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GP returners: guidance from GPC

December 2006 (updated November 2007)

This guidance is designed to advise GPs who wish to return in the current situation while no new central funding is available for the GP returners’ scheme.

• Advice to GPs who wish to return to general practice
• Assistance to BMA members
• Clinical references
• Funding for a GP returners' scheme
• GP returners and the minimum wage regulations
• GP returners and the 'model' salaried GP contract
• Introduction

Introduction
To work as an NHS GP in the UK a doctor needs to be on the General Medical Council's (GMC’s) new GP register, and be on a primary care organisation's (PCO’s) Performers List in the country where they are working or intend to work. Ideally this should be the area where the doctor intends to do the majority of their work.

Funding for a GP returners' scheme
Central funding was previously available in England for the GP returners’ scheme. This was an excellent mechanism for encouraging qualified GPs (particularly those who had taken a career break for family reasons) back to work. It provided a funded placement for the returning doctor normally for six months on a full-time basis or 12 months part-time in a practice experienced in offering support and training. It also represented good value for money to the NHS. Unfortunately, the English Department of Health withdrew the funding for the GP returners’ scheme in 2006, although some deaneries and/or PCOs have retained local sources of funding for returners’ schemes.

In Wales, the deanery was previously able to fund a GP returners’ scheme through a surplus in its education budget. While this was not available for a couple of years, the Welsh deanery has secured GP returner funding for 2007-08.

No formal funded GP returners’ scheme was available in Scotland or Northern Ireland.

Action taken by the BMA
The BMA has made numerous representations about the withdrawal of the funding to the English Health Department, including a meeting with the then Health Minister, Lord Warner. We have also publicised the advantages of the scheme, and have published a dossier of GPs who have been prevented from returning to practise due to lack of funding.

The latest GPC action has been a joint letter with the Committee on GP Education Directors (COGPED) to all Strategic Health Authorities and PCOs in England on the need to ensure that GPs wishing to return are not hindered unnecessarily from so doing and the need to assess GP returners individually. It also highlights the implications of the national minimum wage legislation. A copy of this letter can be found online - go there now.

Advice to GPs who wish to return to general practice
We are concerned that some PCOs have a blanket policy requiring all GPs who have been out of practise for two or more years to undergo some refresher training and/or work in a supervised environment before they are fully included on the PCO’s Performers List. We appreciate that there is a need to ensure that returning doctors’ skills are up to date. However it is unreasonable to presume that every GP who has been out of NHS practice for a certain amount of time is unable to practise competently.

Given that the level of support available from PCOs and deaneries appears to differ throughout the UK, the following are points to consider pursuing depending upon a GP’s individual circumstances and the level of support available:

1. Advise your PCO that you wish to return to NHS general practice, set out when you last worked and also what you have done to maintain your skills.

2. If a PCO is unwilling to fully include you on its Performers List, ask the PCO to explain the reasons for this. If the PCO has genuine reasons for considering that you require refresher training, the PCO should be able to give you a “conditional inclusion” on its List to allow you to work in a supervised setting. We suggest that you seek a written agreement from the PCO as to when the conditional inclusion will be reviewed, with a view to your name being fully included on the Performers List. For example, a review in 3 months, on the understanding that this could be shorter depending on your hours of work, your previous experience and the length of your career break.

3. If you are conditionally included, find a practice or out-of-hours organisation that is willing to provide you with a supervised setting. You will want to ensure that this is a suitable placement that will meet your needs, and so you may wish to take further advice on this from your deanery, PCO and/or local medical committee (LMC). You should receive a salary during this time.

4. Discuss with your deanery the possibility of any funding and/or training and careers support that they can offer.

5 . Discuss with the PCO the possibility of using the Primary Care Development Scheme or other funding stream to help to fund your refresher training.

6. Seek confirmation from the PCO as to whether they have any essential criteria concerning the evidence they require for your successful full inclusion on their Performers List. You may wish to discuss with your deanery as to how the collection and formulation of this evidence might best be approached.

7. Collect evidence of your work during your refresher time to help to demonstrate your competence to the PCO. This could include the educational events that you have undertaken, patient survey and peer feedback data, audit or referrals, etc.

Clinical references
While a requirement of entry to the Performers List is for doctors to supply the names and addresses of two clinical references relating to two recent posts, where this is not possible a full explanation and the names and addresses of alternative referees should be provided.

GP returners and the Minimum Wage Regulations
The legal advice that we have is that, under the Minimum Wage Regulations, it would be illegal for a practice to take on a GP returner without paying them a salary. This is on the basis that GP returners will be doing some work while they are at the practice, even if they are supervised.

It is also important to note that a GP returner offering to work voluntarily does not necessarily resolve the issue. The voluntary arrangement must be genuine (ie the volunteer and practice must not be under any obligations to each other). The volunteer should be able to attend as and when he/she wants and leave whenever he/she feels like it. This is not quite the situation envisaged by the returner scheme. For the returner to be eligible for full entry to a PCO’s Performers List the PCO often requires a fixed period of training to take place and certain work performed. In this case, a volunteer could have a claim against a practice under the National Minimum Wage Act for unlawful deduction in wages. If the individual did not bring the action, Her Majesty’s Revenue and Customs (HMRC) are still able to enforce a claim in any event so there would be no guarantees for the practice.

Please be aware that the General Practitioner Committee (GPC) considers that the lack of PCO funding of the GP returners’ scheme to be a breach of the Sex Discrimination Act on the basis that the majority of GP returners are predominantly female.

GP returners and the ‘Model’ salaried GP contract
The GPC advises that GP returners be offered a contract which is no less favourable than the ‘model salaried GP contract’. Please note that the model contract must be offered to all GPs employed by a nGMS practice since 1 April 2004 (as this is a condition of a GP provider’s contract with their PCO) and to all GPs employed by a PCO since 1 April 2004. In line with this, GP returners should be paid at least the current minimum salary of £51,332 for full-time salaried GPs (pro rata for those working less than full time).

A copy of the model contract for salaried GPs is available on the BMA website - go there now. Please note that the model contract consists of both the model offer letter and the model terms and conditions. The GPC’s Focus on Salaried GPs guidance note also contains helpful information on salaried GP contractual issues.

Assistance to BMA members
BMA member GPs who are considering returning to work are advised to contact AskBMA (email: askbma@bma.org.uk ; telephone: 0870 6060828) particularly for expert individual contractual advice.