Employment status – long-term | HMRC, NHS pension and employee status

This FAQ is from the perspective of being a GP locum in the same practice for a 'long time', rather than about choosing working as a GP locum as part of your career portfolio.

A long-term locum post at a practice often starts off as a short-term venture, but with significant recruitment problems in general practice at the moment, it's likely the practice will want to hold on to you and keep you coming back.

Alternatively, your stint at the practice could have begun very much with the long term in mind. Either way, the longer you're at the practice, the more your role will slowly change from that of ad-hoc short-term locum to being part of the practice team. As this process goes on, not only will your significance within the practice develop in the eyes of patients and staff, but certain regulatory factors will also come in to play.

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There are four areas that need careful consideration the longer you work for the same practice.

Tax purposes

  • The decision of whether you're self-employed or an employee for tax purposes is ultimately down to HMRC, and depends upon factors such as if you run your business for yourself and take responsibility for its success or failure, work for several practices at the same time, and you can decide how, where and when you do your work etc. More details are available on the GOV.UK website.
  • Or you may have already set yourself up as your own limited company.
  • Use HMRC's employment indicator tool to give you a clearer understanding of your tax status.
Our advice is to ask an accountant if you're unsure in any way.

Employment law

Although your work at the practice may have begun with you being self-employed, or employed by an agency, certain factors in the way you work with the practice may, over the duration, inadvertently give rise to you becoming an employee of that practice in terms of employment law.

If you're employed by the practice, you can have access to certain rights such as Statutory Sick Pay, protection against unfair dismissal, the right to request flexible working and quite a few other rights.

Employees have a contract, and this can be written or verbal. Consider adding this to your own T&Cs.

What makes you an employee for the purposes of employment law can depend on about 15 different factors.

To protect both the GP and the practice, we advise having a conversation about your duties with the practice manager sooner rather than later, and taking any necessary legal advice, to make sure both parties are clear about your contractual status.

Long-term status for the purposes of NHS pensions

Mission creep

There are as many reasons for working as a locum GP as there are GP locums. Some of us enjoy working in lots of different practices: spreading best practice; supporting practices in difficulty; offering patients a fresh approach to their care; a second opinion, and focusing on direct patient contact. Whereas others love continuity of care, building therapeutic relationships with patients and getting more involved with the running of the practice on a day-to-day basis.

Often, if just covering a few sessions for a practice, one would expect to simply deal with the patients seen in surgery that day and any necessary paperwork resulting from those consultations (such as writing referral letters etc), and this is what one would generally be charging the practice for.

If working again at that practice over the coming weeks and months, one would expect to results of investigations, tests and referrals to start returning to the practice. These results and correspondence would either go back to that patient's usual GP (if there is one) or one of the other practice GPs. But if no-one is available, and especially if you requested these tests, it's quite likely that these results will be given to you to deal with.

Of course, this may well be all part of what you really value in working as a GP, but it does take time beyond that which you may have initially agreed, and could start to eat into the time you'd normally allocate to your other roles. By being such an obliging GP, no doubt too you could soon become the go-to GP who all the staff find so helpful, and find your workload rising exponentially - greatly increasing your value to the practice, but also having a potentially huge impact on your work-life balance.

Set boundaries

All of this is quite containable to begin with, but if not controlled early on could just get out of hand. Our advice is, if the same level of workload is set to continue, after a certain amount of time and/or workload e.g.

  • two sessions a week for six weeks, or
  • six sessions a week for two weeks

To either

  • negotiate more pay, pro-rata, or
  • reduce the number of patients seen during a session and replace that patient-contact time with administration time.
Consider adding this to your own T&Cs.

It's safe to say that as GPs, we often have a great sense of duty to practices and can find it exceptionally hard to refuse help when our input is genuinely needed. But if we neglect to contain the expectations of practices to a sustainable level that each of us can comfortably manage, it could just end up with us becoming the patient. And that's of no use to anyone.

 

Listen to our podcast on long-term locuming

1 Response

  1. Kyle
    The art of GP locuming Podcast was invaluable listening! I can relate to 'mission creep', I've been locuming 6-7 sessions for 6 months in a practice and I feel swapped by admin work on top of my full clinics. This podcast has empowered me to speak with the PM about reducing the number of patients per session to add some admin time. Thanks

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