What GPs should include in their job plan
Below is what should be included in your job plan as a GP.
- dealing with telephone queries from patients or other health care professionals.
Whether arising directly from this caseload (referrals, investigations, results) and indirectly (reports, medicals, etc).
- Formal or informal.
- Essential to the delivery of team based care.
- Discussing clinical practice standards.
- Developing practice protocols.
- Mutual professional support for the individual practitioners.
- Significant event analysis.
- Meetings with colleagues in the locality, care trust etc. Where these occur on an ad hoc basis, adjustments to clinical workload may be required.
Medical student or registrar teaching or training, responsibility for particular areas of practice development, QoF areas of responsibility, ‘Practitioner with Special Interest’ etc.
This may include a mix of in-house meetings and events, time away from the practice, either in private study, attending educational events or time in lieu of attending educational events outside of normal working hours.
How to evidence your workload
This should be broadly defined in amount (number of patients) and type (clinical, paperwork, team meetings), with provisions for fluctuations in exceptional circumstances.
Workload should reflect the individual employee’s particular abilities and developmental priorities, such as those relating to experience, return after a career break, disability, or knowledge of a second language.
Clinical and non-clinical work
Balanced, recognising both clinical and non-clinical work (including meetings, both formal and informal and administration).
It is estimated that the ratio of clinical work to administrative work is usually in the region of 3:1 for salaried doctors without any practice development role and this excludes meetings. This ratio may vary greatly from practice to practice.
Where the post-holder works effectively like a salaried partner or performer/provider, this ratio is likely to include significantly more time needed for practice development.
It is not appropriate to base clinical workload on that of partners.
This is because partners (defined as performers/providers under the new contract) define their role and workload as a reflection of their profit share rather than in hours. As profits can fall and rise so can the workload of partners in a way which should not be expected to affect salaried doctors on an hour’s based contract.
Employed doctors are contracted and paid on the basis of time worked. There is a risk of breach of contract if employed doctors’ commitments increase due to, for example, a colleagues’ leave, unless these additional duties are entered into by mutual agreement (see Model terms and conditions of service for a salaried general practitioner employed by a practice or PCO and the provision for additional sessions).
Extra contractual duties
There must be clear agreement on arrangements regarding how and when extra-contractual duties (where agreed to) will be recognised, when time in lieu will be taken (e.g. monthly or added to annual leave), or when additional payments are made.
This is of particular relevance where there are significant fluctuations in workload and hours of the employed doctor if she or he is helping to cover another doctors’ absence, for example, sickness or maternity leave.
Although a session is defined as four hours and 10 minutes, periods of duty do not need to be exact multiples of sessions. Short days are permissible as long as the hours are all counted.
An example would be where childcare commitments mean that an employee may prefer to work short days – perhaps two days from 9am to 3pm and one day from 9am to 1.40pm = four sessions (16 hours 40 minutes).
EWTD (European Working Time Directive)
Breaks should be granted within worked hours in keeping with the European Working Time Directive. Start and finish times should consider the employee’s need to meet childcare or other care commitments.
It is helpful to specify whether this includes correspondence or prescriptions addressed only to the doctor or whether it includes a share of the day’s workload.
Whether time is allocated within the general admin time, and reports are shared, or whether time is blocked-off during surgery and whether the fee is retained by the doctor.
Commitment should be specified in terms of frequency but also maximum number in a month or year as on call duties can often extend contracted hours for that day or week.
For instance, 12 mornings a year, and the hours covered. On call frequency should be based and not exceed the pro-rata share of clinical work for that doctor.
So for example a doctor works four sessions in a practice where there are 40 sessions provided by doctors.
The doctor should not be required to work more than 1:10 of the on calls (assuming all are present and not off on maternity and long term sick). On calls in a year (52x5)-8= 252. Share for this doctor is 252/10=25 per year or around 2.5/month.
Assessment of workload
An employed GP contracted to work an eight hour day should not be expected to see the same number of patients as a partner who works a nine or 10 hour day.
Just because partners decide to attend meetings in addition to existing around clinical commitments does not mean it would be appropriate for salaried doctors to do so if this means an unpaid increase in their hours work. Such an arrangement would necessitate additional payment or time-off in lieu.
Surgery times should make a realistic allowance for late arrival of patients, overrunning, as well as necessary time to make urgent referrals which cannot wait until the next worked session.
A session finish time of 5.30 would require the last booked appointment to be at 5pm (or earlier if the doctor only works one day a week and needs to finalise all referrals the same day).
The time at the end of surgery will depend on the length of the surgery, on when the doctor will next be in to act on referrals, and perhaps the practice’s policy on patients who attend late for their appointment.
These are usually expected to take 30 minutes. Any estimation made should be realistic and, for example, in rural practices, a longer time would be necessary where extended travelling time for visits will need to be taken into account.
It is preferable to indicate a number rather than a range. Where a range is indicated for a day, it is advisable to agree a maximum weekly limit so that where visiting time erodes admin time on one day the balance can be redressed on another day without a exceeding contracted hours.
There should be clarity about the cut-off time when the visits become the responsibility of the doctor on call.