links_with_notes_for_sands_gpsdoc - Hillside House - Dr Michael by Levone


									Links with Notes for Sessional and Salaried GPs

Dr Michael Loudon: (updated) September 2009

This document contains advice, some of which will suit you. The rest is just my view.

Getting work:

Email Practices (see lists below)

     Digging up email addresses is tedious, and it takes time to build an address book,
     but it is worth the effort. One of the best methods is to phone a Practice, asks to
     speak to the PM, and ask for her/his email address. (You can delegate this task).
     Add it to your address book, then email the Practice your CV and availability.

Fax if you prefer, but bear in mind that the Fax is yesterday‟s technology.

Send a one page CV (nobody wants to know what A levels you took, they really don‟t)

     Use a sans serif font; your CV will be an e-document read on a screen. This font is
     Verdana pitch 11. Arial 12 will do – but as you can see it is not well spaced for screen
     reading. Tahoma 12 is a good alternative, better still is Lucida Grande 12
     or Lucida Grande 11. Do not use Times New Roman (12 or 14); it’s horrible on
Phone Practice Managers (not on a Monday, or on a Friday p.m.) but remember, if you
phone them, they may phone you back, and offer verbal contracts. As above, I
recommend establishing email as your method of communication. PMs use email.

List of GP surgeries in NHS Nottinghamshire County:

List of GP surgeries in Nottingham City PCT:

Ask local GP friends, who are „in the know‟, which Practices to avoid, if any. As a
Locum your professional safety is crucially dependent on the goodwill, cohesion and
professionalism of the contracting Practice.

Agree   dates
Agree   sessions
Agree   consultation schedule (work slow at first)
Agree   visits
Agree   induction if needed, on computer and Practice set up

Locum induction:

Agree fees

Guidance for negotiating fees for locum services in general practice (from the BMA, the
GPC and the NASGP):

Use Terms and Conditions:

Model Terms and Conditions. You can use these or link to them. If you work without
securing Ts and Cs then sooner or later you will run into difficulty. It‟s when not if.

Referees: It is a good idea to organize references from Referees of good standing. I
would also suggest that you ask the PM of a Practice, at which you have recently
worked, to provide you with a Testimonial.

One view that I have heard from PCT Governance sources is that your most recent
Practice worked in should be your default referee. Sometimes this will be a bad idea.

Be prepared to share your colleague and patient feedback from your Appraisal folder.

SECURE the contract by exchange of emails, or fax or letters. I am confident that an
exchange of emails will suffice.

Confirm the dates and the deal.
If booked far ahead, email near the time to confirm the booking.
Do not cancel.

Other people’s views and advice:

Starting out as a GP Locum:

Life as a GP Locum

Becoming a freelance GP:

On being a portfolio GP:


Robbie Coull's superb Locum Survival Guide, alas no longer available free online, but
maybe worth buying if you plan to work as a Locum widely and for a while.


There is lots of „live‟ discussion about Locum and Salaried GP issues on And
you can start a „thread‟ and ask a question, if you need to. You just need your GMC
number to register. See the 'GP Locums/non-Principals' Forum…

And last but not least:

The National Association of Sessional GPs. Membership is a tax allowable expense.

Getting Paid:

Submit an Invoice promptly at the end of your contracted time at a Practice or at the
end of each calendar month if contracted past the end of a calendar month or for more
than a month.
Get an Invoice signed by the PM.
Get Locum Form A signed by the PM.

See the last 3 pages of this document for Word versions of an Invoice, and Locum
Forms A and B.

The law and process for dealing with late payments. You just might need this.

Jury service information. Yes, you can be called up even if you are a Dr and a wonderful
human being. No, the expenses you‟ll claim will not cover your loss of earnings.

Yes, you need an Accountant, unless you are red hot at handling your own finances.

You‟ll need to sort out payment of National Insurance, ask your Accountant.

The Inland Revenue page about self-employed status. Not entirely reassuring.

Rates of Pay: No, I can‟t suggest rates to you. Locums can meet and discuss Rates,
but must not agree to “fix” rates between them. The problem with discussing Rates is
that such discussion looks like a process likely to lead to an informal agreement to fix
said Rates.

The Office of Fair Trading. You will need to take great care not to co-operate with
colleagues in a fashion that is unlawful. This means you can‟t „fix‟ Rates in discussion
with Locum colleagues. (PCTs are allowed to set rates for Locums employed by them.)

