for replacing an outgoing partner
We are a four-partner practice and our senior
partner is due to retire in September 2005, we have already
been advertising for a replacement partner, but are having
difficulty filling the vacancy. What other options can we
consider and what impact does this have on our finances?
The new GMS contract gives practices greater
flexibility for replacing outgoing partners with employed
GP’s. The funding is now practice based and as long
as your list size does not change, you will not lose any
income when the partner retires. Taking on an employed GP
could also give the existing partners an opportunity to
increase their individual share of profits.
Locums are an expensive option but can be used in the short
term while the practice considers long-term options for
replacing the outgoing partner. Short-term locums will be
self-employed, so the practice will not have the additional
cost of employer’s national insurance and employer’s
An increasing number of GP’s have a preference for
being salaried and therefore it may be easier to employ
a salaried GP rather than taking on a partner. The practice
could then decide whether they wanted to make the salaried
GP a partner in the future. The salary of the GP will depend
on the current market, practical experience, and length
of NHS service and whether they can offer any additional
services. You will need to negotiate this with the GP you
are considering employing.
Currently average salaries for a full time
equivalent GP are between £65,000 to £75,000.
The total cost to the practice will be the salary plus the
employer’s national insurance (12.8% of the salary
after their personal allowance) and if the GP is a member
of the NHS pension scheme, the practice will also have the
cost of the employer’s pension contribution (14%).
For example, if you took on a salaried GP on a salary of
£65,000, the employers national insurance will be
£7,693 and the employer’s pension contribution
will be £8,415, therefore the total cost to the practice
would be £81,108.
As the salaried GP is an employee of the practice,
they would also be entitled to holiday and sick pay. They
would also need a contract of employment like any other
member of staff.
If the practice wants to eventually take on
a partner, then the salaried GP, if suitable could have
the opportunity of becoming a partner in the future. However,
if the total cost of employing the salaried GP were less
than the outgoing partner’s profits, then there would
be more profits left to distribute between the existing
partners. Which could result in their individual profits
increasing, this is illustrated in box a. Remember, if you
decide to take on the salaried GP as a partner, your individual
profits will decrease.
Flexible Careers Scheme GP
Employing a GP under the flexible careers scheme allows
the practice to receive a reimbursement towards the total
cost of the GP. However, a flexible careers scheme GP must
work a minimum of two sessions per week and no more than
5 sessions per week. They must also be given 8 sessions
per annum of funded education time. The practice would be
reimbursed 50% of the cost in the first year, 25% in the
second and 10% in the third year. However, you will need
to consider the number of hours that you require a GP for
and their level of commitment to the practice.
A GP retainer can be employed for up to 4 sessions per week.
As long as the conditions for employing a retainer were
met, the practice would be eligible for a small reimbursement
towards the cost of the salary, which is £57.33 per
session. The practice would be expected to fund the rest
of the salary.
When looking for new doctor to join the practice, there
will be other factors to consider as well as the financial
implication. In particular, their commitment to the practice,
for example a profit sharing partner would want to work
hard to achieve as many QOF points as possible, as this
will increase the income coming into the practice and their
profits. Whereas the number of points the practice achieves
would not impact on a salaried GPs income. As an incentive,
the practice could offer a bonus for their contribution
to the quality and outcomes framework.
The remaining partners may feel that they
want to take on another partner in order to share the responsibility
of running the practice.
Also a new partner may bring a new skill,
which could enable the practice to offer new services to
their patients, which could also increase the practices
|Profits per accounts
Profits per accounts
Less: Cost of salaried GP
Profits to distribute