Salaried GPs in PMS

The Sixth in a series of LMC Guidance notes on PMS

This guidance replaces and updates the fourth and fifth in the series.

The PMS website address is http:/www.doh.gov.uk/pmsdevelopment

Many PMS applications include a bid for a salaried GP. These are dependent on the granting of central growth funding

Growth funding comes from the GP pay pool and so is governed by strict criteria. It can be used:-

The new GMS contract documentation includes a national model contract of employment for salaried GPs. This is both for GPs salaried to a GMS practice, and for GPs salaried to a PCT’s own GMS practice. However, it is expected that the same contract will also apply to GPs salaried to a PMS practice or to a PCT-led PMS practice. The Review Body has also set the range of salary to be expected by salaried GPs for 2003-4 as £46,455 to £70,710.

Salaried GPs in PMS are supported by central growth money, they do not bring with them a basic practice allowance, Out-of-Hours Development Fund or other Red Book allowances based on GMS. The practice will find the salary for its new GP from the growth money which it achieves. This is paid once there is a salaried GP in post.

Pilot practices will be responsible for the employer’s National Insurance and superannuation contributions. At pre-April 2002 budget levels for National Insurance contributions therefore:-

£50,000                 £58,125

55,000                     64,070

60,000                     70,015

Most pilot practices will also pay their employed GP’s medical defence organisation subscriptions.

Practices will be liable as employers for ensuring that employed doctors receive normal maternity and sickness benefits.

GPs who work under PMS are entitled to access family friendly policies which have been introduced recently (November 2001) into GMS and PMS, irrespective of their employment status within the pilot. To make this happen, PMS pilots and their PCTs are able to access money through allocation from the centre – via an exercise called ‘actual costs’. This is designed to meet one off actual costs eg of employment of locums to cover absences due to maternity leave, mirroring the arrangements for GMS GPs. eg:

Periods of sickness which incur locum costs will also be reimbursed as per the conditions set out in paragraph 49.32 of the Statement of Fees & Allowances.

Salaried GPs and Patient Lists

Whilst the PMS implementation directions make it acceptable for salaried PMS GPs to have a patient list, the GPC believes that this is undesirable as it destabilises arrangements between the partners/principals and the position would be difficult to unravel if a salaried GP left the practice. Lists for salaried GPs are not obligatory, PMS legislation neither requires nor precludes a salaried GP from holding a list.

Golden Hellos/Incentive Payments to GPs

If you are employing a salaried GP, eg a retainer taking up a first post after leaving the retainer scheme, they may be eligible for a ‘golden hello’. You will need an application form for payment under the scheme. The payment comes to the pilot and must be paid to the eligible doctor within one month subject to deduction of income tax, National Insurance and superannuation contributions.

The payment of £5000 is adjusted to time commitment. There are additional payments if doctors are working in a deprived area which unfortunately does not include Bedfordshire Heartlands PCT or any Hertfordshire PCT.

The arrangements for eligibility are complex and you are advised to check with the PMS directions. If a salaried doctor leaves the pilot and does not move on to similar NHS employment then they may need to pay some of the sum back.

Retention of Older Doctors: Golden Goodbye Scheme

This has now been scrapped!

Practices moving to PMS should include the cost of employing and educating retainee doctors when negotiating their PMS budgets. Retainees should obviously be employed on terms which are no less advantageous than their previous terms under GMS. The pilot is responsible for maternity and sickness pay and recent amendments to the scheme provides for the retainer fee to the practice to continue during sickness and maternity leave.

Money can also be made available for retainer applications during the year by a transfer of central (not PCT) funding.

The PMS directions operating from April 2002 state that PMS agreements must include the obligation on both GP providers and employed doctors who are required to be named in a PMS agreement and hold a list of patients, to participate in appraisal provided by a PCT.

Keeping your Salaried GPs in Touch

Eventually, there will be a local list of all PMS GPs, both providers (signatories to the PMS contract) and performers (salaried GPs). This will make it easier to ensure that your salaried GP receives LMC newsletters and communications and other essential information about working locally.

Meanwhile please advise your PCT and LMC of the names and details of any salaried GPs who join your pilot, or any change to the doctors working in your pilot, such as retirements and replacements.