Why the Salaried GP contributes to the GP Recruitment crisis

With 1,000 Salaried GP vacancies currently unfilled in the UK, its no surprise GP recruitment is causing Practice Managers and Partners to panic and accept there is no cost-effective solutions available.

Perception has been the reason for General Practice being late adopters of innovation, however its now accepted that General Practice must embrace innovation and accept change. The long-term future of the independent contractor model will rely on Practices achieving efficiencies across the board.

Whilst there are 1,000 unfilled Salaried GP Vacancies the cost of GP Recruitment will continue to rise. Unfilled Salaried GP vacancies will mean:

  • Salaried GPs salary expectations will increase
  • The cost of advertising on job boards will increase
  • Locum rates will increase
  • Locum Agency fees will increase

What is a Salaried GP?

Firstly, we must understand what a Salaried GP is?

A Salaried GP is simply a GP that provides their services to a Practice in return for payment. The terms of engagement are governed via an employment contract which has no contract end date. The employment contract protects the employment rights of GPs providing services as a “Salaried GP.” The GP is paid for their services via PAYE and taxed at source.

There is a misconception in the market that a “Salaried GP” is a permanent solution simply because the employment contract has no end date. It is common for Practices to refer to salaried staff as “Permanent employees” when in fact none of the contractual terms in an employment contract can force a GP to remain with a Practice permanently.

Whilst Salaried contracts provide do not allow for retention of a GP that wants to leave a Practice, the perception is still that a “Salaried contract” is considered to provide the solution to retain GPs. The fallacy has resulted in Practices putting too much reliance on the contractual model being the key factor that determines GP retention.

The over reliance and focus on the contacting model is clearly demonstrated in the way General Practice advertise their vacancies compared to other sectors. General Practice is the only sector where it has become standard practice to include the contractual model in the job title which is why we see the job title as ‘Salaried GP’  ‘Locum GP’ or ‘GP Partner’ rather than GP.

Although Practices use the job title “Salaried GP” to indicate they require long term commitment with no end date, GPs see the term “Salaried GP” very differently. GPs see it was the lowest paid GP engagement model, with an expectancy of more work and pressure with less flexibility compared to Locum or Partnership contracting models.

What is the solution?

Practices need to understand that the purpose of advertising is to communicate a message to GPs to influence them to apply for an interview. Advertising a GP Vacancy as a “Salaried GP” indicates a lack of flexibility to secure the right candidate.

Practices clearly understand the purpose of advertising as they are willing to advertise a degree of flexibility with sessional rates, day-setup and other aspects of the Vacancy to secure the perfect GP. Practices need to adopt this same flexible approach towards the contracting model as they do with other aspects of the vacancy.

Practices need to change their mindset towards recruitment, and instead of searching for the perfect GP for the job, they need to have the flexibility to create the perfect job for the right GP.

Why Training Practices don’t struggle to recruit

GP Recruitment has not been such a challenge for Training Practices as they are fortunate enough to secure commitment from GPs before they qualify. The GPs decision to commit required the GP to reflect on their experience working at the Practice during training. Accepting employment with a Practice you have worked at and are familiar with is lower risk than accepting employment with a Practice you have only interviewed with.

What about Practices that aren’t Training Practices?

Practices need to offer a solution that allows them to gain commitment from GPs over time in the same way Training Practices do as this will reduce the risk of the GPs decision to join a Practice. If a GP is certain that they want to join a Practice before they commit to a salaried contract, you will find a greater willingness to offer flexibility regarding remuneration.

Non-Training Practices can create this situation by recruiting GPs using the same recruitment methodology used by Investment Banks known as “Temp to Perm.”

Adopting a “temp to perm” methodology allows the GP and the Practice to experience working together for a maximum of 12 month before having to commit to engaging under an employment contract. The GP would engage under a temporary contract for 12 months with the option of being paid under a PAYE, self employed or Limited company structure.

Is a “Temp to Perm” method suitable for every Practice?

The key factor that determines whether a “Temp to Perm” agreement is suitable for a Practice is ensuring that the annual cost of engaging the GP during the temp period is equal to or below the annual cost of engaging them on an employment contract. If the annual cost of engaging the GP during the temp period is higher than the annual cost of employing the GP then a “temp to perm” method will not be suitable.

The reason that the temp cost must be equal or lower is because the Practice has to fully commit for 12 month, so there can’t be any financial motivation for the Practice to replace the GP due to affordability or a more cost-effective option. If the cost does not vary then there is no negative financial impact if the GP does not join or request to extend the temp engagement for a further period before committing.

Are there any risks recruiting a GP using a “Temp to Perm” method?

If a Practice can’t demonstrate to HMRC that the engagement is IR35 Compliant the cost of the GP will double. This is due to recovery by HMRC of the undeclared tax, penalties and interest. IR35 liability remains with the Practice for 4 years after the temp engagement period has completed.

Practices must ensure that they include all costs when calculating the GPs annual cost during the temp engagement. Practices regularly fail to include:

The cost of pension if the GP is part of the NHS Pension

The cost of VAT if the GP invoices via a Limited company and is VAT registered.

CCGs have discretionary powers to reimburse Practice costs if they can demonstrate significant challenges with GP recruitment.

If you require further guidance or support recruiting a Salaried GP via the “Temp to Perm” model, please contact Primary Care Medical Chambers and speak to a Vacancy Manager.

1 thought on “Why the Salaried GP contributes to the GP Recruitment crisis

  1. “…none of the contractual terms in an employment contract can force a GP to remain with a Practice permanently”

    There are no models of employment that will “force” an employee to stay with any employer in a free market liberal democracy. Even GP partners will walk if conditions become unacceptable to them.

    As an industry, no specific employment or recruitment model will make up for supply side constraints in the GP labour markets. There simply aren’t enough GP’s and no method of employment or recruitment can solve this. There are only two viable solutions: 1) Moderation of demand for GP labour force through new models of working that outsource non-core GP tasks to other members of the primary care team. 2) Training more GPs.

    How can individual practices increase their ability to recruit and retain GPs? Well, first they have to recognise that the odds are against them. This might sound trivial but far too many practices simply do not appreciate the implications of this fact that they are competing with others for a scarce commodity. If they did, they would become better attentive supportive employers seeking to develop and build relationships with employees that values and challenges the latter. Doing away with stone-age HR practices would be a good start. I completely agree with you that they would need to find the right job for the candidate and not the other way round.

    Beyond recruitment and employee relations, working conditions and compensation packages need to be addressed. Workload need to be shared in a manner that is not only fair but seen to be so. Day to day operations and workflow need to be optimised eliminating unnecessary paperwork, reworks and duplication. Practices compensation packages need to reflect market conditions. Paying average rates offers average chances of recruitment and retention unless a practice has other unique offerings such being located in a very good school district. A rational practice management will offer a very competitive compensation package balanced against the rather exorbitant options of locums, high staff turnover, costs of rerun of recruitment activities and of course adverse effects on patient experience and outcomes.

    Temp to Perm

    Most salaried GP contracts already reflect a 3 month trial period before longer commitment. Would option of being paid as a LLC make it more attractive? Unlikely, especially if the candidate will not be better off financially as you stipulate.

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