General practitioner Contract

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Minimum terms and conditions

The Model terms and conditions bring important improvements to the terms and conditions of salaried GPs, in line with the terms and conditions of other employed doctors in the NHS.

The Model contains the minimum terms that must be offered to full-time salaried GPs (with these available on a pro rata basis for those who work part-time) employed by a GMS practice or PCO on or after 1 April 2004.

It is also possible for all salaried GPs to be employed on enhanced terms and conditions.

 

Hours of work

Under the Model, full-time is defined as 37.5 hours per week. The Model breaks this amount down to nine notional sessions of 4 hours and 10 minutes per session – although the time of a session can be altered to suit the parties.

Working hours should be carefully defined in a job plan. A job plan is a condition of the Model, and the BMA/GPC has produced guidance on the content of a job plan which is available online.

 

Part-time working

The ratio of contracted hours in relation to the definition of full time as 37.5 hours a week determines a less than full-time employee's entitlements to annual leave, public holidays, protected continuing professional development (CPD) time and pensionable service. The salary of part-time employees should be calculated pro rata in relation to this definition of full time hours - for example, a GP employed for five sessions should receive 5/9ths of the full time salary.

 

Additional hours

If a salaried GP accepts a contract of more than 37.5 hours then the extra time must be recognised by a pro rata increase in salary. Extra non-contractual hours must be mutually agreed and should be either remunerated or recognised with time off in lieu.

Practitioners employed in salaried posts will have the basic rights and protection as the European Working Time (ETW) Regulations provide. This includes (but is not limited to):

  • a working time limit of an average working week of 48 hours a week which a worker can be required to work (though workers can choose to work more if they sign an individual waiver form)
  • a right to a minimum 20 minutes' rest break where the working day is longer than 6 hours.
    It is an employer's duty to ensure that employees are given adequate rest breaks. The times quoted above are the minimum, and where work patterns can be intensive or stressful there is a case for longer breaks to be implemented.

Changing hours of work

For guidance on the action to take if the employer proposes to change the contracted hours of work (eg for the extended access DES), see the section below on changing hours of work.

 

Annual leave

Under the Model, full-time salaried GPs are entitled to a minimum of 30 working days per annum. They are also entitled to 10 statutory and public holidays per year (which includes two "NHS days" which NHS staff receive and these two days may be taken at any time by the salaried GP). These amounts of leave should be calculated pro rata for part-time salaried GPs.

To calculate the annual leave entitlement (minus statutory/public holidays):

  • number of contracted hours worked per week x 0.8 = number of days leave per year [D]
  • D x 7.5 = number of hours of leave per year
    If 'NHS days' are added to annual leave entitlement, then calculate the full entitlement as follows:
  • number of contracted hours worked per week x (32 divided by 37.5 = full entitlement
    Please note that the above ready reckoner calculations do not include bank or public holidays. The model contract states that full-time salaried GPs will receive these days off in addition to their annual leave  entitlement and that where they are required to work on these days to time off in lieu. It is good employment practice to provide additional time off when a part-time salaried GP's normal days of work do not fall on a bank/public holiday.

More details of this are set out in the BMA's Salaried GPs Handbook, and BMA members are advised to contact the BMA for individual advice on this.

 

Salary

The Model contract notes that the DDRB salary range will apply for both GMS and PMS employed GPs. The minimum salary for a full-time salaried GP (pro rata for those working less than full time) employed under the Model contract is £56,525 for 2017-18, as recommended by the independent Doctors' and Dentists' Review Body's (DDRB).

While the DDRB suggests a salary range for 2017-18 of £56,525 to £85,298, this is only a minimum range, and employers have the flexibility to offer enhanced pay rates to aid recruitment. Employers cannot offer less than this.

In addition, under the Model contract a salaried GP's salary must be uplifted annually at least in line with the DDRB recommended increase. For 2017-18 the DDRB recommended an overall uplift of 1% for salaried GPs on the 2017-18 figures.

Please see the later guidance to salaried GPs on negotiating salary.

For details of how the salary of those who work less and more than full-time should be calculated, please see the previous section of hours of work.

