An overview of job planning for GPs as suggested by the BMA
What to include:
Clinical duties:
appointments;
visits;
dealing with telephone queries from patients or other health care professionals.
Administration
Whether arising directly from this caseload (referrals, investigations, results) or indirectly (reports, medicals, etc).
Primary care team meetings
Formal or informal.
Essential to the delivery of team based care.
Discussing clinical practice standards.
Developing practice protocols.
Mutual professional support for the individual practitioners.
Audit.
Significant event analysis.
Meetings with colleagues in the locality, care trust etc. Where these occur on an ad hoc basis, adjustments to clinical workload may be required.
Specific specialist roles in the practice
Ie: medical student or registrar teaching or training, responsibility for particular areas of practice development, QoF areas of responsibility, ‘Practitioner with Special Interest’, etc.
CPD time
This may include a mix of in-house meetings and events, time away from the practice – for example, in private study, attending educational events or time in lieu of attending educational events outside of normal working hours.
Evidencing your workload
This should be broadly defined in amount (number of patients) and type (clinical, paperwork, team meetings) with provisions for fluctuations in exceptional circumstances.
Workload should reflect the individual employee’s particular abilities and developmental priorities, such as those relating to experience, returning after a career break, disability, or knowledge of a second language.
Clinical and non-clinical work
This should be balanced, recognising both clinical and non-clinical work (including meetings, both formal and informal, and administration).
It is estimated that the ratio of clinical work to administrative work is usually in the region of 3:1 for salaried doctors without any practice development role; this excludes meetings. This ratio may vary greatly from practice to practice.
Where the post-holder works effectively like a salaried partner or performer/provider, this ratio is likely to include significantly more time needed for practice development.
Clinical workload
It is not appropriate to base clinical workload on that of partners. This is because partners (defined as performers/providers under the new contract) define their role and workload as a reflection of their profit share rather than in hours. As profits can fall and rise, so can the workload of partners in a way which should not be expected to affect salaried doctors on an hours-based contract.
There must be clear agreement on arrangements relating to how and when extra-contractual duties (where agreed to) will be recognised, when time in lieu will be taken (e.g., monthly, or added to annual leave), or when additional payments are to be made.
This is of particular relevance where there are significant fluctuations in workload and hours of the employed doctor if s/he is helping to cover another doctors’ absence – for example, sickness or maternity leave.
Session length
Although a session is defined as four hours and 10 minutes, periods of duty do not need to be exact multiples of sessions. Short days are permissible as long as the hours are all counted.
European Working Time Directive
Breaks should be granted within worked hours in keeping with the European Working Time Directive. Start and finish times should consider the employee’s need to meet childcare or other care commitments.
Paperwork
It is helpful to specify whether this includes correspondence or prescriptions addressed only to the doctor or whether it includes a share of the day’s workload.
Reports
Specify whether time is allocated within general admin time, and reports are shared, or whether time is blocked-off during surgery and whether the fee is retained by the doctor.
On-call
Commitment should be specified in terms of frequency and also maximum number in a month or year, as on call duties can often extend contracted hours for that day or week.
Assessment of workload
An employed GP contracted to work an eight hour day should not be expected to see the same number of patients as a partner who works a nine or 10 hour day. Just because partners decide to attend meetings in addition to existing around clinical commitments does not mean it would be appropriate for salaried doctors to do so if this means an unpaid increase in their hours of work; such an arrangement would necessitate additional payment or time-off in lieu.
Surgery times
Surgery times should make a realistic allowance for late arrival of patients and overrunning, as well as necessary time to make urgent referrals which cannot wait until the next worked session.
A session finish time of 5.30 would require the last booked appointment to be at 5pm (or earlier if the doctor only works one day a week and needs to finalise all referrals the same day).
The time at the end of surgery will depend on the length of the surgery, when the doctor will next be in to act on referrals and, perhaps, the practice’s policy on patients who attend late for their appointments.
Visits
These are usually expected to take 30 minutes. Any estimation made should be realistic and, for example in rural practices, a longer time would be necessary where extended travelling time for visits will need to be taken into account.
It is preferable to indicate a number rather than a range. Where a range is indicated for a day it is advisable to agree a maximum weekly limit so that, where visiting time erodes admin time on one day, the balance can be redressed on another day without a exceeding contracted hours.
There should be clarity about the cut-off time when visits become the responsibility of the doctor on call.
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