, meetings (necessary ones as part of the employment), and travel between different sites, but see the caveat below.

Home to work journeys are not allowable.

Additional mileage may be claimed in restricted circumstances such as:

  • Dr D is employed by multi-site practice A to work at surgery X. If Dr D is asked to work at surgery Y for a limited time (perhaps to cover a maternity leave), then temporary travel from home to another place of work for an intended period of less than 2 years will be treated as allowable.

Note on the other hand that if Dr E was employed on a temporary basis for the maternity leave mentioned above, home to work mileage would not be allowed because surgery Y would be his main (and indeed only) workplace.

Travel between sites cannot be claimed in the following circumstance:

  • Dr D is still employed by practice A at surgery X. He lives close to surgery Y and pops in each day on his way to work to pick up post. This does not make the journey between the two surgeries a business journey.
  • Dr D is still employed by practice A. He works Mondays and Tuesday at surgery X and Wednesday and Thursday at surgery Y. These are two separate places of employment and travel between them or from home to work for either of them is not deductible.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

A recently retired partner was becoming a salaried GP, and wrote in for some advice.

Is a ten minute appointment time the standard, or can one negotiate longer?

  • 15 minutes is standard in some places - you can certainly negotiate longer. Whatever consultation length you finally agree to, it must be one that lies within your personal competency and fits in with your professional boundaries.

Are any breaks allowed mid surgery?

  • Absolutely - it's entirely up to you what you finally accept as your contracted hours and breaks. If you settle for something that you're not going to be happy with, you won't last long there.

How long does one get to deal with admin after the surgery (referrals phone calls etc)?

  • Again, it's up to you to agree how much time you need to feel comfortable performing this work in the allotted time, within your professional boundaries.

How long should one be allowed for a visit?

  • There are no fixed rules here; if you're having to rush a visit, you'll put yourself at risk. It's up to you whether the terms fit your own safe working standards and are within your professional boundaries, only accepting what you know to be safe.

If one did a full day of two sessions, would one get a lunch break built in?

  • You are entitled to at least twenty uninterrupted minutes, although we recommend at least thirty minutes. It can be paid or unpaid, which is down to you to negotiate. If you don't take a break, your performance in the afternoon would be equivalent to having drunk a few glasses of wine - it's always in an employer's interests to ensure all staff have at least 30 minutes for lunch, and a good employer will insist on it.

If one is expected to deal with path results and referral letters just for patients seen during sessions, what time should be allowed?

  • Depends on you, and a sensible employer should be realistic about the time you'll require. Some GPs are comfortable to skip through these sorts of tasks quite quickly, others prefer a lot longer. Our experience is that a lot of salaried GPs end up being dissatisfied with their post because of mounting paperwork, and the longer you remain in post, the more the paperwork becomes, so be realistic about the time you need.
  • Our rule of thumb is that, on average, practice-based GP consultations generate five minutes of paperwork on the day, and a further five minutes over the following months. Double this if it was for a visit. So if you're seeing 18 patients in surgery in the morning and 12 in the afternoon, it would not be unusual to within a few months be working an extra five hours on top of the scheduled 5 hours you were actually contracted to work.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

Salaried GP

  • This will be stated in the written contract. The private fee can either be entirely subsumed within the normal, regular work of the salaried GP, or there could be a provision for private work to be undertaken over and above the their usual work, stating how much of the fee they receive (bearing in mind the practice's overheads.

Locum GPs

For locum GPs, there is no issue as to whether or not a freelance GP can perform private work in a GP practice.

The practice and locum will need to agree beforehand whether their normal clinical caseload will contain private as well as NHS patients, with adequate time given for the private work in line with what other GPs in the practice would expect.

The practice and locum will also need to agree between them whether private work is charged at the same rate as NHS work.

NB you can now set your T&Cs online in NASGP's LocumDeck.

If you're doing any sort of locum work, you'll definitely need your own personalised Terms and Conditions that will protect both you and the practice you're working for. NASGP's model T&Cs has been specifically developed for us by a specialist employme law firm, and allows you to not only fully adopt all its recommendations, but also to add any necessary clauses, and tailor it to suit your personal needs.

  • cancellation policy
  • employer's pension contributions
  • legal employment status
  • tax status
  • duties
  • payment terms

As an NASGP member, go to your T&Cs generator, choose your settings and then save. You'll then be given a unique link "View my TCs" which will automatically be added to your automated invoices and session request emails, or you can paste the link into your own website.

As an added bonus, you can update your T&Cs as often as you like, with each change being saved in an archive accessible by your practices for extra confidence.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

In our experience, if private patients are seen within the usual agreed hours then the locum would not expect to be paid any extra. But if seen outside the usual agreed hours, the locum would expect to be paid the full private fee, with any practice overheads being offset by the additional service being offered by the locum. It makes the paperwork easier too.

 

 

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

CCGs, GMS and PMS practices employing GPs have to use the BMA Salaried GP Model Contract (it's been illegal to otherwise do so since 1st April 2004, with PMS practices coming on board in 2015). NHS Professionals partly administer the scheme, and can turn down a practices/PCTs application if the model contract is not being used.

Although PMS practices don't have to offer the BMA Salaried GP Model Contract, don't forget that you DO NOT have to sign anything that you're not happy with.

NASGP advice remains that a salaried GP should never accept anything less than the BMA Salaried GP Model Contract.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

Because amongst other things it includes:

  • An entitlement to one session of CPD per week for full time (and pro rata for part time)
  • Paid time for practice meetings
  • Whitley council pay for sick and maternity pay
  • Recognition of all previous NHS work experience as "continuous" for the purpose of these entitlements

But beware:

  • Some employers are refusing to recognise previous NHS service as continuous so you must ensure that the contract you sign has an agreed date from which you are considered to have started in the NHS (usually when you started working unless you have taken large breaks)
  • Ensure that you agree some form of annual pay rise, including seniority, as there is no provision for this in the contract and the current recommended pay range does not include a "ladder" which you can climb up automatically (unlike salaried hospital doctors).
  • Check any amendments suggested by your employer with your local BMA Industrial Relations Officer.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

We’re the independent not-for-profit support organisation run by and for any GP in the UK working as a locum or salaried GP. Please support our work by joining us as a full member, from only £11 per month, and includes full use of LocumDeck.

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