New care models threaten salaried GPs' employment rights, warns BMA

New models of care being introduced across the NHS could undermine employment rights for salaried GPs, BMA guidance has warned.

The bulk of UK GP practices are currently obliged to offer salaried GPs terms and conditions at least equivalent to those set out in a model contract agreed by the BMA and the NHS Confederation.

A requirement to offer salaried GPs terms no worse than the model contract is written into both the GMS contract and the 2015/16 standard PMS deal.

Currently, only practices on APMS contracts - which cover just 3.5% of GP practices - are not required to offer the model contract. But BMA advice suggests large-scale NHS collaborative arrangements could enable employers to work around this requirement even where constituent practices hold GMS or PMS deals - reducing protection for salaried GPs.

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Map: Which areas have the most APMS, PMS and GMS practices?

Collaborative structures such as limited liability partnerships and companies limited by guarantee can only hold APMS contracts in their own right. Member practices, however, retain their own contracts and could continue to operate under GMS or PMS deals. If salaried doctors working for these practices are employed by the collaborative structures, rather than the practices themselves, they may not be offered the full model contract terms and conditions, the BMA fears.

Guidance for salaried GPs working under new models of care published by the BMA warns doctors to watch out for employers offering contracts on terms worse than those set out in the model agreement.

The guidance says that 'the traditional model of general practice is under pressure’, adding that rising demand and diminishing resources are ‘creating an impetus to take forward new ways of working’.

With more and more practices beginning to explore both formal and informal collaborative arrangements with other local practices, pitfalls are emerging for the salaried GP workforce, it explains.

Working at scale

The GPC has urged caution when signing up for work with organisations not obliged to offer the model contract, and recommended that GPs should request at least the same terms. They should further ensure they are not contractually disadvantaged compared to doctors from secondary care settings, who may also be employed by the provider, it added.

The guidance says: ‘If your employer retains their GMS or PMS contract, then they are contractually bound to offer "terms no less favourable" than the model contract for salaried GPs.

‘However, if the employer is not a holder of a GMS or PMS contract that has signed the 2015/16 agreement, then it is possible that you will be offered a contract that is not based on the nationally agreed terms and conditions of service.

‘In such cases it is extremely important to understand what you are signing up to in advance and we would strongly recommend to contact the BMA’s contract checking service, which is free for BMA members, to assist with the process.’

Sessional GP subcommittee member Dr Pooja Arora said in a blog post: ‘While there may be some risks associated with these new arrangements, like with anything new, there are a lot of opportunities for us too.

‘In our recent sessional GP survey we found that these setups can offer flexible working options and roles that enable us to develop our own interests and explore opportunities that were not readily available before.’

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