See in particular:

But you might want to look at how other Locums sell themselves online, and a few of
these quote personal rates.

Click on the section “Locum GPs and Related Websites” on:

Getting Pensioned:

The NHS Pensions Authority

It has a section for Locums. See:

If you belong to the NHS Superannuation Scheme then you are obliged to pension all
eligible NHS income. Promptly. Essential surfing.

I have included „word‟ versions of Locum Superannuation Forms A and B as appendices
to this document (the last two pages). For PDF versions:

Local Superannuation business is dealt with by:

Pat Holborow, Supervisor for Primary Care Payments
NHS Nottinghamshire County Primary Care/Superannuation Department
Byron Court
Brookfield Gardens

0115 883 1768    ext: 31768

Pat is who you send your Forms A and B to, and any GP Solo Forms.

Working out of hours: I don‟t know anything about this, but it is pensionable (GP
Solo). Ask a colleague friend for advice.

Superannuation if you work as an Appraiser or in PCT management. Not possible if
you only work as a Locum, but OK if you also have a Salaried or Principal post. Done on
a GP Solo Form.

Getting to Perform:

You need to be on a PCT Performers’ List.
Contact your host PCT. You will need to work some of each year in the PCT area. If you
don‟t, the PCT will be obliged to remove you from the Performers‟ List.

If you plan to work as a Cruise Ship GP, or to work abroad for more than a year, tell the
PCT, and you‟ll need to negotiate with the Medical Director.

Rules for those on a Performers‟ List. Statutory Instrument 2004 No. 585: The National
Health Service (Performers Lists) Regulations 2004. Worth a look so that you fully
understand your contractual relationship with a PCT.

And to get on a Performers‟ List you‟ll need an enhanced CRB check, among other
things. Can be a slow process:

And of course you have to be Registered and Licensed. The GMC.

Getting Protected:

You must join a Defence Society (you know that):

The Medical Defence Union:

The Medical Protection Society:

The Medical and Dental Defence Union of Scotland

You should consider joining the BMA, or MPU (I belong to the NASGP instead):

The BMA.

The MPU (part of “Unite”)

Your most important protection is to develop good professional relationships with
colleagues, especially senior colleagues. Take this process seriously.

The LMC: I would strongly advise joining the LMC; if you work solely as a Locum you‟ll
need to pay a small Fee. The Notts LMC takes its responsibilities for Sessional GPs
seriously. They will support you if you are in difficulty:

The website of Notts LMC. Click on the sub-section 'Salaried and Sessional GPs' (lots of
helpful information): or:

There are real people at the LMC, and they are helpful. They are not expensive.

It‟s a smart move to attend LMC Open Meetings, for lots of obvious reasons. Meet,
greet, listen and speak.

Getting together:

Local Groups:

The Nottinghamshire nGP group. Supported by the Vale of Trent Faculty of the RCGP.

There is also a “new GP” group in Derby, also supported by the local RCGP. Contact:
Tel: 01332 254 755

Lincoln Sessional GP Group, RCGP supported. Contact:

The Post-Graduate Centre at the City Hospital has lots on offer:

It is also a good idea to get on their local CME mailing list. Contact the Staff: (Faculty Admin) or see:

And there‟s the Vale of Trent Faculty of the RCGP itself:

There are Sessional and Salaried GP groups around the country, and some are affiliated
to the National Association of Sessional GPs, the NASGP:

The NASGP, you need to pay to join (tax allowable).

Richard Fieldhouse, who set up the NASGP, also set up a Locum “Chambers”:

And here discusses “Setting up a Locum Chambers”:

And if you want, set up your own group:

How to set up and run a group for Sessional GPs:

Getting educated:

People vary, and some doctors, even young ones, don‟t like computers. That‟s bad luck,
because in future, it‟s all going to be on the interweb thingy. Everything. Your personal
preference is of no consequence.

The links section of my personal website. This includes a section called “E learning”,
with several links. Medscape (US) is good for eCME, and you get a Certificate.

BMJ Learning: Costs a few quid. Very good, as you probably already know. Excellent set of eCME modules:

You just need your GMC number to register.

