Career options

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Career options

  1. 1. Career Options in GP June 2004
  2. 2. Post VTS Freelance GP Salaried GP Profit Sharing Partner Portfolio GP
  3. 3. Freelance GP. <ul><li>Advantages/disadvantages </li></ul><ul><li>Getting work </li></ul><ul><li>Finance </li></ul><ul><li>Pay </li></ul><ul><li>Resources and support </li></ul>
  4. 4. Advantages and Disadvantages. <ul><li>Advantages </li></ul><ul><li>Flexibility and freedom of working </li></ul><ul><li>Exposure and experience of different practices </li></ul><ul><li>Top-up your income </li></ul><ul><li>“ Try before you buy” </li></ul><ul><li>Local knowledge about prospective posts </li></ul><ul><li>Increased profile </li></ul><ul><li>Workload is less stressful than being a principal in GP </li></ul><ul><li>Disadvantages. </li></ul><ul><li>Unpredictable income. </li></ul><ul><li>Holidays, sick and maternity leave. </li></ul><ul><li>No paid study leave (initiatives to fund education for non-principals). </li></ul><ul><li>Practices may cancel bookings at very short notice. </li></ul><ul><li>Locums may be seen as second best or as a new opportunity to get a second opinion on! </li></ul><ul><li>Continuity of care difficult. </li></ul><ul><li>Different practices will different systems and procedures, e.G computers. </li></ul>
  5. 5. Requirements to Work As a FGP <ul><li>Supplementary list </li></ul><ul><li>VT certificate </li></ul><ul><li>GMC </li></ul><ul><li>Medical defence </li></ul><ul><li>CV </li></ul><ul><ul><li>Details of previous employment </li></ul></ul><ul><ul><li>References </li></ul></ul>
  6. 6. Getting Work. <ul><li>Start early </li></ul><ul><li>Circulate your CV to local practices and LHBs </li></ul><ul><li>Register with LHBs locum list </li></ul><ul><li>Mention to drug reps that you are looking for locums </li></ul><ul><li>Advertise in local postgraduate centre </li></ul><ul><li>Contact local co-operatives and deputising services if you want &quot;out-of-hours&quot; work </li></ul><ul><li>Locum agency </li></ul>
  7. 7. Communication <ul><li>Mobile phone </li></ul><ul><li>Answering machine </li></ul><ul><li>Email </li></ul><ul><li>Fax at home </li></ul><ul><li>Check and respond even if not able to do work </li></ul>
  8. 8. Agreeing to Work <ul><li>Make sure you know exactly what you are expected to do! </li></ul><ul><ul><li>Surgery, calls, on call, emergency appointments </li></ul></ul><ul><li>Agree a fee </li></ul><ul><ul><li>BMA rates? Travelling costs </li></ul></ul><ul><ul><li>When will you get paid </li></ul></ul><ul><ul><li>Weekly rate versus daily rate </li></ul></ul><ul><li>Invoice, copy for practice and keep a copy for accountant </li></ul>
  9. 9. The Accountant <ul><li>You get the following note from your accountant. </li></ul><ul><li>Dear Dr </li></ul><ul><li>Please can you provide me with details of your income and expenditure for the last financial year so that I can prepare your practice and personal accounts. </li></ul><ul><li>What do you do? </li></ul><ul><li>What information does he need </li></ul>
  10. 10. Finance <ul><li>Being self employed doctors requires you </li></ul><ul><li>Keep records of all your income and work related expenses </li></ul><ul><li>To pay your own national insurance contributions </li></ul><ul><li>To collect the income tax that you have to pay to the inland revenue at the end of the tax year </li></ul><ul><ul><li>Keep 1/3 rd income for tax. </li></ul></ul>
  11. 11. Finance <ul><li>Personal. </li></ul><ul><li>Meet the accountant. </li></ul><ul><li>Income and expenditure. </li></ul><ul><li>Check what the accountant wants from you and how he wants it presented. </li></ul><ul><li>National Insurance </li></ul>
