Department of Postgraduate GP Education
GP RETAINER SCHEME
(GPRS)
INFORMATION PACK
Updated Dec 2014
Professor Abdol Tavabie
Interim Dean Director
Dr Hilary Diack
Interim GP Dean & Head of GP School
Dr Kevin Hurrell
Head of Post-Certification GP School
Dawn O’Grady
CPD Manager
Health Education England (KSS LETB)
General Practice (Primary Care) Education
7 Bermondsey Street, London SE1 2DD
Tel: (020) 7415 3447 | Fax: (020) 7415 3687
www.kss.hee.nh.uk
CONTENTS / Page NoIntroduction / 4
Application Procedure Flow Diagram / 5
Map of areas covered by KSS Deanery / 6
Criteria for the Appointment of a Practice
Criteria
Practice Visit
Failure to be approved
Approval for funding a Retainer Doctor / 7
Approval for more than one Retainer / 10
Criteria for the appointment of a Doctor to the Retainer Scheme / 11
Details of the Retainer Scheme
Application Procedure / 13
Reappointment of a doctor to the Retainer Scheme / 13
Time on Scheme / 14
Leaving the Scheme / 15
Terms and Conditions of Employment
Contractual Issues
Continuity of Service
Professional Expenses
Salary
Course Fees
Financial Support for NHS Appraisal
Financial support to Practices Employing a Retainer
Periods of leave
Taxation
Superannuation
National Insurance
Redundancy Compensation
Grievance Procedures
Representation / 15
Educational Aspects of scheme
Educational Supervision
Induction
Clinical Experience
Appraisal
Hours of Education
Study leave
Forms of Education
In House
Non-Principal Groups
Other forms of Educational Activity / 19
Useful Contacts / 22
Appendix a Letter from The GP Dean / 23
Appendix b Educational Plan Guidelines / 24
Appendix c Health Service Circular / 25
Appendix d BMA document - Guidance to GP Retainees / 31
Appendix e Claim Form for Expenses / 35
Appendix f First Application Form / 37
Appendix g Practice Application Form / 39
Appendix 1 BMA Model Contract
Appendix A
Appendix B Induction Period
Appendix C
Appendix D Job Plan
Appendix E Duties / 40
INTRODUCTION
The GP Retainer Scheme was introduced in 1998 and replaced the Doctors’ Retainer Scheme which was first conceived in 1969. The scheme affords doctors the opportunity to maintain their practice whilst not seeking a role as a partner in practice. The scheme is a combination of service commitment and continuing professional development. The retainer’s appointment is renewed and reviewed annually by the Dean of Postgraduate General Practice Education (DPGPE) or his deputy.
The arrangements for the appointment of retaining practices and retainer doctors in HE KSS are based on the NHS Executive Guidance (HSC 1999/04) and the Statement of Fees and Allowances para 39. These latest guidelines also incorporate the new minimum terms and conditions laid out in the GMS Contract of April 2004.
HE KSS has long had a role in the Retainer Scheme. This relates to supporting the education of the doctor on the scheme and also quality assuring the working environment.
FLOW DIAGRAM SHOWING APPLICATION PROCEDURE FOR DOCTORS WISHING TO ENTER THE RETAINER SCHEME
FLOW DIAGRAM SHOWING APPLICATION PROCEDURE FOR PRACTICES WISHING TO EMPLOY A RETAINER DOCTOR
Map of Areas Covered by HE KSS
HE KSS has a role in approving practices to host GP retainer doctors and also grants approval for individual doctors to become retainers. A practice should not enter into any contractual arrangement with a doctor seeking to be employed on the retainer scheme until approval for both practice and retainer doctor is confirmed.
CRITERIA FOR THE APPOINTMENT OF A PRACTICE
All practices seeking to employ a retainer doctor are required to complete a Retainer Practice First Time Application Form
A Training practice is accredited to host a retainer doctor by virtue of the visiting process undertaken by HE KSS to accredit such practices.
A practice which is a non-training practice may apply to host a retainer doctor and must seek approval before advertising a Retainer post. The process of accreditation involves a practice visit by the local GP Tutor acting on behalf of HE KSS. The criteria for appointment can be found in more detail in our guidance on the KSS Website http://www.kssdeanery.ac.uk/gp-mentoring and in appendix g of this guide.
