Contracts

As a doctor working remotely, you may be self-employed, on a zero hours contract, or working as an employed doctor. In all cases, BMA members can seek advice through our contract checking service.

Employed contract

The BMA recommends all employed GPs to be on terms no less favourable that our salaried GP model contract. This applies equally to doctors working remotely or in practice. If you are offered a contract of employment, take time to consider how it compares with the model contract. If you are unsure, we offer guidance on your contract of employment.

Remote working for a private provider

If you are working remotely for a private provider:

• your employment may not be pensionable under the NHS pension scheme
• you may be seeing patients from across the UK who are either paying directly for their consultation or via a work-based insurer. This may impact on the range of services you can provide, what you can prescribe and where you can refer to- this signposting information should be made available by your employer.
• the expectations of the patients may not align with the services you are able to provide. Managing these expectations may become an unforeseen part of your role, as they may be very different to those of patients in a standard NHS practice (for example immediate access to referral, expectation of tests being organised, convenience of prescription without a face-to-face examination).

Equipment

As an employee, you will need to find out what equipment is provided as a part of the role: for example a laptop, second screen, headphones, and consumables like cartridges, paper, and smart card readers. You may be expected to use and maintain your own equipment, in which case you should enquire into maintenance expenses.

IT support can be important when things go wrong. It is useful to know if IT support is available on every shift and if time lost due to unresolvable IT issues may be deducted from your pay. You will also need to ensure you are provided with all the necessary rights and permissions to access and provide information remotely.

Some digital providers have restrictive clauses preventing you from working for competitors during your employment and for a period after leaving. If your contract has a clause of this kind, BMA members can seek advice by contacting us.

The role

Scope of clinical role and job satisfaction

You may need to refer a patient for a face-to-face assessment. This may occur within the same organisation, with their registered GP, UTCs, 111 or Accident and Emergency.

CQC requires that an organisation makes any triaging or referrals processes clear to patients. As an employee you should be aware of this process and be able to follow it. It may be worth reviewing the last CQC inspection of the organisation you are looking to work for to see what issues were highlighted.

When seeing private patients, you may be expected to discuss costs of treatment directly with them, or this may be carried out with their insurers. There may be a list of exclusions for what you are expected to offer for private patients by the provider. For example, this might exclude antenatal care, chronic disease management, and prescribing of controlled drugs.

You may require additional time for consultations with patients who do not speak English. Ask if there are mechanisms in place to flag the need for an interpreting service on records, and to book longer appointments by default for these patients.

The organisation may allow for the patient or the clinician to book longer appointments when it is likely there will be a multi-item patient agenda.

In some digital roles, you cannot request tests or make referrals. This can make the encounter feel frustrating as you will have to ask the patient to rebook with their usual GP in their traditional practice. This can lead to dissatisfying encounters for both parties.

If there are some actions you cannot follow through with for the patient, the main value you are offering is providing advice, navigation and safety-netting, so it is important that you are well prepared to focus on these skills.

You should also ensure the patient knows the limits of what you can provide, to manage their expectations and mitigate against potential complaints.

Caseload

When working from home, there is a risk that your availability will be assumed beyond the end of a timed shift. For example, you may find yourself doing unforeseen follow up admin for more complex cases, managing a handover to a duty doctor, or responding to calls or messages beyond the end of your shift. It is important that you clarify handover arrangements to help mitigate the risk of these unplanned extensions, especially if you are going on to work for a different employer immediately after your shift.

Many digital providers are accessed through a mobile phone app and provide immediately accessible patient-facing notes. This means you will need to learn to write consultation records in a patient-friendly way, which can take extra time. Find out if the organisation provides any efficiency or productivity guidance to support this, such as the use of text expanders or pre-written text for specific situations.

If working to timed appointments, find out:

• if the rate per hour is realistic for the type of caseload, if you are self-employed
• if you able to rebook later appointments to accommodate complex cases (such as mental health, safeguarding) or if there is a mechanism for claiming overtime due to having to extend the planned session
• how much of the follow-on administration will fall to you and how much can be delegated to support staff: for example, obtaining missing clinic letters, completing complex referral forms, adding test requests to systems, or completing forms requested by patient (such as insurance forms and TWIMC letters)
• whether additional paid admin time will be allowed to respond to complaints, to log SEAs or to attend SEA meetings. If working without a pre-defined clinic allocated to you, the employer should inform you of the rough expectation of consults per hour, and what mechanisms are available to offer continuity to the patients you see who require a follow-up appointment
• whether you will be remunerated if you have to discuss a case with the Coroner’s Officer or complete a medical certificate of cause of death at a later date.

Continuity

Many remote working roles are for large organisations where continuity of care is less common than in the average GP practice. Your patient may already have explained their problem to several clinicians and the problem may be partly under investigation. You may need to piece together what has happened already by looking through existing documents and results.

If appointment slots are only opened at very short notice, it may be difficult to arrange patient follow-ups with you, which can make the role less fulfilling or more frustrating for you both.

You may find that large remote services affect the experience of prescribing at the limits of the GP scope of work. Clinicians may vary as to whether they are comfortable prescribing unlicensed or more specialised medications. In a traditional practice, usually a consensus is reached for consistency as to whether such prescriptions will be provided or whether they will be declined (to be provided by the specialist service). In a much larger remote service, there can be difficulty establishing consensus for specific cases, and a lack of consistency between consultations and clinicians can lead to 'doctor shopping' by the patient, more patient complaints against doctors, and frustration for the doctors.

Risks of intimate digital encounters

Patients can readily share intimate images of children via their consulting app, or try to embark on intimate video examinations without appreciating the legal consequences of this for both them and you. The organisation should protect you from these risks by warning patients not to do this without prior discussion with a clinician, and have a robust system for handling unsolicited intimate images uploaded to the app. There should be strong information governance arrangements in place for all information sharing, and this should include clear processes for storing images.

The BMA has guidance for GPs on GDPR, to improve understanding of personal responsibility under the 2018 UK Data Protection Act.

Training

Digital providers regularly update their processes and systems in keeping with the fast pace of change in the digital industry. This means clinicians need to be promptly alerted to changes in processes and sometimes need to undergo appropriate additional training. You should expect any additional training required specifically for your role in that organisation to occur in paid time.

If you are based in England and the requirements generically apply across several clinical and non-clinical roles, then a digital employer may allow you to carry out training through an external platform, such as e-learning for health.