  12. 12. Personal Expenses <ul><li>Motoring </li></ul><ul><li>Petrol and oil </li></ul><ul><li>Repairs and servicing </li></ul><ul><li>Road Tax </li></ul><ul><li>Insurance </li></ul><ul><li>Breakdown </li></ul><ul><li>Car parking/washing </li></ul><ul><li>Mileage log 3 months, watch out for this! </li></ul><ul><li>Other </li></ul><ul><li>Books magazines and journals </li></ul><ul><li>Home study </li></ul><ul><li>Clothing allowance </li></ul><ul><li>Drugs and equipment </li></ul><ul><li>Courses </li></ul><ul><li>Telephone </li></ul><ul><li>Home Computer </li></ul><ul><li>Locum payments </li></ul><ul><li>Locum insurance </li></ul><ul><li>Subscriptions </li></ul>
  13. 13. National Insurance Contributions <ul><li>Self employed people are liable to pay two classes of contributions: </li></ul><ul><li>Class 2 contributions. </li></ul><ul><ul><li>Flat rate, direct debit, set this up ASAP. </li></ul></ul><ul><ul><li>Penalties for late payment. </li></ul></ul><ul><li>Class 4 contributions which are paid on profits at or above a certain level. </li></ul><ul><ul><li>Calculated by accountant. </li></ul></ul>
  14. 14. NHS Superannuation. <ul><li>If you are a 'freelance' GP locum performing GP locum work and work for a GMS, PMS or a PMS+ GP or GP practice, you will be able to pay NHS pension scheme contributions on the gross pay you receive (less expenses of 10%). </li></ul><ul><li>Any NHS GMS, PMS or PMS+ work can be pensionable, provided there is a clear and direct transaction for the work , between yourself and the employing GP practice or absent GP. </li></ul><ul><li>You will be able to claim tax relief at your usual rate in your annual tax return on the contributions you pay. </li></ul>
  15. 15. Pensionable Pay. <ul><li>Examples of GP locum work that WILL be pensionable. </li></ul><ul><li>'Out of hours' cover based on a direct transaction between the GP locum and a named GP, e.G. One who is unable to do their scheduled shift will be pensionable. </li></ul><ul><li>Additional work performed for a specific GP practice will also be pensionable. </li></ul><ul><li>Examples of GP locum work that WILL NOT be pensionable . </li></ul><ul><li>GP locum work that has been arranged and paid through a third party, such as a commercial deputising firm, a commercial agency or a co-operative itself, is not pensionable under the NHS pension scheme. </li></ul>
  16. 16. Remember <ul><li>Appraisal and revalidation </li></ul><ul><li>Professional development </li></ul><ul><li>Local NP facilitator </li></ul><ul><li>Holidays </li></ul><ul><li>Sickness </li></ul><ul><ul><li>Insurance </li></ul></ul><ul><ul><li>Critical illness </li></ul></ul>
  17. 17. Resources <ul><li>NANP </li></ul><ul><li>NP Network Wales </li></ul><ul><li>BMA </li></ul><ul><li>NHS pension </li></ul><ul><li>National Insurance Contributions </li></ul>
  18. 18. Salaried GP <ul><li>Options for working as a salaried </li></ul><ul><li>GP Salaried v partnership </li></ul><ul><li>Who pays your salary? Does it matter? </li></ul><ul><li>Salaried contract what to look for? </li></ul>
  19. 19. Options <ul><li>Who can you work for as a salaried GP? </li></ul><ul><li>Department of PG medicine </li></ul><ul><ul><li>GP assistant scheme </li></ul></ul><ul><ul><li>Research fellow with sessions in practice </li></ul></ul><ul><li>Primary care organisation e.g.LHB </li></ul><ul><li>Individual practices </li></ul><ul><li>Deputising and private firms </li></ul><ul><li>Others, armed forces </li></ul>