Criteria
The criteria for training practices reflect the standards required of GP training practices. The main focus is to ensure that the environment provided for a part time retainer doctor is supportive and of a good standard.
1. There are robust communication systems relating to:
Patient care
Record Keeping
General Information
2. There are adequate facilities and practice and attached staff to support the retainer
3. The practice is undertaking regular Clinical Governance activity
4. There is an appreciation of the role of education across the whole practice
5. There is a realistic expectation of the role of retainer doctor
6. There is adequate supervision:
A named Educational Supervisor specific to the retainer must be appointed by the practice. They should be a principal or non-principal working regular sessions within the practice. Help and advice, from the named educational supervisor should be available to the retainer during sessions.
7. The practice has an induction pack for use by sessional doctors and undertakes to arrange an appropriate induction process for any GP retainer doctor
It is hoped that practices will be motivated to extend themselves towards GP Registrar training once they have become accustomed to educationally supporting a doctor in their practice and this should be agreed between the DPGPE and the practice. The timescale will depend on the starting point, the size of the practice, and other complexities in the practice. DPGPEs should normally expect practices to be up to the acceptable standard within 3 years.
Practice Visit
The practice visit will last approximately 2 hours and although it may appear daunting those who have undergone the process have found it useful in looking at practice organisation, how the practice functions as a team and how effective communication between all members of the team can be facilitated.
During the visit the Lifelong Learning Advisor may need to see examples of the clinical records. The practice should consult the GMC website www.gmc-uk.org to ensure the current guidelines on confidentiality are not breached.
Upon completion of the visit the report will be shared with the practice and forwarded to the Deanery. The practice will be informed in writing of their approval, with a copy of this approval being sent to the PCSA (Primary Care Support Agency).
The process of appointment may take a significant period of time to complete, up to 30 working days for approval of the retainer and up to 2 months to allow time for a practice visit. Practices and individual retainer doctors should bear this in mind when making an application.
Practices and individuals must receive approval before entering into a formal arrangement.
It is not acceptable for the retainer to start working and then apply for membership of the scheme and the attendant reimbursement to be backdated.
Where a practice is approved the approval runs for 5 years.
Where an individual doctor is approved the approval runs for 1 year. Subsequent approvals must be applied for on an annual basis. HE KSS will send a reminder letter 1 to 3 months before the annual renewal is due.
Practices taking on a non-principal for the first time are advised that an induction pack is available from the National Association of Sessional Doctors (Nasgp), PO Box 188, Chichester, West Sussex, PO19 1FP, Fax: 01243 536428, e-mail: , www.nasgp.org.uk.
Failure to be approved
Where a practice is not approved the decision can be discussed with the responsible Lifelong Learning Advisor and Head of Post-CCT GP School. If there is no resolution an appeal can be made to the Dean for Postgraduate GP Education.
Approval for funding a Retainer Doctor
All practices planning to employ a retainer doctor must seek approval from the PCA/PCSS for their plans. The PCA/PCSS is responsible for Retainer reimbursements and will expect a practice to have discussed this proposal with them prior to a doctor being appointed.
The PCA/PCSS’s obligation to reimburse practices for their retainees is laid down in the Statement of Financial Entitlements, as follows:
“Payments in respect of sessions undertaken by members of the Scheme
14.2 Subject to paragraph 14.2A, where:
(a)A contractor who is considered as a suitable employer of members of the Doctors’ Retainer Scheme by the Regional Dean employs or engages a member of the Doctors’ Retainer Scheme; and
(b)The service sessions for which the member of the Doctors’ Retainer Scheme is employed or engaged by that contractor have been arranged by the local Director of Postgraduate GP Education,
The PCA/PCSS is obliged to pay a fixed retainer fee to the practice and this currently applies to both GMS and PMS practices Details relating to payment can be found at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_062647
APPROVAL FOR MORE THAN ONE DOCTOR ON THE GP RETAINER SCHEME
Permission from the GP Dean is required in the following circumstances:
· Retaining practices can employ more than one retainee providing they only work a combined maximum of 4 sessions a week in the practice.
