Benefits of working in general practice
Welsh Government have published a guide for working in General Practice as shown here: Benefits of working in general practice (cavgp.co.uk)
The independent contractor Status of General Practice means that without GP Partners there would be no General Practice. The Partners hold the contract for their surgery form the health board to take responsibility for delivery General Medical Services (GMS) for those patients. Working as GP Partner can be one of the most rewarding roles you can do as a GP. It can be as challenging as it can be enjoyable and as with all jobs there are pros and cons to the position that do not suit everyone. Not only do you get to Care for your patients and develop rapport and continuity with families on your list but you get to take an active role in how your practice provides these services.
Advantages of being a GP partner
This is the biggest advantage as a GP Partner. The surgery is now YOUR Business. If you don’t like how something is run, how the appointment system is designed, when you provide different services – speak to your Partners and change it. If you look at your patients and feel there are needs you are not providing or services you would like to add – again you have the power to add these. This can be very satisfying and can provide a greater connection with your surgery and patients than can be achieved with any other GP role.
As partnership your salary comes from the profits of the practice once all bills are paid, staff are paid etc. GP partners can be well paid to reflect the extra responsibility they have. Average drawings for a GP Partners in the UK is approximately £110,000 per annum. There is variation for different parts of the UK and Wales is usually a bit less than this somewhere between approx. £93,000 and £100,000. Being a property owner can increase this further and the take home is usually significantly higher than a salaried GP.
Most GP Partners will stay with their practice for most if not all of their careers. This gives them the opportunity to really mould their surgery to how they want to deliver Primary Care. Being stable in 1 practice allows you to form fantastic relationships with your patients and truly become the family doctor with “cradle to grave” level of care. This stability of work and pay allows for stability in personal life also.
Disadvantages of taking up a GP partnership
Ultimately as a Partner and Business owner it is your responsibility to deliver on the contract you hold with the Health Board. This can mean longer hours at times where sessions are not filled and a need to be flexible at others to cover vacant sessions form illness or unfilled positions. Unexpected disasters such as floods or fire can mean phone calls and work after work, on weekends and during holidays. A good relationship with your partner and well written disaster contingency plan can mitigate some of this but not all things can be predicted.
Existing partners will have a variable amount of finances tied into the practice depending how they choose to manage their finances. This can be even higher if the Partnership owns the building or buildings they practice form. Joining a Partnership may require a new Partner to “buy in” to the practice to match the finances of the other partners. This would need to be discussed with the existing partners and agreed plan of how this could be done. (Personal loan, Practice loan or re-mortgage and gradual buy in from drawings or 1 off payment). This can be expensive particularly where premises are involved so needs to be considered.
As a partner, you are the employer of all the staff in the surgery from salaried GP to Nurse, Receptionist and administrator. You have a leadership role in the practice and can be stressful for some people. Much of the HR side of things is managed by the Practice Manager but Partners are always involved in employee issues. This does not have to be a negative thing and many GPs enjoy the responsibilities.
As the business owner you are liable for the business. If the practice is unable to recruit Partners have personal liability for the business. Cardiff & Vale UHB has a team dedicated to try and help with the sustainability of GP Practices. They will try and get involved as early as possible to look at ways of helping recruitment and reducing workload. In some cases this may result in Practice mergers to strengthen the partnership. If despite this support a practice cannot continue it may mean handing back the contract and making staff redundant. This results in redundancy pay which can be expensive. Partnerships which own their own premises can be left with the burden of an ongoing mortgage for a prebuilding which is no longer a GP surgery.
Partnership Hints and Tips
Partnership agreements: Partnerships work great when everyone is working together with the same agenda and everyone is getting along. Sadly relationships do breakdown and sometimes out of the blue. In situations where a partnership cannot see eye to eye, a Partnership agreement can steer you through the storm and allow decisions to be made where common ground cannot be found. Ensuring there is a good Partnership agreement in place before trouble starts is extremely important. If your practice does not have one in place or their existing agreement needs updating, there are many local and national legal firms who have experience in drafting these documents and can help you get things written up. Many partnerships agreement have a clause which prevents more than 1 Partner leaving the business in a given period of time. This is to prevent the practice becoming unstable and dropping an unsustainable responsibility on the remaining Partners. Some agreements allow for sabbatical periods to work away from the practice for 6-12 months and return back to the surgery.