  20. 20. Salary or Partnership <ul><li>Advantages </li></ul><ul><li>Introduction to life as a G.P. without the business worries </li></ul><ul><li>Flexibility no long term commitment, and working hours can be easily negotiated to suit family or outside work interests(?) </li></ul><ul><li>Less paperwork and administration than partners </li></ul><ul><li>Guaranteed income </li></ul><ul><li>Superannuation scheme is maintained </li></ul><ul><li>No equity to bring or financial risk involved </li></ul><ul><li>Disadvantages </li></ul><ul><li>Usually lower income than peers who go into partnership </li></ul><ul><li>May be viewed by some as &quot;lower&quot; status than partnership </li></ul><ul><li>Short term contract </li></ul><ul><li>Full maternity and sick pay may have to be negotiated) </li></ul>
  21. 21. Who Pays Your Salary? <ul><li>Does it matter? </li></ul><ul><li>May determine how much you get but also additional benefits and security. </li></ul>
  22. 22. Contracted to Whom? <ul><li>Trust </li></ul><ul><li>1 or more practices </li></ul><ul><li>Full holiday, study leave, maternity and sickness (Whitley) </li></ul><ul><li>Difficult to change contract and working conditions </li></ul><ul><li>Individual Practice </li></ul><ul><li>Single practice </li></ul><ul><li>May need to negotiate leave entitlements </li></ul><ul><li>Negotiate car, defence subs </li></ul><ul><li>Easier to change working conditions </li></ul><ul><li>? Salary higher </li></ul>
  23. 23. GPC and RCGP Recommendations for Salaried GP Contract <ul><li>Paid, protected time for educational activities of 30 hours per year. </li></ul><ul><li>Financial support towards continuing education activities when undertaken in support of the employing authority's objectives. </li></ul><ul><li>Payment for bank holidays , adjusted pro rata for part-time employees. </li></ul><ul><li>A minimum of six weeks paid annual leave. </li></ul><ul><li>Financial recognition of the costs incurred in securing childcare where necessary. </li></ul><ul><li>Car allowance , where the provision of transport is a necessary requirement to discharge the responsibilities of the contract. </li></ul>
  24. 24. GPC and RCGP Recommendations for Salaried GP Contract <ul><li>Telephone allowance , where telephone access at home is a necessary requirement of the contract and which should include recognition of the costs of mobile phone provision where necessary to fulfil in hours or out of hours obligations under the contract of employment. </li></ul><ul><li>Maternity leave in full compliance with current statutory provisions. </li></ul><ul><li>Full compliance with statutory provisions on parental leave and dependants leave. </li></ul><ul><li>An undertaking to treat the employee with freedom from discrimination on the grounds of race, religion, gender, sexual orientation, disability or contractual status. </li></ul>
  25. 25. Profit Sharing Partnership <ul><li>Why? </li></ul><ul><li>Choosing a practice? </li></ul><ul><li>What to look for? </li></ul>
  26. 26. Advantages of Partnership <ul><li>Higher income? </li></ul><ul><li>“ Ownership.” </li></ul><ul><li>Own boss with equal say. </li></ul><ul><li>Ability to develop skills. </li></ul><ul><ul><li>Clinical. </li></ul></ul><ul><ul><li>Non clinical. </li></ul></ul><ul><li>Security. </li></ul><ul><li>New contract. </li></ul><ul><li>Pension opportunities. </li></ul>
  27. 27. Pitfalls of Partnership <ul><li>Pitfalls are many and varied and, although not all can be predicted, they tend to concern the five Ps: </li></ul><ul><li>Profits, ? parity </li></ul><ul><li>Property, fixtures, capital account, buying in to property </li></ul><ul><li>Patients, registration rules </li></ul><ul><li>Performance, who does what? </li></ul><ul><li>Personalities, mutual assessment </li></ul>
