Working as a GP in the private sector

Authors: Kate Adams 

Publication date:  14 May 2008

Like it or not, private sector involvement in primary care is here to stay. The government seems committed to a programme of privatisation and encouragement of a wider range of providers. The private commercial sector is keen to get a foothold in the NHS primary care market. More and more private companies are entering the market, bidding to take over practices and actively recruiting general practitioners.

The job market for newly qualified GPs has changed dramatically in the past two years. There is a lack of partnerships on offer and an increase in the number of salaried GPs. It is estimated that salaried doctors now comprise 15-30% of the GP workforce, and numbers are increasing. Some salaried GPs are dissatisfied with their pay and working conditions.[1] Salaried doctors in general have not benefited from the reported increases in GP pay.

The days of a job for life with the NHS are over, and recently qualified GPs in particular may need to explore options working for the private sector. But first it is important to consider the contractual implications of leaving the NHS.

Contractual issues: salaried model contract

NHS (General Medical Services Contracts) Regulations 2004 state that all doctors employed by a general medical services practice or a primary care organisation from 1 April 2004 must be offered no less favourable terms and conditions than those model terms and conditions of service as set out in the model salaried GP contract.[2]

These minimum terms and conditions do not apply to doctors employed by personal medical services providers or alternative provider medical services, though these employers have the option to follow best practice.

Some salaried GPs may find themselves working in a practice taken over by a private provider. In this case, Transfer of Undertakings (Protection of Employment) Regulations 2006 may apply. Generally speaking, existing employed staff are entitled to remain on existing terms of employment except for pensions.

The BMA says that GPs considering employment by private providers not using the salaried contract should be aware of the following risks[3]:

• A decrease in entitlement of annual leave from six weeks to the statutory minimum of four weeks

• Disputes over pro rata entitlement to bank holidays for part time salaried employees

• Demise of protected time for continuing professional development

• Loss of current terms for maternity leave, and a resulting return to statutory maternity pay or maternity allowance

• Loss of current terms for sick leave, and the resulting return to statutory sick pay

• Increased work hours

• Possible loss of any financial support given for professional fees.

Doctors who leave the NHS to work for a private provider should be aware that they will lose the benefits of the NHS pension scheme.

UnitedHealth UK

Founded  in 2004, UnitedHealth UK is the European subsidiary of the American company UnitedHealth Group, a company which directs its resources into designing products, providing services, and applying technologies that improve access to heath services, simplify the healthcare experience, promote quality, and make health care more affordable.

The company’s UK plans are to use its expertise to manage primary care services in areas of high deprivation, where Pete Smith, its primary care director and also a partner in an NHS PMS (personal medical services) practice in Kingston, believes it can “make a significant difference.” To date the company has taken over two GP practices in Derby and has just been awarded three practices in Camden. Derby City Primary Care Trust board meeting on 4 October 2007 reported that UnitedHealth Europe had made “considerable improvements to patient care, the patient experience and staff morale.”

The company is looking to expand. Dr Smith believes the company offers a range of opportunities for salaried doctors. Opportunities exist for doctors who simply enjoy day to day general practice and for those who would like to develop a specific area of expertise, such as diabetes. There are potential opportunities for GPs who want to be involved in the development of the business and further their careers with the larger UnitedHealth Group.

Dr Smith said that being a good employer is key to attracting, motivating, and keeping staff. He says the company expects to honour the terms and conditions set out in the salaried model contract and has set up its own pension scheme with Prudential, which he believes is “comparable to the NHS scheme.” The company pays on “the upper end of the recommended pay scale” (minimum range for salaried GPs as recommended by the Doctors and Dentists Review Body 2007/8 is £51 087 to £77 462, but note employers have the flexibility to pay more). In addition, UnitedHealth Group offers share options, bonus payments, and childcare vouchers. The company also supports part time flexible working and seeks to accommodate employees’ needs where possible.

A salaried GP’s perspective

Steffen Osbelt joined UnitedHeath Care in September 2007 and is the lead GP in a practice in Derby. He previously worked as a GP partner in the NHS. Dr Osbelt enjoys the responsibility of working like a partner “without the headache of the admin and legal side.” He feels supported by the management team and is aware of a better use of skill mix.

The practice is open 8 am to 8 pm from Monday to Friday. One week he works from 8 am to 4 pm, the next week 12 pm to 8 pm. There are plans to open on Saturday mornings.

Comparing his experience with friends, he believes that he is “working in one of the best salaried jobs you can get” and would certainly “recommend it to others.” He says an advantage of working for a larger company is the opportunity for promotion. He is not at liberty to disclose his salary but is happy with it. There is a bonus scheme which rewards quality and outcomes framework results, among other things. He gets a minimum of two weeks’ protected continuing professional development, five weeks’ annual leave, and his BMA, General Medical Council, and defence fund fees are paid.

Atos Healthcare

Atos Healthcare is a division of Atos UK, a subsidiary of Atos Origin, a French based multinational company specialising in information technology services. The company has a turnover of £4 billion in 40 countries.

The medical services division has three main areas of activity. These include disability assessment work for the Department of Work and Pensions, occupational health support services, and primary care. Atos Healthcare employs 318 doctors, in addition to 900 sessional doctors, most of whom work on disability assessments.

In primary care, Atos Healthcare runs two walk-in centres and it has recently been awarded contracts for two NHS practices, which includes a practice in east London that the company took over in January 2008.

Peter Taylor, clinical director of primary care, says that Atos Healthcare “aspires to grow its primary care business.” He believes Atos brings experience of management processes applied to clinical practice. “Doctors are employed to be doctors,” and Atos supports the structured environment they work within so there is no need for doctors “to get bogged down in activities that others can manage,” he says. The core hours at one of the practices are 8 am to 8 pm Monday to Friday and Saturday 9 am to 5 pm. The doctors work in a shift system doing GP consultations, seeing walk-in service patients, providing telephone advice, doing triage, or processing results and prescriptions. When asked about accommodating flexible working, Dr Taylor says the company is prepared to be flexible if “the service can be accommodated.” There is a need to be “fair to everyone” and staff are expected to be “willing to muck in.”

Atos has a structured way of looking at clinical governance, practice performance, patient safety, and quality issues. Up to 10% of clinician consultations are audited. Initially doctors are defensive about this, but Dr Taylor says soon “they embrace it” as they see it “as an opportunity to learn and develop.”

As the business expands Atos is looking to recruit salaried GPs interested in operating more like partners, with defined areas of responsibility such as clinical governance and the quality and outcomes framework.

As the primary care division expands there will be opportunities for GPs to develop a portfolio career and be cross trained and work also for disability assessment and occupational health services.

Doctors are employed on standard Atos contracts which offer full time salaries of up to £80 000, depending on experience, five weeks’ annual leave, and a range of other benefits including private health insurance, income protection, and other flexible benefits such as childcare vouchers. There is no automatic study leave, but Dr Taylor says that this is typically granted if it supports recertification and the business.

Atos Healthcare was not able to offer an interview with a salaried GP because they had only just made their first appointment.

To date a lot of negativity has been directed towards the entrance of private sector companies into the primary care market, and as a result many GPs may not have considered working for these organisations. Given the current job market and lack of jobs and opportunities for GPs, it is worth considering the career opportunities and employment packages on offer outside the NHS.

Kate Adams general practitioner London

 kateadams@doctors.org.uk