These are posts in which GPs are employed but work flexibly across teams and locations in a particular area, rather than in a single team or practice. Employers that offer these posts are normally organisations which sit above practice level. This can include acute NHS Trusts, Health Boards, Clinical Commissioning Groups (CCGs) or Primary Care Network (PCN) federations.

These types of posts have existed for more than two decades and experience of these posts can vary significantly between employers and settings. As with any type of post, there are benefits and drawbacks which we will address in this guidance. There are generic issues applicable to most non-traditional roles which can be read in the first section of this toolkit.

Benefits of these posts

These posts are often created with the ultimate goal of addressing recruitment difficulties which practices have not been able to address themselves. As a result, beneficial packages are created to attract GPs (often newly qualified) into underdoctored areas. These might offer enhanced terms such as additional Continuing Professional Development (CPD) time, sabbaticals, peer -mentoring, additional educational opportunities, or the chance to develop specialist clinical skills through a local trust.

Some of these schemes have been labelled ‘Career Start’ or ‘GP Choices’. They aim to provide extra capacity into practices by creating posts with additional protections, particularly in terms of work/life balance. This is to mitigate against the often onerous and unappealing workloads that are a feature of understaffed practices which might otherwise deter new GPs from applying to work there. In many instances, the schemes have attracted some mentoring input from a local GP and have successfully managed to retain GPs in areas that are hard to recruit to.

Things to consider

Contract

Does the post offer the BMA salaried GP model contract? This should include the appropriate amount of CPD time, paid Local Medical Committee (LMC) membership, and recognition of previous NHS service for the purposes of employment benefits (such as sickness absence, redundancy and parental leave). These are features of the Model contract, which was negotiated in 2004 for all GMS practices, and all PMS practices with contracts since 2015. It represents the benchmark that all salaried GPs should expect from their employer.

Workload and Job plan

You will want to clarify details of the expected workload within your job plan. It is important to establish whether the workload will be appropriate for your level of experience, your professional style, and your work life balance needs.This is regardless of whether the practice you are placed in is understaffed. These details will need to include the number of appointments and the amount of non-consulting work you are expected to do.

It is important that your workload is clearly defined at the outset by the scheme and independent of the base where you are working. Otherwise there is a very real risk that you will be in a less favourable position than either:

• a traditional salaried GP (where the GP can settle into a team - but has less autonomy in relation to their workload)
• or a locum (where the GP has autonomy but doesn’t belong to a team)

This would mean experiencing the worst of both roles.

Some control over workload can be retained by:

• a centrally determined job plan that would remain the same regardless of the team where you work
• or ensuring that any changes to a schedule are made with the agreement of the salaried doctor.

Some variation in number of appointments seen in a surgery will need to be agreed with you to reflect differences in the role of GP in different practices depending on the wider clinical team. In practices where Allied Health Professionals (AHPs) deal with most minor illness, sickness certification, straight forward medication reviews, GPs are left to deal only with more complex long -term conditions. Fewer longer GP appointments may need to be agreed with the salaried doctor to keep work within the contract hours.

'Crediting' special situations

There can also be mechanisms of ‘crediting’ special situations where longer sessions are needed. For example, when doing duty doctor sessions or a longer-term placement where the non-patient facing clinical workload may be heavier, such as for parental leave absence. ‘Duty doctor’ or on-call sessions should not be allocated to you without your agreement and unless you are familiar with the practice. This is because such sessions often extend the day beyond its standard length, which may affect caring responsibilities, and often involve working under significant stress. Scheme managers could consider working with practices to implement a credit system where a duty day can count as 3 sessions to help incentivise working duty days.

Administrative work

Administrative work (such as tasks, labs, prescriptions or e-consultations) can take up anywhere between 20-40% of working time. Organisation of this work varies significantly between practices, with greater or lesser delegation to administrative staff, pharmacists or AHPs (e.g. for coding, reports, etc.). This can in turn lead to uncertainty in workload when moving between practices. It is important for the job plan to be clear for you and every practice what administrative work the post will entail.

This work can be difficult to quantify and make it hard to ensure the job plan and worked hours are adhered to. As such, mobile salaried doctors should generally only expect to undertake administrative work arising directly from their consulting caseload. This is unless they are working in one practice in a longer-term placement (like a long-term locum).

Where this is the case, additional admin work will need to be accommodated in the job plan in place of some of your consultations to maintain sessions within contracted length. Alternatively, with the agreement of the doctor, longer sessions could be worked providing all hours worked are counted as paid time. So, for example, if you are doing all the administration work due to an absent partner on maternity leave, your day at the practice would consistently last an average of 10 hours and 25 minutes. This would mean 2 days would count as 5 sessions of the model contract.

Support and induction

Induction to new practices is essential and should be provided within paid time. When starting at a new practice, you will need to be given relevant, organised and succinct information to get you up to speed quickly. This will need to cover both internal processes and external referral pathways and services. This is to ensure that care received by patients meets the same high standard regardless of the clinician they see.

Points of contact

You should expect to have two points of contact. The first would be an organisational advocate such as a manager who you would be able to communicate with and who wouldact as an advocate on your behalf when liaising with practices. They would also deal with leave requests, placement discussions, liaising with practices and ensure you are properly supported whilst there. This person should help organise inductions and logins (to clinical systems, video consulting platforms, lab requesting systems, intranets, etc.) as well as ensure your workload in each practice is appropriate to your role and contract. They also need to manage the competing demands on your time from practices and ensure that their expectations of the role are appropriate. This is especially important as appointment systems have seen significant changes with the move to total triage during COVID and then back to more face -to -face consulting after relaxation of restrictions. The second point of contact would be a senior GP . They will support you with professional matters like complaints, significant events, CPD requests and development within your role.

There should be a senior clinician available for this support across practices where you may work.. Adequate support on the ground at the level of each practice is also important, especially if you have not worked there before, or will be working alone.

Meeting colleagues

You will also want to know whether there are regular opportunities in paid time to meet colleagues working in a similar role within the PCN or Cluster area, and how you can make your collective voice heard. Your role will be very different to those of your practice-based peers.

We know that peer support and belonging to a network is essential for resilience, retention, and professional development. It will be important to understand what opportunities there are to be part of the wider GP community. This can include protected learning events, consultations on service changes, and other meetings within the Primary Care Network/Integrated Care System/federation/Primary Care Cluster.

Flexibility

You will need to know whether commuting distance is manageable for your personal circumstances (e.g., because of caring obligations) and how much choice will you have over your practice location. You will want to know what will count as your base for the purpose of claiming mileage costs, when you are working between different surgeries.

You will also want to know whether you have some choice in the types of work available (in-hours, Urgent Treatment Centre (UTC), consultations, directly managed practices) and mode of work (remote by telephone/video or only face-to-face). Generally, schemes which have a larger pool of doctors have the potential to offer more choice. Allocation to popular types of work is decided centrally when several colleagues request the same placement.

There may also be the flexibility to change your working days and times, such as to fit around other roles in your portfolio career, relevant CPD events (such as meetings, conferences or courses), or caring responsibilities. It may also be possible to agree to annualised sessions that enable you to deliver fewer sessions during school holidays.

In the absence of demand for your sessions by practices, it will be important to clarify what your deployment options are (for example, in UTCs). It would not be acceptable to be forced to take CPD or annual leave if this does not meet your needs as you may need to reserve this for other times.

You should be provided with remote working options (laptops/ VPNS/) in the event that you have to self-isolate, or become clinically vulnerable.