  28. 28. Choosing a Practice <ul><li>Before looking for a practice you will need a checklist of essentials and desirables for your ideal practice. </li></ul><ul><li>Many factors that you need to consider when looking for a practice. </li></ul><ul><li>Geography. </li></ul><ul><ul><li>Do you want to work in a particular part of the country? </li></ul></ul><ul><ul><li>Do you want to work in an urban or rural practice? </li></ul></ul><ul><ul><li>Where do you want to live? </li></ul></ul><ul><ul><li>What sort of schools out of hours. </li></ul></ul><ul><li>Work commitments. </li></ul><ul><li>Partnership size and characteristics. </li></ul><ul><li>Buildings. </li></ul><ul><li>There may be other major factors. At the end prioritize how important each of the factors are to you and your family. </li></ul>
  29. 29. What to look for? <ul><li>The partners </li></ul><ul><ul><li>What are their interests? </li></ul></ul><ul><ul><li>Outside commitments? </li></ul></ul><ul><ul><li>Approach to PHCT?, RCGP </li></ul></ul><ul><li>Practice Agreement </li></ul><ul><ul><li>Is there one? </li></ul></ul><ul><ul><li>Study leave </li></ul></ul><ul><ul><li>Holidays </li></ul></ul><ul><ul><li>Practice meetings </li></ul></ul><ul><ul><li>Maternity leave </li></ul></ul><ul><ul><li>Sabbaticals </li></ul></ul><ul><ul><li>On call </li></ul></ul>
  30. 30. What to Look for? <ul><li>Income </li></ul><ul><li>What goes into the pot </li></ul><ul><li>What sort of income should one aim for </li></ul><ul><li>How is the income distributed and what will be your share </li></ul><ul><li>What about parity </li></ul><ul><li>Is there a mutual assessment period </li></ul><ul><li>Buying in. What share will you be expected to buy and when </li></ul><ul><li>How is tax dealt with, do you have to manage your own tax </li></ul><ul><li>Private income and its distribution </li></ul><ul><li>Will you be expected to have an outside appointment </li></ul><ul><li>Are targets met </li></ul><ul><li>How are the drawings decided </li></ul><ul><li>Accounts </li></ul><ul><li>When will you be able to see an set of the practice accounts </li></ul>
  31. 31. At the End of the Day Ask Yourself? <ul><li>Does the practice suit me as a doctor? </li></ul><ul><li>Do the existing partners share my professional values? </li></ul><ul><li>Am I going to get a fair deal? </li></ul><ul><li>Is this a practice I want to call my own? </li></ul><ul><li>Do I need to take advice? </li></ul>
  32. 32. Portfolio Medical Career <ul><li>General practitioners have opportunities to control both their career development and the shape of their working week </li></ul><ul><li>Flexible working, with a variety of hours and posts, is increasingly becoming accepted </li></ul><ul><li>Interests and areas of expertise from your hospital training can be brought with you into general practice in the form of clinical assistantships </li></ul><ul><li>Education, research, and medical writing are examples of non-clinical &quot;add ons&quot; to clinical life </li></ul><ul><li>Sessional posts, such as community health, lend themselves to being mixed with part time general practice </li></ul>
  33. 33. GMS Hospital GPSI C.A Education UG GPR CPD App Trainer C.O CMO Research Medical Advisor LHB DSS Medical Politics Forensic OTHERS!!
  34. 34. Advantages <ul><li>Motivation </li></ul><ul><li>Reduce burnout </li></ul><ul><li>Continuous development </li></ul><ul><li>Change with time and needs </li></ul><ul><li>Income generation </li></ul><ul><li>Meet new people </li></ul>
  35. 35. But Watch Out for <ul><li>Time management </li></ul><ul><ul><li>Allow plenty of time for family and self </li></ul></ul><ul><li>Often work more than your “salary” </li></ul><ul><li>May cause resentment </li></ul><ul><ul><li>Patients </li></ul></ul><ul><ul><li>Partners </li></ul></ul><ul><ul><li>Relatives </li></ul></ul>
  36. 36. Options <ul><li>Clinical Assistant </li></ul><ul><li>GP SI </li></ul><ul><li>Retainer </li></ul>

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