· A retainee can work in more than one practice providing they only work a maximum of 4 sessions per week.
Permission from the GP Dean and approval by the Postgraduate GP Education Committee is required in the following circumstances:
· A practice can have two retainees working a maximum of 4 sessions each if they have at least 6 full-time partners and 12,000 patients.
· At the discretion of the GP Dean, an increase in GP Retainer sessions per week to a maximum of 8 may be approved for practices which have more than 6 full-time partners and 12,000 patients.
EMPLOYMENT CRITERIA
Practices must comply with employment law, as with other practice staff.
· The retainer must be an employee of the practice.
· A written contract of employment should be signed within two calendar months of the retainer joining the practice.
· The Model Contract of Employment for a Retainer Scheme GP should be the minimum standard contract used
· The retainer is entitled to paid study leave, which may include educational activities within the practice
· The EU Working Time Directive gives the retainer the right to a minimum amount of paid holiday.
· Retainers are entitled to join the NHS Pension Scheme.
Retainer’s Allowance
· The retaining practice can claim the retainer allowance from their health authority for each session the retainee works, including paid study leave, up to a maximum of 52 sessions per quarter.
CRITERIA FOR THE APPOINTMENT OF A DOCTOR TO THE GP RETAINER SCHEME
1. Doctors seeking to join the scheme must have successfully completed a vocational training scheme and be on the GMC's GP Register. They must also be on the Performers List held by Kent & Medway/Surrey & Sussex Area Teams and so eligible to work as a GP in Kent, Surrey or Sussex.
2. All retainers must be registered on the General Medical Council (GMC) GP register. GMC Website: www.gmc-uk.org
3. There is now no age discrimination relating to the Retainer scheme
4. Doctors must have a declared intention and explicit plan to return to general practice as a principal or non-principal in a substantive post
5. There must be personal well-founded reasons for limited, paid employment.
6. The doctor must hold full registration with the GMC
7. The doctor must be on the Medical Performers List
8. The doctor must be a member of a defence organisation
DETAILS OF SCHEME
The contract of employment is between the retainer doctor and the practice
A Model Contract has been developed for the GP Retainer Scheme. All sessional doctor contracts are now congruent with and reflect the changes to general practice brought about by the new GMS Contract. HE KSS would expect to see the model contract being used to ensure equity across HE KSS for all sessional doctors.
The retained doctor should work a minimum of 1 session per week, not more than 4 sessions per week on average and no more than 52 sessions in any one quarter. Whilst the minimum number of sessions permitted under the scheme is 1, HE KSS regards this amount as insufficient for a doctor to maintain their skills and would normally approve 2 sessions as the minimum requirement.
A doctor may, with permission from HE KSS, work two sessions in one practice and two in a second practice. Both practices will need to be approved; there will need to be an educational Supervisor at both sites and good communication between all parties.
A “session” is now defined as up to 4 hours 10 minutes, including paperwork, surgery consultations, visits and any other GMS function. The balance should be similar to GMS work. The sessions of work should be detailed in Appendix D of the Model Contract.
It is expected that there will be regular dialogue between the retainer and the Educational Supervisor, so that workload may be monitored and duties discussed. Retainers can be expected to undertake home visits and provide on-call responsibility provided that there is adequate negotiation and that the work can be completed within the agreed session time.
A retainer doctor may work more or fewer sessions than the usual maximum of 4, for up to 6 weeks, then can make them up over the next few weeks. The underlying principle is continuity of care for service delivery and personal development. Thus, retainer doctors should work an absolute maximum of 6 sessions, or 2 sessions more than they normally do (whichever is fewer), with a minimum of 1 session (unless on annual leave) The Dean’s approval is required if there is a substantial variation in sessions per week.
HE KSS does not need to be notified about minor, temporary variations in the employment arrangements
The doctor may undertake a limited amount of non GMS work such as Family Planning or clinical assistant sessions subject to approval by HE KSS and this will be at no more than two sessions per week. It is important to note that the retainer scheme is not designed for doctors with a portfolio career. It is the Dean of postgraduate GP education who will decide on the balance between clinical and non GMS work
Doctors on the Retainer Scheme are not expected to undertake out of hours work, but may do so in discussion with HE KSS