About this guidance
Sessional GPs are increasingly working outside of a traditional GMS practice setting, with an increased desire for flexibility of working patterns that may not be possible within GP practice.
Many of these engagements involve work that is not being performed under a GMS or PMS contract and, as such, the GMS/PMS regulations do not apply and there is no requirement to offer terms that are no less favourable than the national model salaried GP terms and conditions.
A number of organisations, including NHS employers, are increasingly seeking to employ GPs on zero hours contracts, for which there are no nationally agreed terms and which often do not provide security or the level of contractual entitlements found within the national salaried model terms.
This guidance seeks to set out some guidelines to GPs and employers on the key contractual and engagement considerations.
If you are a GP and have been offered work on a zero hours contract, and are in doubt about its terms, we recommend that you seek independent legal advice or approach the BMA’s contract checking service.
General principles
Whilst there is no legal requirement for employers offering zero hours contracts to GPs to follow any nationally agreed terms, the principle should be a minimum of ensuring equity with the national model contract for salaried GPs.
Many aspects of the model salaried terms can be adapted to a context of flexible working. The broad outline of how this can be achieved across key contractual and non-contractual areas is set out below, with specific suggested provisions for each outlined in the table that follows.
Hours and pay
Offering/accepting shifts
Zero hours contracts often work on a basis of shifts being offered as and when the need arises. This can sometimes lead to work being offered with little notice provided and can result in uncertainty of work/income and can impact the ability of GPs to properly plan their work schedules.
Under zero-hour contracts, it is important to recognise that there is no obligation on an employer to offer work. Conversely, there is no obligation of a worker to accept work when it is offered. Further, the offering and acceptance of work under a zero-hours contract should not give rise to an expectation that more work will be offered in future.
Therefore, if possible, it is beneficial to agree on a regular time period for the offer/acceptance of shifts to provide some certainty whilst maintaining flexibility – i.e. will hours be offered monthly, weekly, quarterly, or flexible upon agreement and offers or requests to work the shifts will be confirmed promptly within a certain number of days.
This will be key as the period between the offer to work a shift and confirming it requires the worker to decline conflicting competing work for that day without any guarantee that the shift will be confirmed by the provider.
Similarly, you should aim to agree a minimum notice period for cancellation by the employer of any previously agreed shifts to avoid work being cancelled at the last minute, set at a length that both parties are comfortable with. It should be agreed that breaching the minimum notice period will result in full or part payment being made to the GP in order to compensate them for the loss of earnings.
Pay
As many organisations offering zero hours contracts will not be bound by nationally agreed terms and conditions, the level of pay on offer will be determined between the GP and the employing organisation and based on what the organisation is willing to offer. However, we recommend that the rate is agreed to be uprated in line with the annual DDRB award. When assessing pay rates, it’s useful to keep in mind the overall value of any benefits on offer, such as paid annual leave, parental leave, training etc.
Pay terms should include an agreed additional rate to cover any shifts that overrun due to clinical need, at least matching the agreed hourly rate.
It is also recommended that contracts include an obligation to match any increase in pay rates offered for already agreed shifts, should the rates being offered to new sign-ups be raised, ensuring parity across the GP workforce. For example, if an organisation is struggling to fill certain shift ahead of time, it may up the rate offered in order to do so.
Leave
Sick Leave
If sick leave benefits are afforded in a zero-hour contract, it is desirable for the level of sick leave to be in line with the provisions available to salaried GPs. This provides sick leave allowances in line with length of NHS service, with all previous continuous NHS service, including locum service, aggregated for the purposes of calculating the amount of sick leave available.
When translating these to a flexible working contract, the level of ‘monthly pay’ when on sick leave could be set to an equivalent number of weekly sessions or an average of actual sessions worked over a given period.
Maternity and Parental Leave
Similarly, maternity and parental leave and pay provisions should also reflect what is available under the model salaried contract, with 52 weeks maternity leave, and access to shared parental leave, as is becoming standard across the NHS, subject to the regular criteria and requirements.
Training, CPS and appraisals
When agreeing any contract it’s important to ensure that it includes appropriate time for undertaking training, CPD and appraisal related activities within paid working hours.
CPD
The amount of paid CPD time provided should be pro-rated with the weekly number of hours worked, in a similar way to that used for part time salaried GPs. This follows the formula:
(Hours worked per week x 6.4) / 60 = CPD hours per week.
This could be aligned with the agreed time periods for hours to be provided, (week/month/quarter) but as it will have to be earned based on actual hours worked, the shorter periods for calculation may be better as it will provide access sooner (i.e. after a week/month rather than 3 months). This could therefore be adaptable, and subject to agreement between the individual and the employer.
Appraisals
The employer should also provide time to be set aside during working hours for the GP to both prepare for their annual appraisal and undertake the appraisal interview itself. GPs employed under the contract should have the right to receive feedback for appraisal and the service should support the doctor in obtaining patient feedback, e.g. through the use of online surveys which may require the use of text messaging functionality.
Training
Additionally, the employer should also ensure the provision of paid training time when new training requirements are introduced and for undertaking of any mandatory training requirements.
Flexible working contractual framework
Area |
Provision |
|---|---|
Hours and pay |
Annual uprate in line with DDRB award for sessional GPs. Agreed regular time period for offer and acceptance of hours to provide some certainty whilst maintaining the flexibility. Minimum notice period for cancellation of any previously agreed shifts. Agreed additional pay rate to cover shifts that overrun due to clinical need. Agreement to match any increase in pay rates offered for already agreed shifts, should the rates being offered to new sign-ups be raised. |
Annual leave |
30 days pro-rata based on hours worked in the preceding weeks, months, or quarters as agreed. |
Sick leave |
Paid sick leave in line with salaried model contract:
Sick pay will be paid for the equivalent of and agreed number of sessions per week at the regular agrees payable rate. |
Maternity and paternal leave |
52 weeks maternity leave, and access to shared parental leave, subject to the regular criteria and requirements. Entitlement to contractual maternity pay following 12 months of continuous service at the beginning of the 11th week before the expected week of childbirth. If this condition is met, the pay will be:
‘Full pay’ set at average weekly earnings over the 8 weeks prior to the qualifying week, as per the calculation for SMP. Weeks with 0 worked hours counted for continuous employment purposes to account for periods when the individual may not have worked any hours. Access to the same for those on shared parental leave. |
CPD |
Paid CPD time should be calculated as per: (Hours worked per week x 6.4) / 60 = CPD hours per week. The period of time to assess an average of hours worked per week should be agreed in advance. |
Appraisal |
The employer will provide for time to be set aside during working hours for a salaried GP to prepare for NHS GP appraisal and undertake the appraisal interview. GPs engaged under the contract will have the right to receive feedback for appraisal and the service will provide support the doctor in obtaining patient feedback, e.g. through the use of online surveys which may require the use of text messaging functionality. |
Training |
Provision of paid training time for new training requirements and any mandatory training required. |
Equipment provision |
The employer will provide the necessary equipment and IT support to the individual employed under the contract. Both parties will make reasonable endeavours to resolve equipment issues. Should such failures result in cancellation of the arranged session at short, the employer to maintain payment for the time lost. |
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