Tax and accounts: Having an experience Accountant looking after not only the practice accounts but your own is extremely important. The tax rules for a GP practice (when you are self-employed and when you are not) can be complicated. There are a number of excellent accountants around with experience of dealing with GP surgeries. Changing from a PAYE salaried post of the VTS scheme a salaried position it can be easy to forget about tax. It is very worthwhile setting aside a regular amount in preparation for your tax bills. Your first Tax bill can be larger than expected as you pay half on the next years predicted amount and is worth discussing with your accountant.
Jobs: There a many national level places for job advertisements. Such as RCGP, BMA and Pulse etc.
GP Wales website
- Practical guide to taking on new GP partners (bma.org.uk)
- Why being a GP partner is still a great career choice | GPonline
Why become a Partner
Follow the link for some thoughts of local GP Partners and why they choose to be GP Partners
At Cardiff and Vale Health board we are committed to supporting doctors who are thinking of becoming partners, or who have recently become partners in their new venture.
We can provide confidential help and guidance in becoming a new partner, answer any questions and talk through any concerns you may have.
We can offer face to face, telephone or email advice with one of our experienced GPs. The area of support will depend upon your needs. Examples include:
- Is this the right practice for you?
- Do the numbers add up - do you understand the accounts?
- Buying in? Leasing?
- Is there an up-to-date partnership agreement and are you happy with it?
- Workload - how much do you want to work? How are on-calls, house visits shared?
- Non NHS work - how is this shared out and paid?
To arrange a session please contact us on:
A Salaried GP can have the benefits of a stable base that a GP Partnership provides without the added pressures of being a business owner. According to the BMA website the pay for Salaried GPs in Wales ranges between £61,945 and £93,474. The exact salary is negotiated between the salaried GP and the GP Partners.
There is excellent advice on Standard Salaried GP contracts, negotiating salary and terms etc on the BMA website or through the LMC as below.
Reasons I chose to become a salaried GP
There are so many options available to you when you finish your VTS, and I found it quite stressful making such a big decision about my future – previously your jobs are chosen for you by whichever training programme you are under, and yet suddenly the decision is all yours!
The big draw for me of becoming a salaried GP initially was the stability. I liked the idea that, once settled into a practice, I didn’t have to worry about different ways of working, different computer systems or ways of referring.
I also felt that I needed the structure to keep me focussed – although locum jobs looked quite appealing, with the ability to choose when and where you work and name your price, I was fairly sure I would choose days off over working if I had the option and struggle to keep myself working regularly, whereas the structure of a working week suits me well.
Being a salaried GP is a great opportunity post-training to get used to being an independent practitioner without the added pressure of partnership initially. I think becoming a consistent part of a team is a good opportunity to gain some confidence, with the support of your colleagues around you. I have also had opportunities to branch out into medical student teaching within my normal working week, which I have really enjoyed.
Going into a salaried job also gives you the flexibility to do other work in the week if you choose to go part time, with the benefits of a stable job and employee benefits as your safety net.
Although a lot of my VTS group went into partnership fairly quickly, I think being a salaried GP was the right choice for me when we finished training, and being in the same practice now 3 years later proves that!
Dr Charlotte Wilson
Jobs and resources
Jobs: There a many national level places for job advertisements. Such as RCGP, BMA and Pulse etc.
LOCUMING IN CARDIFF AND VALE UNIVERSITY HEALTH BOARD
Written by Dr Gneeta Joshi
GP Locum Pros and Cons
The advantages of a GP Locum role are as follows:
- It is flexible method of work.
- High earning potential in comparison to a Salaried GP role.