 

Pension

Details on the NHS pension scheme for salaried GPs is set out in the BMA's Salaried GP handbook 2017 and in the BMA Pensions Department factsheet for GPs.

See the NHS Pension Scheme FAQs

 

Job plan

The Model notes that a job plan must be produced and appended to the salaried GP's terms and conditions. The job plan is a key component of the Model contract.

The job plan produced should outline the employee's normal duties, workload and important non-clinical roles undertaken within paid work time (such as participation in practice meetings, clinical governance, primary health care team meetings, etc).

An element of flexibility between both parties, for example regarding working later when busy and leaving early when not so busy and for childcare reasons, may be mutually agreed.

See our detailed job planning guidance for GPs

 

Continuing Professional Development

Entitlement to protected time for CPD

Full-time salaried GPs employed under the Model contract are entitled to at least four hours per week on an annualised basis of protected time for professional development. This is adjusted on a pro-rata basis for part-time employees. For FCS and retainer scheme GPs it is subject to a minimum of eight protected sessions.

Use of protected CPD time

CPD time should be used according to the educational needs of the salaried GP, as specified by their NHS appraisal and personal development plan (PDP). The CPD protected time may be relevant to the priorities of the practice and the wider NHS, provided it is in accordance with the doctor's PDP.

The arrangement for taking CPD is discussed in detail in the GPC's job planning guidance. The model contract allows CPD time for full and part-time salaried GPs to be accrued and taken on a flexible basis. Using the CPD time flexibly allows it to be taken in a variety of ways and to accommodate different learning styles in order to meet a GP's personal development needs. For example, it could be accrued to be taken in blocks for courses and/or in single hours for meetings.

The employer and salaried GP may mutually agree to use some of the allocated CPD time to allow the salaried GP to extend their management and development skills (e.g. to allow the salaried GP to take responsibility for a QOF domain). This should be with the proviso that these activities are used for the salaried GP's development and that sufficient time is available for other personal development opportunities. The proportion of time spent on this will depend on the GP's PDP.

CPD activities may include:

  • self-directed or private study, i.e. to keep up to date or for professional exam preparation
  • developing or updating a personal development plan
  • courses
  • specific clinical refresher experience
  • audit
  • practitioner or self-directed learning groups
  • PCT protected learning events
  • researching clinical queries
  • obtaining clinical experience relevant to specific PDP aims
  • management development activities provided these benefit the salaried GP's personal or skills development
  • in-house practice based educational meetings (excluding practice meetings which do not have a direct educational purpose, such as business, practice development, multi-disciplinary clinical team meetings, etc, since there is separate provision for these under the model contract).

The balance of these various CPD activities needs to be appropriate to the individual's educational and developmental needs.

 

NHS GP appraisal

Under the Performers List regulations, it is compulsory for all NHS GPs to participate in NHS GP appraisal. The BMA has sought external legal advice which has noted that time must be set aside during working hours for a salaried GP to prepare for NHS GP appraisal. This further noted that this preparation time was in addition to the protected CPD time of four hours (pro rata) per week.

 

The appraisal interview itself should be taken outside of the minimum CPD time, but within normal working hours. If it is not possible for the appraisal interview to be conducted during normal working hours, the interview may be held outside of working hours provided the salaried GP agrees and receives appropriate reimbursement or time off in lieu.

Salaried GPs are not require to contribute financially for an NHS appraisal. Funding for appraisal for salaried GPs employed by a GMS practice is via an appraisal premium which is included in the practice's global sum. Comparable arrangements should be in place for PMS practices. Funding for appraisal for PCO-employed GPs and freelance GPs is via the PCO. Further details are available in the GPC guidance note on appraisal funding.

CPD leave entitlements

A full-time salaried GP working 37.5 hours per week is entitled to 208 hours of CPD a year. To calculate a part-time salaried GP's CPD entitlement:

  • number of hours worked per week x 6.4 = number of minutes of CPD per week [X]
  • X divided by 60 = number of hours of CPD per week [Y]
  • X or Y x 52 = annual entitlement to CPD (X = minutes; Y = hours).