I recommend, if you have not done so already, that you complete the eCME modules on
SEAs and on „complaints‟. You need to fluent in these two processes. I have attached
as Appendices the RCGP‟s Structured Reflective Templates for Complaints and for SEAs.

And not forgetting the Trent Deanery:

And to impress your Appraiser (whilst avoiding paying for Honey and Mumford):

An online learning style questionnaire. Online. Free. Quick. May help you.

Getting smooth in consultation:

You may have a fantastic memory, error free. The rest of us look things up, often.
Wherever you work you can open up my website links directory, and surf at speed, even
during consultations.

My personal website, which includes a Links Directory, and other stuff. I don‟t make any
money out of this.

Getting through complaints:

It‟s not if, it‟s when. Make sure you have personal support if you are subject to
complaint, because you will be distressed.

Contact your Defence Society immediately, and the LMC.

If the PCT are involved, stay in touch with one of the PCT’s Complaints Officers. And
if you need help and support the PCT will have a designated GP attached to the
Complaints Department (in Notts County that‟s currently Dr Arthur Lacey).

The NASGP guidance documents about complaints are specifically for Sessional GPs: …and search “complaints”.

Here below are some other links that repay attention:

New NHS complaints procedures were introduced April 1st 2009. The MPS offer:

NHS Choices advises patients as follows:

And you‟ll need to know about the role of the PHSO:

The following articles are good:

At your next Appraisal you could put this topic into your PDP. Then work through these
links, log your reading, write brief notes, and put it in your Appraisal folder. It will be
time well spent.

Both Sessional and Salaried GPs are vulnerable to a Practice handling a complaint in a
manner that is unfair (unintentionally or otherwise) to the GP concerned. This is
probably best addressed by a contractual agreement with the Practice as to how you will
be involved in the handling of a complaint against you.

Please see the section “complaints” in my Terms of Business (bottom of the page):

It might be tempting to hide from a complaint by allowing others to deal with it for you.
I advise you not to do this; you cannot turn the clock back on the process.

Getting Appraised:

Your PCT organise this. Both the County and the City pay Locums a fee for being
appraised (as indeed they should). Some PCTs elsewhere don‟t pay unless pressurised.

Make sure you know who the relevant PCT Officers are, stay in touch, give them an
email address, correspond, reply when you need to.

For the County, try:

For the City, try:

Suggestion. Enjoy the process, make it work for you. And don‟t hide; that just isn‟t an
option now.

Notts County PCT reported in 2009 that:

“15 GPs [failed] to engage [with Appraisal] for more than 12 months, all of whom are
locums. The names of these Doctors have been passed to the Primary Care Contracting
and Quality and Governance Directorates so that appropriate action can be taken in line
with National Regulations.”

Very unwise conduct by the Locums concerned, and it gives the rest of us a bad name.
In addition there were „overdue appraisals‟, with “8 difficult to engage”.

It is extremely unwise to hide, because if you run into difficulty with the PCT you should
bear in mind you have already damaged their confidence in you.

You will now have to use the NHS Toolkit. This is due a complete update and rebuild,
but there‟s no money for that until the whole business of Revalidation and Recertification
is sorted out:

The NHS Toolkit:

This works with IE6 from your surgery desktop, and with Firefox from home. Lots of
bugs, especially if you use Safari on a Mac.

The DH‟s page on appraisal and revalidation.

The BMA on Appraisal Funding.

The North-East Employed and Locum GPs group.
NELG site on appraisal, written by Paula Wright. Good stuff.

The RCGP on Revalidation.

Appendices below:->
Significant event audit (SEA) structured reflective template
Requirement: one annually

Name of doctor:                                       GMC No:
SEA Title:

Date of incident:

Description of events:

What went well?

What could have been done better?

What changes have been agreed?

For the team:

Final outcome after discussion at appraisal:
(Complete at appraisal considering how your outcome will improve patient care)
Complaint report structured reflective template
Requirement: one for each complaint you have received.

Name of doctor:                                GMC No:
Date of complaint:

Nature of complaint:

Status of complaint: On-going / resolved

Involvement of other bodies: Responsible organisation / SHA / NCAA / GMC / Other

If resolved, what were the findings?

How will my practice change?