- Increased opportunity to work for different Health Boards, different Practices, with exposure to different clinical services and patient demographic.
- Useful to locum before you commit to a Salaried GP or Partnership role.
- You have a choice to work for one or a few practices on a regular basis, or you can work for multiple practices. You can establish your own work practice.
- Annual leave is unrestricted, which is advantageous when you have a young family or other commitments.
- Greater opportunity to mix GP Locum work with other Portfolio work.
The disadvantages of a GP Locum role are as follows:
- Clinically, locum work can be limiting, for example reduced input with palliative care, cancer care or chronic care management. You may not be able to get involved in baby clinics, family planning or minor surgery services, etc.
- Difficult to follow up patients unless you work as a long-term or a maternity cover GP locum. Therefore there can be reduced continuity of care with patients.
- Income uncertainty.
- You can feel isolated professionally.
- Risk of being on your own in a Practice that you may not be familiar with.
- Your involvement with business management, practice or service development for a Practice or Locality can be limited.
- Potential of a greater medico-legal clinical risk unless clinical records, safety netting and handover instructions are clear and immaculate.
Locum Hints and Tips
If you are planning on becoming a GP Locum in Cardiff and Vale, here is some helpful hints and tips:
- Ensure that you are registered on a Welsh Medical Performers List if you intend to work in Wales.
- Link for the MPL application forms and information: https://nwssp.nhs.wales/ourservices/primary-care-services/our-services/gp-services/apply-for-inclusion-in-the-medical-performers-list/
- Ensure that if you are on a Welsh MPL, that you update your status that you are a GP Locum.
- Ensure that any changes in your personal details, address or contact details are updated on your MPL via contact with NWSSP. It is your responsibility to do so.
- In order to receive GMPI (General Medical Practice Indemnity), you need to register on the All Wales Locum Register (AWLR).
- If you do not register to the AWLR, then you will need to pay for your own indemnity and Practice’s may request for proof of indemnity cover.
- Do I need to register to the All Wales Locum Register? https://nwssp.nhs.wales/ourservices/employment-services/employment-services-documents/primary-care-sustainability/awlr-quick-reference-guide-english-version/
- GMPI require you to record your shifts via the Locum Hub Wales website, so you will need to register to this site: https://gpwales.co.uk/ . Jobs are advertised on this site. Once registered, you will receive an AWL registration number.
- Do I need to register to Locum Hub Wales? https://nwssp.nhs.wales/ourservices/employment-services/employment-services-documents/primary-care-sustainability/lhw-quick-reference-guide/
- When finding work in Cardiff, it is useful to familiarise yourself with the practices in Cardiff and Vale. A list of local practices can be found here: http://www.wales.nhs.uk/ourservices/directory/cardiffvaleuniversityhealthboard/gps
- PENSION - For each shift you will need the Practice Manager to complete the GP Locum A pension form which can be found here: https://www.nhsbsa.nhs.uk/sites/default/files/2021-03/NHS%20Pensions%20-%20GP%20Locum%20A%202021-22-20210319%20%28V1%29.pdf and you will need to submit the GP Locum B pension form to the Cardiff and Vale UHB Pension Office. The Form B can be found here: https://www.nhsbsa.nhs.uk/sites/default/files/2020-06/NHS%20Pensions-GP%20Locum%20B%202020-21-20200610-%28V3%29.pdf
- Post your GP locum B forms to: GP Locum Pensions, NWSSP Cardiff and Vale Pension Department, 4th Floor, Companies House, Crown Way, Cardiff, CF14 3UB. They can also be contacted on email@example.com .
- Pension information for GP Locums can be found here: https://www.nhsbsa.nhs.uk/member-hub/information-practitioners-and-non-gp-providers
- BMA Pension information for GP Locums can be found here: https://www.bma.org.uk/pay-and-contracts/pensions/being-a-member-of-a-pension-scheme/an-introduction-to-the-nhs-pension-scheme-for-locum-gps
- Other useful GP Locum websites include:
- Locum Hub Wales (gpwales.co.uk)
- Red Whale - The Locum Essentials Guide http://www.gpone.wales.nhs.uk/sitesplus/documents/1000/Locum_Essentials_Guide.pdf
Locum acces to Consultatn Connect
Just a reminder to let you know that advice and guidance is available to all Primary Care locums working within the Cardiff and Vale Health Board area through Consultant Connect. This INCLUDES THE ACUTE GENERAL SURGERY REFERRAL LINE.