Please note that Flexible Career Scheme and retainer scheme GPs are entitled to a minimum of 8 protected sessions per year for CPD regardless of working hours.

LMC levies

Under the Model contract, the employer (ie the practice or the PCO) will pay the LMC voluntary levy for the salaried GP.

 

Continuity of NHS service

Paragraph 1.7 of the Model terms and conditions defines NHS employment as previous work for an NHS Trust, PCO, Strategic Health Authority or Special Health Authority (or any of the predecessors in title of those bodies or the equivalent bodies in Wales, Scotland and Northern Ireland), together with time as a GP provider or performer . Thus time spent as a GP principal, salaried GP or locum GP is regarded as NHS employment. The GPC lawyer's view is that the wording of paragraph 1.7 means that previous salaried GP work and locum GP work (regardless of the employer or contractor) is counted provided that the GP was performing primary medical services.

Details of how paragraph 1.7 may affect a salaried GPs' entitlement to maternity, sickness and redundancy under the model contract, as well as the types of breaks that do not affect continuity of service, are set out in the relevant sections below. The GPC lawyer's expert opinion in these sections has been confirmed by external lawyers. However, please be aware that because of the wording of the model contract it is not possible to give a definitive view.

Maternity leave benefits

  • Statutory minimum leave and pay
    All employees are now statutorily entitled to 52 weeks' maternity leave – made up of 26 weeks' ordinary maternity leave and 26 weeks' additional leave - regardless of how long they have worked for their employer.
  • Maternity Allowance (MA) will be payable up to 39 weeks (subject to the employment and earnings criteria test), with Statutory Maternity Pay (SMP) payable up to 39 weeks if the qualifying criteria for it are met. For general details on the qualifying criteria, please see the DBEIS website. BMA members can receive advice on how this applies to them by contacting the BMA. Also, the BMA Salaried GPs' Handbook 2009 contains detailed guidance on the statutory provisions.
  • Maternity pay under the Model salaried GP contract
    Under the Model contract, salaried GPs will be entitled to the provisions of the General Whitley Council (GWC) Handbook (Section 6). While the GWC Handbook no longer applies to non-doctor NHS employees, it is still applicable in this context as it is explicitly referred to in the Model salaried GP contract.

    The most recent changes to the maternity leave arrangements of the General Whitley Council benefits were identified in the English Department of Health's Advance Letter (GC) 1/2003, which is available on the DoH's website - and this is similarly replicated in Scotland, Wales and NI. Section 6 of the General Whitley Council Handbook is attached to the letter and explains the maternity leave and pay entitlements of NHS employees under the NHS contractual maternity leave scheme. However, it must be noted that our legal view is that where there is any inconsistency between the GWC Handbook requirements and the provisions of the Model contract, the Model contract prevails.

    In summary under the model salaried GP contract:

    - a salaried GP working full-time or part-time will be entitled to paid and unpaid maternity leave of 52 weeks in total if she has 12 months of NHS continuous service at the beginning of the eleventh week before the expected week of childbirth

    - the amount of contractual maternity pay receivable is as follows: - for the first eight weeks of absence, the employee will receive full pay, less any SMP or MA receivable - for the next 14 weeks, the employee will receive half of full pay plus any SMP or MA receivable providing the total amount does not exceed full pay

    - to be eligible for the above benefits a doctor must fulfil certain notification requirements before the end of the 15th week before the expected date of childbirth

    - statutorily if the salaried GP is eligible for SMP or MA, they will now receive SMP or MA for the next 17 weeks in total (even though the GWC refers to the next four weeks) since SMP or MA are now available for 39 weeks in total

    - with prior arrangement of the employer the entitlement may spread differently across the maternity leave

    - employees will also be entitled to unpaid leave for the remainder of the 52 weeks.

In terms of what counts as NHS service, our legal view is that paragraph 1.7 of the model contract means that previous service as a GP principal, salaried GP or locum should be classed as NHS service.1 Work for a PCO and NHS hospital certainly counts as NHS service.

