SYGN evening – 16/10/12 “How to survive general practice” Use our GP website for: Referral forms Online referrals Consultant directory Education meetings Consultant presentations

Becoming a GP how to survive post VTS Robin Partridge Gupta

Bit about me Qualified from St Georges 2002 PRHO, 3yrs medical SHO, 1yr AE Registrar East Surrey VTS shortened scheme Aug to 2011 ad hoc locum and salaried locum Offered Partnership August 2010 Started full time Partnership September 2011

E-portfolio: It never ends! PCT decide which one you have to use Surrey uses RCGP: currently free. They will allocate your appraiser if don’t hassle them +++. Abigail Holm for Surrey CPD points, Courses, audits, significant events, PSQ, MSF, PUNS and DENS. REVALIDATION STARTS NOW

Things you should already have GMC: GP register, Local PCT: Performers list HMRC registered as self employed + class 2 NI Defence Union letter, CV, Letter about yourself A5 picture card for patients? Calendar, Invoice program, Sat-nav Doctor’s Bag

Job options Locum Choose what work Choose pay Holiday when want Money better Find long term job in good place / trial Salaried Regular income Sick, study, maternity and holiday pay Member of a team Tax and pension deducted before paid May be tied to place for length of contract

Locuming: The annoying things Still have revalidation No sick leave or study leave and no pay if don’t work Have to look for work Negotiating rates and work Easy to work too much Save for tax man AGHHHH

Getting Jobs Ask your practice manager to spread word Canvas local/wanted surgeries with CV + letter to manager Network with VTS to if people needed. Word of mouth is huge Locum agencies PCT locums Out of hours

Future Job Options Long term locum Sessional locum: Work regular session like salaried but as locum Chamber locum: Group of locums who sell services Salaried Partner Media doctor Cruise Ship Doctor: Good pay, see the world Private Doctor: In surgery or for companies Pharmaceutical Industry Go back to hospital Rio 2016?

How to get ahead When work make time to chat and get along with the manager, reception and any non doctor staff. Manager will get your name out locally and if any jobs coming up in surgery you will get opportunity. If work regular get involved - go to meetings, education events, nights out. Take out extra duties - audit, practice meeting agendas - review of drugs/notes (these should be quick and not take up ages of “unpaid time”). Be willing and open to areas of need at the surgery - nursing homes, contraception, partners retiring in next few years, salaried Dr’s leaving / pregnant. By doing above people see you are interested and keen and easy to get on with. Bit extra work now pays later. WARNING: Practices can try to overburden you. Negotiate on rates, work and load.

Rates Weekly rateDay rate Half day inc visits Two-hour surgery In hours per hour London £1,000- £2,500 £300-£700 £180- £ £140-£230£40-£100 £2,473- £2,500 £450-£500£200-£250£130-£150£60-£90 South East Coast £300-£520£170-£350£130-£200£60-£90 £450£200-£250£70 Mine£ £250£ * My rates: I charge ½ day or full day rates +/- visits. £50 extra for visits or “on-call”. Often when start locum job work is light then gets heavier and take on more duties. At that time may need to re-negotiate.

My jobs 1 st job at local surgery through my practice manager to cover partner annual leave for few weeks. Extra shifts later for sickness and annual leave. 2 nd job at my reg practice 6 month extended to 1 year maternity locum. Then asked to stay on with view to partnership. 3 rd Job word of mouth via practice manager few days a week to permanent work. Heavily involved in partnership and took over EMI nursing home 4 th Job via VTS mass . One day then offered 4 months 1.5 days then more regular days.

Job numberHow Got JobAM ClinicPm ClinicHalf DayFull day 1Prac manager2.5hrs2hrs£205£410 or £450 with visits 2Reg job3hrs2hrs£225£450 with visits 3Prac manager2.5hrs3hrs£200£410 or £450 with visits 4VTS 2.52£225£410 or £450 with visits Overview of jobs 1+4: Low work load, easy job 2: Heavy work but thinking long term job offer. Renegotiated £550 for full day with nursing home cover when days I work reduced 3: Started off easy with large lunch break to go swimming but work increased and paperwork heavy, practice meetings, audits, took over Nursing Home would have been back up partnership practice. Renegotiated £450 a day with £500 if visits or on-call

Negotiating Tips  Decide on your minimum worth  If a job is quiet and easy review situation  If thinking about job there, may take lower pay or do extra for nothing  If work hard, get involved, patients + staff like you (very important and huge importance) you will be able to negotiate easily  If work load changes monitor and then discuss, they may prefer to take work away or pay more.  Write an or letter detailing matter  Do not let it affect your work, it is business

Locuming Calendar, Invoice, Get paid, Pension A+B, if OOH C+D, mileage. Penny Perfect: £29 a year BUY IT -locumorganiser.com £12 a month Pension: Pay to Surrey PCT ND. Amount varies on income, added years ect. You can claim back tax on this with self assessment.

Tax Rebates REBATES: GMC, BMA, MDU/MPS, all subscriptions journals, work items (bag, steth, otoscopes ect). Phone costs Stationary, printer costs If have study used for work can claim % back on heating/mortgage ect I would not. Pension: Private and NHS (if locum)

Motoring expenses: : 45p per mile for 1 st 10,000 then 25p per mile (on your business miles not all). Work out your business to personal miles. Accountant get you to do typical month record. OR can claim all car costs ie servicing, MOT, road tax, RAC/AA, tyres, any service parts, Petrol - need to keep all receipts (VAT receipt on petrol). You then again claim back business %. Can claim depreciation or interest on loan as well depreciation max £3000 a year

In summary GMC, Performers list, Defence union HMRC + self employed + self assessment Best jobs word of mouth Penny Perfect program Get an accountant Spend time with staff and have fun Go to meetings and get involved Have fun and enjoy life