As a salaried GP your experience at work is, to a large degree, dependent on the environment your employer creates.

This guide reflects current best practice in the relationship between employed GPs and employers.

It is for GPs to recognise their situation, and for employers to recognise where they can improve.

What good looks like

These good practice standards should be considered as the benchmark across general practice. If your experience of employment falls below them, the next section suggests approaches you can take to seek improvements.

Your voice and status in the workplace

• Your viewpoint is valued and considered equal to that of other doctors and employees.
• Your presence at meetings is valued and facilitated in paid time.
• You are consulted on proposed changes within the practice and you receive responses to your input.
• Suggestions and feedback are frequently invited, with the option to input anonymously for more sensitive issues.
• You are supported to meet in paid time and are encouraged to foster meaningful relationships with colleagues to strengthen your collective voice.
• Your perspective and opinions are invited and respected when managing complaints and analysing significant events. Learning from these takes into account the impact of organisational, environmental and workload on clinical outcomes and clinician performance.
• Your experience is in line with ACAS guidance on involvement in workplace matters.

Workload

• Your expected workload is deliverable within the contracted job plan.
• Contracted hours and job plans reflect your work pattern meaningfully and consistently.
• Changes in systems are monitored for their impact on working hours and the intensity of work. Where additional services are taken on by the practice, adjustments are made to workload and pay to address these changes.
• Unforeseen circumstances, such as additional worked hours or sickness cover, are acknowledged, appreciated and paid or compensated with time off in lieu.
• If workload creeps up, systems are rapidly reviewed to improve delegation and efficiency rather than relying on unpaid goodwill.

Work/life balance

• You are not subject to unforeseen demands which impact on your personal or domestic responsibilities.
• The system for agreeing annual leave is transparent, efficient and fair, with decisions on requests made promptly.
• There is a clear, collective process for managing leave demand for popular periods, including 9-12 months’ advance planning to help with childcare and coordination with your family.
• Your team works together to try to make sure everyone has the leave they want (eg swapping usual working days, if possible) and the practice accommodates these solutions.
• Leave is well coordinated, and locums are booked to ensure the practice does not lack cover.
• You are able to take leave during school holidays, or have annualised hours.
• There is fair access to CPD, public holidays and NHS holidays (or time off in lieu is provided where worked days do not fall on bank holidays).
• You can adjust your start and finish times to accommodate childcare or carer needs.
• Your job plan considers the need to attend team meetings within normal working days rather than being expected to come in for a meeting on a day off.
• Your experience is in line with ACAS guidance on flexible working and work-life balance.

Career and personal development

• You are supported to develop areas of interest which align with organisational goals, and have the same opportunities as GP partners, including protected time for training.
• You are offered leadership opportunities within paid time, and increases in responsibility are met with increases in pay.
• Your role as a salaried GP is respected and supported by your employer, regardless of whether you wish to pursue management or leadership responsibilities.
• If you get an additional role outside the practice, your career development is valued and any necessary scheduling change accommodated, where enough notice is given.
• Your contractual CPD entitlement is provided for by the employer, with your personal development goals prioritised and supported.
• CPD time is kept separate from other administrative work, non-educational meetings and of any further mandatory training requirements.

Support

• Informal time and interaction between team members is encouraged, for example with communal coffee or hotdesking areas, and by prioritising meeting times.
• You work in a non-hierarchical culture.
• You have a mentor or regular contact with a line manager with whom you can develop a relationship of trust.
• Clinical advice from peers is readily available, and case discussions are often and encouraged.
• After a stressful encounter, it is easy to talk to a colleague for a debrief or support.

If your experience falls short of the good practice benchmarks

If you are a BMA member and have concerns about your experience in the workplace, contact a BMA adviser who can give advice tailored to your individual circumstances.

The following approaches may also be helpful.

1. Discuss your concerns with your employer

Reference this guidance and ACAS guidance. This could be through your mentor, nominated line manager or the practice manager.

2. Discuss your concerns with your salaried peers

Seek a collective approach to raising them with your employer. You may wish to agree a set of priorities, concerns and discussion points to take to your employer.

3. Fill out a work diary

Capture areas where you think your experience is falling short, for example:

• extra contractual worked time
• activity which could otherwise be done by non-clinical staff
• activity which could otherwise be done by non-medical clinicians
• volume of tasks, appointments, results and letters.

This could form the basis for a discussion and for objective monitoring of the impact of any changes your employer implements.

4. Get negotiating skills training

These issues can be explored in your NHS appraisal.

5. See an occupational health doctor

Where your health is affected, you are entitled to access an occupational health doctor. This may be through a department within your organisation, or your practice may need to make separate private provision for you.

An occupational health doctor can advise your employer on changes needed for your wellbeing. BMA counselling and peer support services and the practitioner health programme can also help.

6. Discuss with an external peer group

This could be a sessional GP group, peer group, practitioner group or co-mentoring group. These could be in person, on social media or online forums.

Comparing setups with peers can help you to bring positive suggestions and solutions to the table. 

7. Contact your LMC (local medical committee)

It represents the interests of all GPs at a local level, and may have a sessional GP subcommittee which can support you and understand your unique perspective. The LMC can also mediate in discussions with employers.

8. Access BMA resources

Get more advice from the BMA’s handbooks, webinars and guidance:

• salaried GP handbook
• locum GP handbook
• career planning webinar
• GP retention scheme.