For the purposes of calculating whether a salaried GP meets the 12 months of continuous service qualification, if a doctor has a break in service (ie has not done any NHS work) for over three months in the preceding 12 months then the calculation of the continuous service must start again. However, the following breaks in service are disregarded (but not count as service):

  • break in service of three months or less
  • absence due to maternity, paternity or adoptive leave (paid or unpaid)
  • employment under the terms of an honorary contract
  • up to 12 months abroad as part of a definite programme of postgraduate training on the advice of the Postgraduate Dean or College or Faculty Advisor in the specialty concerned
  • up to 12 months (exceptionally extended by a further 12 months at the discretion of the employer) of voluntary service overseas with a recognised international relief organisation.

While the GWC Handbook notes that NHS GP locum work does not count as service, our legal view is that this is inconsistent with the Model contract and thus should not be incorporated into the maternity provisions for salaried GPs. On this basis all GP locum work (where the locum is providing primary medical services) will count as NHS service provided that there is no substantive break in NHS service.

It has been a grey area as to whether a salaried GP who goes on maternity leave and returns to another GP practice would be required to repay her maternity pay, less any Statutory Maternity Pay, to her original employer. Advice from the GPC lawyer is that the wording of the model salaried GP contract (reading paragraph 1.7 of the model contract and the GWC maternity provisions together) is likely to mean that if a salaried GP goes on maternity leave and returns to another GP practice or NHS employer then she is entitled to retain her full maternity pay from her original employer. This advice is based on the expert opinion of the GPC lawyer. However, due to the wording of the model contract it is not possible to give a definitive view. The box below outlines the difficulties in giving this advice.

The Model refers to the maternity provisions in GWC section 6. Historically, the GWC when drafted was not intended to apply to GP practices; hence, when interpreting the definition of NHS employer for maternity pay purposes, there is a difficulty. If the definition of NHS employer under GWC does not refer to GP providers as employers, then under GWC paragraph 5.2.3 a salaried GP will not be entitled to paid and unpaid maternity leave even if she returns to the same employer. This is clearly nonsensical. Furthermore, GWC part C (which refers to continuous service) carves out a definition of NHS employer and implies that this definition, which excludes GP providers, does not apply elsewhere in the document. Due to the imprecise nature of the drafting of GWC and the lack of a clear definition of NHS employer, it would be reasonable in the circumstances to revert to the definition in paragraph 1.7 of the Model (which recognises working for a GP practice as NHS employment) and include GP providers in the definition of an NHS employer for the purposes of maternity.

When the Model contract was introduced the maternity provisions were consistent with hospital doctors. However, since then hospital doctors have received the following enhanced maternity pay arrangements:

  • for the first 8 weeks of absence, full pay less any SMP or MA receivable;
  • for the next 18 weeks, half of full pay plus any SMP or MA receivable provided that the total receivable does not exceed full pay
  • 13 weeks' SMP or MA that they are entitled to under the statutory scheme.

Salaried GPs and their employers may therefore wish to renegotiate their individual employment contracts to reflect the above enhanced provisions.

 

Sickness leave benefits

Further guidance on the statutory and contractual provisions are set out in the BMA Salaried GPs' Handbook 2009.

Statutory sick pay

All employees are entitled to at least Statutory Sick Pay (SSP) from their employer. SSP is payable on the fourth day of any period of sickness and is then paid for every day that you would normally be working for up to a maximum of 28 weeks. It is not possible to claim SSP at the same time as SMP or statutory paternity or adoptive pay.

Provisions under the Model salaried GP contract

The Model contract offers improved sick leave benefits, in line with hospital doctors. Under the Model, 'a practitioner absence from duty owing to illness, injury or other disability shall… be entitled to receive an allowance in accordance with the NHS scale contained in paragraph 225 of the Hospital Conditions of Service.' This means that those salaried GPs employed under the Model will be able to receive the following sick leave allowances:

  • during the first year of NHS service: one month's full pay and (after completing four months' service) two months' half pay
  • during the second year of NHS service: two months' full pay and two months' half pay
  • during the third year of NHS service: four months' full pay and four months' half pay
  • during the fourth and fifth years of NHS service: five months' full pay and five months' half pay
  • after completing five years of NHS service: six months' full pay and six months' half pay.