You can EITHER download the free Consultant Connect App from the App Store or Google Play. On the app, you will find all the available specialties and their operating hours. (Please note, to sign up to the app, you will need to use your NHS email address to verify your clinical account).
If you are unable to acces your nhs emial you can reactivate your password by contacting the service desk at firstname.lastname@example.org
If you do not have a NADEX account you can request an account without being affiliated to a particular practice. You can request this agin via the service desk
Ask the Practice Manager at the surgery you are working out of, for the surgery’s unique telephone dial in number for the Consultant Connect service.
Cardiff & Vale University Health Board is excited to promote opportunities to work as a “specialist generalist” working across General Practice and a range of secondary care specialities.
These posts will offer incorporate a general practice partnership or salaried GP role with a specialist role within a specific hospital service, e.g. emergency care, paediatric care, cardiology, etc. This is a great opportunity for any GP to continue to develop their interest, skills and passion in specialities they will have enjoyed during training while pursuing a career in general practice. These roles will also present an opportunity to help to develop collaborative working between primary and secondary care.*
Working across primary and secondary care is a great opportunity to;
- Work in an area of special interest
- Retain and practice key skills
- Learn new skills and develop confidence
- Enjoy variety
- Help to improve collaboration across the healthcare system
- Help to improve patient pathways
- Helps to keep you refreshed and stimulated
Click on the link below to read an RCGP article by a GP with Special Interest, talking about how working flexibly between specialities helped her to stay “refreshed and engaged”.
*Please note that these posts seek to support improved recruitment and retention of GPs in the Cardiff & Vale area. As such the hospital posts advertised are reserved for GPs who are committed to working as a partner or a salaried GP in Cardiff & Vale.
In 2018 the Welsh Government decided to establish a discretionary state backed scheme of indemnity provision for General Practitioners on Welsh Medical Performers Lists, their staff and those engaged by the GP practice from 1 April 2019. NHS Wales Shared Services Partnership Legal and Risk Services (NWSSP-L&R) was commissioned to manage the scheme.
The main change for General Medical Practices is that in relation to incidents occurring on or after 1 April 2019, the Health Boards in Wales will provide an indemnity arrangement and will be the named Defendant for clinical negligence litigation rather than the General Medical Practices. Some aspects of GP work are not covered by the Scheme, for which membership of a medical defence organisation will remain necessary e.g. private work, inquests, disciplinary issues, issues with the GMC.
For more information on the scheme please follow: General Medical Practice Indemnity (GMPI) - NHS Wales Shared Services Partnership
For specific advice for what is required as a GP Locum : https://nwssp.nhs.wales/ourservices/legal-risk-services/legal-risk-services-documents/general-medical-practice-indemnity-gmpi-docs/faqs-new-guidelines/
HMP Cardiff, is a category B prison serving the courts in the Eastern half of South Wales. The prison is a remand facility with high turnover of prisoners. It has an average of 252 receptions per month and an estimated 3024 annually. Cardiff & Vale University Health Board is responsible for providing health care at the prison.
Cardiff & Vale University Health Board provides a range of services to men residing at the prison.
- 24/7 primary health care services comprising nursing and GP staff.
- Out of hours services at weekends is a contract service through which a GP is either available by phone or in person.
- Mental health team based on site during weekday daytime hours, comprising a range of nursing, medical and allied health professions staff.
- Visiting community dental service.
- Visiting optician.
- Sexual health services including patient testing and education sessions.
- Visiting podiatrist.
For more information about working in Prison medicine please click on the following for a blog from Dr Jake Hard and his work in this field: