Starting out as a salaried GP

7th November 2023 by NASGP

Starting out as a salaried GP

Of all the correspondence we receive from members, the majority is from dissatisfied salaried GPs.

It’s not that they don’t like the job or the patients or the staff – it’s often because they feel they’re being (for want of a better word) exploited by their employer.

We’re not suggesting here for one minute that their employer is necessarily wicked or greedy or nasty; it often transpires that they’ve just not necessarily prioritised the welfare of their salaried GP colleague; a conspiracy of ignorance, perhaps. After all, general practice isn’t renowned for the cutting-edge management of its personnel.

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More salaried GP FAQs

What is the model contract?

The BMA’s model contract helps salaried GPs get a good contract.

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.

Does my practice have to use the BMA model contract?

Yes. 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.

The BMA Salaried GP Model Contract covers annual leave, study time and CPD, parental leave (maternity and paternity), sessions and job plans. It’s a useful document, as well as an essential one.

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.

Why is the new model salaried GP contract worth asking for?

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.

Read our guide.

How should private work be charged?

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.

Model locum Terms and Conditions template

If you’re doing any sort of locum work as part of your portfolio career, you’ll definitely need your own personalised Terms and Conditions to help protect both you and the practice you’re working for.

NASGP’s model T&Cs has been specifically developed for NASGP members by a specialist employment law firm. It allows GP locums to not only fully adopt all its recommendations, but also to add any necessary clauses and tailor it to suit each locum’s personal needs.

You can now set your T&Cs online in NASGP’s LocumDeck.

LocumDeck’s T&Cs generator allows you to set:

  • Your own cancellation sliding scale from 0 to 100% of your booked fee for 0 to 28 days in advance.
  • Your 14.38% employer’s pension contributions
  • Legal employment status
  • Tax status, IR35 etc
  • Duties (on-call, triage etc)
  • Private fees (HGV medical etc)
  • Cremation fees
  • Payment terms (14 days? 28 days?)
  • Plus much more.

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, confirmation emails and session request emails, or you can paste the link into your own GP locum website.

As an added bonus, GP locums can update their T&Cs as often as they like on LocumDeck. Each change is saved in an archive, accessible by practices, for extra confidence.

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.

 

 

What should be in my salaried GP job plan?

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

Is a 10-minute appointment time the standard, or can I negotiate longer?

Fifteen 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 do I 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 I get for a home 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 I did a full day of two sessions, would I get a lunch break built in?

You are entitled to at least 20 uninterrupted minutes, although we recommend at least 30 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 I am 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 as part of this job.

What mileage and travel expenses are salaried GPs allowed to claim for?

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 10,000 miles a year) 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 10,000 per annum then the reimbursement rate drops to 25p.

Join the conversation on salaried GP mileage in our GP-only Facebook Group

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 two 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.

Salaried GP articles

"I rely on the NASGP for advice and support. I use LocumDeck for all my locum admin – my profile, certificates, terms and conditions, practice contacts, booking and invoicing sessions, pension A and B forms, recording mileage and other expenses and monthly earnings.

Having been a locum in the past without LocumDeck, I realise how much easier LocumDeck makes my life, especially as I don't enjoy admin. It automates much of the admin for me. I can see at a glance how many bookings I have and where the gaps are. I have some practices who instant book me - booking directly into free sessions I have added. I have income/expenditure spreadsheets to share with my accountant.

I would highly recommend it to others."

Dr Susannah Denny, GP, Berkshire

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