Calculating years of service for sick leave under the Model

All previous continuous NHS service (including locum service) is aggregated for the purposes of sick leave. Continuous service means without a break of more than 12 months, although there are specific circumstances in which a break of more than 12 months does not mean a break in qualifying service. NHS 8
service here certainly refers to any work undertaken for a PCO and in an NHS hospital. In addition, as paragraph 1.7 of the model contract notes that NHS employment includes all GMS, PMS and APMS work undertaken as a GP principal, salaried GP and locum doctor, the view of the GPC lawyer is that this wording can be interpreted as meaning that such work counts as previous service for the purpose of calculating continuous NHS service.2
Further details are contained in paragraphs 225 to 244 of the Hospital Medical and Dental Staff terms and conditions of service and section 57 of the Whitley Council Handbook.

 

Unfair dismissal and redundancy

The statutory and contractual position is set out in detail in the BMA Salaried GPs' Handbook 2009.

Statutory provisions

Under employment law, an employee gains full employment rights after two years of service (in terms of eligibility to claim for unfair dismissal), except in Northern Ireland where the length of service is one year, and is eligible for statutory redundancy pay after two years. Appendix A sets out a brief legal position for employees with regard to some entitlements. However, as is noted in Appendix A it is possible to claim unfair dismissal from day one where dismissal is for certain reasons.

Redundancy provisions for salaried GPs employed under the Model contract

The view of the GPC's lawyer is that the wording of the Model contract can be interpreted to take a GP's continuous NHS service (including previous NHS hospital or NHS GP work, and also includes all salaried GP and locum GP work where the GP is performing primary medical services) into account for the purposes of contractual redundancy pay3. Thus if a salaried GP has two years or more of continuous NHS service on joining a practice then he/she may automatically be entitled to contractual redundancy pay based on his or her previous years of service if a redundancy situation arose4 (although entitlement to the nominal statutory redundancy payment is only available after two years with their current employer).

Contractual redundancy pay = an additional redundancy payment available under the model salaried GP contract.

Statutory redundancy pay = available as of right to all employees but only after two years of service with a current employer.

For all employees, including salaried GPs, there are certain criteria that must be met before a redundancy situation applies (ie the dismissal of a salaried GP does not automatically mean that they have been made redundant). When considering the end of a contract of employment for a salaried GP, practices should seek expert legal advice. This is available to BMA members through the BMA, and so members should contact the BMA as a matter of urgency.

If a redundancy situation applies, then the provisions of s45 of the General Whitely Council Handbook will apply (reproduced at appendix B – see pdf attachment). However, due to the recent age discrimination regulations it is likely that some of these provisions (eg regarding not being entitled to redundancy pay at 65 years of age or over) would not apply.

Unfair dismissal provisions for salaried GPs employed under the Model contract

The GPC's legal view is that previous NHS service is not taken into account in determining a doctor's eligibility to claim unfair dismissal. However, as for all employees, the statutory provisions listed above will apply.

Fixed term contracts

Where a doctor is employed on a fixed term contract, they (as with other employees) already have basic employment rights and may acquire full employment rights after being employed for a period of one year or more. However, as is noted above, the ability to claim unfair dismissal for dismissals on certain grounds is available from day one. Also, fixed term contracts for four years or more automatically means that the employee's contract is made permanent.

 

Downloads

Focus on Salaried GPs (PDF)

 

Notes:

  1. The views of the GPC lawyer are based on expert opinion and confirmed by an external firm of lawyers. Please be aware however that because of the wording of the model contract it is not possible to give a definitive view.
  2. Please see footnote 1.
  3. Based on reading paragraph 7 of the model offer letter in conjunction with paragraphs 1.7 and 9 of the minimum terms and conditions, and these with the other relevant parts of the minimum terms. Also see footnote 1.
  4. Please see footnote 1.
  5. To be qualified to make a claim of unfair dismissal on general grounds, an employee must have been employed by the same employer for at least one year. Claims of unfair dismissal on some special grounds, such as any form of unlawful discrimination, may be made from day one of employment.

 

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