Salaried GPs are on a time-based contract and must be remunerated for every hour they are expected to work. This includes direct clinical care, indirect clinical care (referrals, prescriptions, messaged tasks) and other activities like meetings. All time at work counts as work and all work must be paid for (including work done opportunistically). This is in keeping with the SiMAP and Jaeger rulings under the EWTD (European working time directive).

Indirect clinical care does not include necessary time spent in team meetings. 

Salaried GPs are currently working on average 25% additional hours on top of contracted hours (according to the University of Manchester National GP Work life Survey). Urgent steps must be taken to identify these hours, which can then be paid promptly or where mutually acceptable should be recognised with time off in lieu (TOIL). The use of a diary or the BMA’s Dr Diary application may help in identifying these additional hours.

Where demand for additional work arises unexpectedly (for example to cover sickness absence) the salaried doctor should be offered remuneration or TOIL for this time. This hourly rate for this work may be higher than the standard salaried hourly rate reflecting its unscheduled nature and lack of accrued benefits for this time (annual leave, CPD, sick leave).

For ongoing predictable demand which exceeds contractual hours, in addition to payment, there needs to be urgent discussion to reach agreement on one of 2 possible solutions: 

• 1. Prioritisation: identify which areas of work can be dropped from the salaried doctors workload to enable them to continue to work within their contract 
• 2. Develop a revised job plan, hours and pay: agree a mutually agreeable change to the working hours and the payment rates for those hours. The job plan should reflect a realistic case load for the contracted hours ideally based on 15-minute average appointments with 3:1 ratio for indirect clinical care, having deducted time required for team meetings. 

Increased demands on general practice must not cause salaried GPs to work beyond their contracted hours or terms of employment, and effective planning and discussion must take place at the earliest opportunity.