Final outcome after discussion at appraisal:
(Complete at appraisal considering how your outcome will improve patient care)
Dr Young Bright                                                                    INVOICE


Invoice date:     e.g. May 30th [May 2009]

Invoice to:       Dr xxxx
                  The Surgery…

For Locum services provided (as per contract) as detailed below:

  Date            Sessions    Extras         Visits         Mileage         Total £s
7                 2 (1 day)                  1                              £xxx
26                2 (1 day)                  1                              £xxx
28                2 (1 day)                  1                              £xxx

                                   Total Amount Due £s (NHS services):      £ xxxx

Paid by: _______________________________               Date: ____________

Received: ______________________________               Date: ____________

Copy Number ______ of 3
GP LOCUM A                                                                                        GP Locum use only
NHS Pension Scheme - GP Locum's monthly certificate of
                          NHS work and pay for one GP Practice

To claim NHS Scheme membership for GP Locum work, you must complete PART 1 of this form and send it with your monthly invoice to
the appropriate GP Practice. You will need a separate form for any additional GP Practices. Only NHS GP Locum services contracted
directly between a GP Locum and a NHS GP Practice for an absent GP(s) may be entered on this form. GP Locum work contracted with
organisations outside the NHS, e.g. Cooperatives, multifunds, etc., cannot be pensionable in the NHS Scheme.

Part 1. To be completed by the GP Locum

Your name                                      Dr Youngbright ..
National Insurance Number                      XX | 12 | 34 | 56 | X .

Host HA / PCT                                  Anyplace PCT .

Host HA / PCT Registration No.                 AB 1234                                     .

Please enter below the dates you worked for the GP Practice.

From 01 / 01 / 2001           to      30 / 01 / 2001          From                 to
From                          to                              From                 to
From                          to                              From                 to

Signature                                       Dr Youngbright

Date                                               1st / February / 2001

Part 2 To be completed by the GP Practice Authorised Signatory (e.g. practice manager, partner)

GP Locum's gross pay for the NHS work shown in Part 1 above.                    £ 2,000

Which absent GP(s) was this work done for, or which GP(s) have you provided cover for?

Name                               Dr Experienced

GP Practice Code                   c 12345
GP Practice Stamp
                                   Drs Experienced and Mates
                                   The Surgery…

Declaration: I certify that this Practice has paid the GP Locum the gross amount shown above for the NHS
work declared in Part 1.


Date of payment

                                           /              /
GP LOCUM B                                                                          GP Locum use only
NHS Pension Scheme - GP Locum's monthly record
                     Of all NHS locum pay and
                     Related pension contributions
         Surname                       Other names                           Sex (M/F)     Date of birth
         Youngbright                   Frankie                               M/F           01-04-1900
         NI number              NHSPS ref number        Host HA / PCT        Host HA / PCT reference no.
         AB 12 34 56 C          12 / 34 56 78           Anyplace PCT         AB 1234
                                                                             GMC No: 1234567

         Address                                                                    Calendar Month
         Your Business Address                                                      month
                                             Postcode     AB12 3CD                  Year 2009


GP            Name of GP Practice      First day          Last day           Date                Gross Pay
Practice                               worked for         worked for         gross pay           £      p
Code                                   this payment       this payment       received
              Anyplace PCT                                                   superann =          117.00
C12345        Nice Surgery             01-04-2009         30-04-2009         01.05.2009          2,000
              Anyplace PCT                                                   superann =          117.00
C67891        Lovely Surgery           02-04-2009         29-04-2009         02.05.2009          2,000

                       PART 2          Total of gross NHS locum pay                              4,000           a

                                       Professional expenses deduction (a x 10%)                 400             b

  For HA / PCT use only                Net NHS pensionable pay (a - b)                           3,600
                                       NHS scheme gross employee
  Total Contributions                  Contributions (c x 5%, 6.5%, 7.5%, 8.5 %)                 234       00    d
                                       Total of any NHS extra % added years                                      e
  Employee         £
                                       Contributions (c x %)
                                       Total of any NHS extra % AVCs
                                       (c x % or agreed sum)                                                     f
  Employer         £
                                       Grand total of NHS Pension Scheme                                         g
                                       gross employee contributions (d or d + e/f)               234       00

IMPORTANT Now attach a cheque to this form, payable to your Host HA / PCT, for the total amount at (g) above
and send it to arrive no later than the 7 day of the month, following the month this form relates to. You must
attach a properly completed GP Locum A for every payment declared on this form.


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