Before your employment, you should clarify that your role is covered by the state indemnity scheme, which is a scheme all doctors undertaking NHS work are covered by.
For private practice work, you will need to obtain individual clinical indemnity. You may be offered indemnity through your contract of employment, but it is important that you check that this is in line with the level of cover recommended by the GMC, and that you understand which type of indemnity cover it is. Private practice is not covered by the state-backed clinical negligence schemes in England and Wales.
You should consider joining a Medical Defence Organisation (MDO), which will provide representation at regulatory proceedings should you need it, for a membership fee.
Zero hours workers
If you have a zero hours contract, it is important that you have a straightforward way to book shifts, as the process for each provider may be different:
- Some providers may have rules around booking shifts in advance or notice periods for cancelling shifts.
- Many organisations release shifts in waves - for instance, 3 months at a time.
- Some providers may allocate requested shifts according to undisclosed and predetermined criteria, such as rewarding positive workplace behaviour like productivity and good time-keeping.
If your shift is cancelled
Abrupt cancellations can occur if there is an IT issue, an administrative error, or due to a decision to reduce cover. Whatever the reason, it is important that you are paid for a cancelled shift if cancellation occurs at less than the agreed notice period.
Cancelling your sessions
If you need to cancel your sessions, the provider may have a process in place whereby you have the option of arranging appropriate cover, or cancelling subject to an agreed notice period.
Check the policy
When working on a zero hours basis, you should check the employer's policy with regards to booking and cancelling shifts, and necessary overtime:
- Cancellation terms on both sides: what is the notice period you must give to cancel a shift and do you receive a cancellation fee if your shift is cancelled outside of the agreed notice period?
- In the event of an equipment or IT failure, the employer may offer specialist support. You may want to ask the employer what procedures are in place for remuneration if the session does not go ahead as planned due to equipment or IT failures.
- When requesting shifts, your requests should be actioned promptly. You may want to ask the employer for the length of time you should expect to wait for shift confirmation, and their policy on how long before the shift is due to take place you should receive confirmation.
Claiming worked time
In some instances, you may occasionally have to extend your shift to complete an episode of care and handover safely.
There should be provision for claiming such time without the need for the additional time to be authorised either during the shift or prior to the overtime occurring. There should not be a tension between offering professional and safe care and claiming worked time.
You should not be penalised by non-payment if you are able to demonstrate that every effort was made to seek such authorisation, and that it was reasonable in all circumstances to work beyond the planned end time of the shift.
Late arrival for shifts outside of your control needs to be catered for fairly in terms of adjustments to payments.
Parental leave and SSP (statutory paternity pay)
Each organisation may provide different leave entitlements, which should be laid out in the contract of employment. The BMA can support members with accessing their parental leave entitlement and negotiating better terms if necessary.
Annual leave guidance for practices can be found here. The same principles for best practice can be applied to all settings who employ sessional GPs.
Supervision of AHPs (allied health professionals) and colleagues
As a GP, you will be working as part of a team with a number of different HCPs (healthcare professionals). You may be expected to provide clinical leadership and answer queries from your colleagues. You may need to clarify if extra time is allocated to facilitate this part of your role.
Providing informal support and supervision to colleagues is a standard part of any role, but a greater level of managerial responsibility would need to be agreed formally and remunerated appropriately. Similarly, training and ongoing learning may be necessary for formal supervisory roles.
Supervising trainees can be a rewarding experience and should be facilitated by your employer. Supporting trainees should be a formalised element of a clinician’s job role.
Support from peers and line managers
Working in a role outside of a traditional practice may not have the same cultural and environmental support systems in place as a traditional practice. In some cases, you may not have met your colleagues or line manager.
You may not feel comfortable seeking advice from colleagues and the size of the organisation may mean that you do not have the same close rapport to your line manager and may feel inhibited in asking for advice on challenging cases.
Performance metrics and benchmarks
Providers place great value on metrics, so it is important to know what metrics are held on you and how you can access them. These may include:
- patient ratings
- concerns and complaints
- referral and prescribing data
- audit of your consultation records
It is good practice for these to be provided to you, so that you can learn from them and see if there are any trends that need addressing.
NHS appraisals and revalidation
Your appraisal team and linked RO (responsible officer) will be based on the area where your patients live. If you work for more than one organisation, you may have a choice of which region you link to. If working for a large remote organisation, you may find that the RO linked to that patient population is quite distant from where you live. Thankfully, with the advent of remote appraisals this no longer constitutes a significant barrier to engaging in an NHS appraisal.
The provider may offer support towards meeting your NHS appraisal and revalidation requirements. As this is a requirement of all GPs, time for NHS appraisal should be provided within paid time.
If you are only seeing private patients through the remote provider, you may not be eligible for an NHS appraisal unless you are keeping up your NHS practice through another organisation. If this is not the case, you may need to identify your 'designated body' for revalidation purposes using the GMC tool.
Complaints and significant events
There should be a documented complaints handling process and you should be informed of how to escalate concerns, including whistle blowing concerns.
Find out how clinicians are involved in and supported through complaints handling processes, and how the organisational learning from complaints is embedded into improvement of systems and not merely focused on clinician performance.
The organisation should consider and protect your reputation when responding to incidents where the outcome was not a result of your actions but of systems shortcomings. When a complaint is made, and the event was as a result of systematic shortcomings, the organisation should make changes to prevent the same problem from occurring again.
You may wish to read recent CQC reports regarding the complaints profile of the provider and whether there are organisational factors which contribute to these (such as lack of continuity, lack of access to face-to-face consulting, high patient turnover, or consumerist expectations) as complaints are a recognised course of clinician distress and burnout.
Initial and ongoing training
Training, onboarding and an induction should be provided by your employer when you start your role. Following this, when you start consulting, there may be a period of consulting at longer intervals to allow you to adjust to the organisational processes.
If so, you should determine how long it is and if it can it be extended if you are struggling. Mentoring by colleagues may be provided at the beginning of your role. In the event your employer does not organise a mentor for you, other mechanisms to access informal advice from your peers may be provided by designated online forums or approved social media, like Slack.
All employers in England are required to set their requirement for mandatory training which they then need to demonstrate to the CQC. If the training is organisation specific, then employees should expect this to be provided wholly within contracted time.
Workload and annual leave
Find out about processes for cover arrangements and locum sourcing. Working in a larger organisation may mean that there is a readily available pool of staff willing to pick up overtime shifts, to cover unforeseen absences or planned leave. This may protect substantive staff from some of the impact of sickness or absence.
Pressures in a practice (for example significant pressures that may arise for a duty doctor) may not be immediately apparent to the employer or senior leaders in settings where GPs are not represented at management level. Make sure you understand the processes for highlighting such pressures, both for immediate pressures and for sustained pressures if needed.
If possible, it is worth finding out how responsive the organisation is to rising pressures, and how readily locums are contracted when unforeseen absences occur. You might ask what the processes are for this – for example, who is contacted to notify of absence, and how decisions are made about cover. It may be that working for a larger organisation means access to more individuals to provide cover and therefore there may be more flexibility for leave arrangements; or it may be that leave arrangements and cover are to be agreed at practice level.
All employers have a legal requirement to consider applications for flexible working – if you have a specific preference for flexible working that provides you with a better work-life balance (e.g. working in school hours only, doing purely clinical work or working outside the duty doctor rota) then you should seek to agree these with the HR department as part of the application process or as the need arises.