Locum, Salaried GP or Partner in General Practice – Who is best placed to create a private medical practice?

Jan 18, 2022

The majority of GP’s who choose to undertake private medical practice will also be working for the NHS. Many GP’s spend a large part of their careers in a salaried capacity and traditionally this was a prelude to gaining a partnership.

One advantage of being a GP partner over a career as a salaried GP is job security. That security is not just about income but also knowing that you are putting your stamp on the local community. In addition GP partners often have more autonomy, being able to dictate the hours they work and decide the way they deliver services. Sounds perfect right? Well, not always.

One of the biggest difficulties and indeed one of the major barriers to becoming a GP partner is ownership of practice premises. GPs are moving away from property ownership because of issues with recruitment and retention – as partners leave the risk to remaining partners gets higher and higher. Ultimately the buck ends with you. Pay, sick pay, training and organising locum cover. Remember you are self-employed and all these issues will have to be dealt with by the partners.

In addition, one the most important aspects of both the GMS and PMS GP contract is that you cannot subcontract any work to a company that is related to you in any way. So what does this mean? It means you cannot provide private medical services to any of your practice patients. Think about that! By removing your local practice base as a potential source of patients, it can place a huge barrier to actually being able to develop a successful business locally. You may be faced with the prospect of some reciprocal arrangement with another practice or setting up private practice outside of your area, both of which are less than ideal solutions. 

Having said that, many GP partners develop the skills, knowledge, and attributes to successfully run a business, and, if they pursue a private GP route after some years of partnership, processes such and employing staff, CQC registration and other key aspects of running a business can be extremely useful and transferable skills. Many successful private GPs were previously successful GP partners, or still are alongside their private work.

There are however some large differences you need to be aware of between working as a GP partner and running a private practice, which is essentially a healthcare business.

You will need to decide whether you should be setting up as a partnership, a limited liability partnership (often referred to as a LLP) or using a more formal structure like a limited company which is treated as a completely separate legal entity. It is important to choose the correct legal personality for your particular circumstances. If using a company, you will need to register this with register with Companies House, and understand things like articles of association, issuing shares in the company to shareholders and corporate tax. Terms like shareholder agreements, A and B classes of share, dividends and distributable reserves are all things that you will need to be on top of. In addition, you need to have a firm grasp on how to run a profit and loss statement, balance sheet, cash flow statement and understand how to read financial statements in general. You will essentially need to learn a new language.

You may also be identifying opportunities to form strategic partnerships with other organisations which may include partnership agreements (which can be notoriously difficult to execute) or bringing together a group of doctors to form a limited liability partnership.

Modern healthcare businesses are also defining very different business models as they identify niche sectors to exploit, for example at home personal care (Cera for example). To do these things requires reading, planning and sensible legal advice and creating a great team. You my even decide to raise money to scale the business, be it from bank loans, equity investment or even crowdfunding. The most important thing you will need is time, and partners in General Practice are not often able to create that time.

It is not surprising therefore, that there has been a rapid trend away from more formal GP partnership towards a portfolio career and this seems set to stay. Being a portfolio doctor with a number of different jobs is now the new normal in general practice and many GP’s will see their 4-6 sessions of NHS work as only one of their medical roles.

So what if you are a salaried GP? As a salaried GP one attraction is the chance to sidestep the financial responsibilities and outgoings of partnership, which is why the number of GP’s in salaried positions has risen steadily. You are free to undertake private practice outside of your working hours and the newer contracts allow paid time for CPD, practice meetings and sick and maternity pay. Many practices are obliged to use the BMA salaried GP model contract. But remember any job contract is a negotiation, for example an annual pay rise which is standard in a hospital setting is not automatic in a salaried GP contract.

As a salaried GP you can negotiate to undertake private work outside of your working hours and this is why a salaried GP approach may be best for the portfolio doctor. It may be possible to perform this onsite at the practice, depending on who owns the building and services and you need to negotiate the terms of this work. For example how much of a private fee you would receive after deduction of overheads. 

For those of you working as Locum GP’s you may well be in the best position of all. This type of work has become popular as it is the ultimate in flexibility as you choose when, where and for how long you work. This does require a level of organisation, building of relationships to gain regular offers of work, but the very effective locum GP’s can earn a great deal of income by negotiation and effective working. It is a very good idea if you are considering locum work as private additional income aside from salaried contracted work to develop a clear set of terms and conditions under which you are working. These should include:

  • Definition of duties (on-call, triage, letters and the home visits)
  • Clear definition of length of appointments, number of patients seen per session, session length and admin time
  • Cancellation fee on a sliding scale from 0%-100% for 0-28 days in advance
  • Including employer pension contributions
  • Legal employment status
  • Tax Status, IR35
  • Private fees (HGV Medical etc)
  • Cremation fees
  • Payment terms
  • Invoicing

There are several organisations that can help you with, for example the association of sessional GP’s that uses a locum deck to help you run your locum work. healthcare business alongside your delivered sessions to patients.

Finally what about chambers with designated members? This is another option where the collective power of the group can provide a better offering for prospective clients and commissioners of care. For a tightly knit, like minded group of individuals with a shared philosophy this can be a highly effective organisation. However I would be cautious. I wonder how many of you have been bitten by being part of chambers? Often the founding members are the winners with everyone else playing second fiddle.   

If you are reading this and don't know where to even start with your private practice itself, then we recommend reading how to set up a private practice

So in summary:

  • Partners often have the skills, knowledge and attributes to run a private practice
  • Partnerships can be a barrier to local private practice
  • Salaried GP’s and locums have the flexibility and freedom to develop business interests and become the ultimate portfolio doctor
  • As a locum GP make sure you have a clear set of terms and conditions, if you are smart you can fund your dream business alongside your locum work

Don't forget that whatever road you take, there are many other factors that go into whether your private practice will be successful. Take a look at this article where we go into some of the factors to keep in mind to ensure that your practice is successful. 

Do you want to create a fully booked private medical practice without working any evenings or weekends? 

With over 50 on-demand videos, templates and guides, our on-demand course covers everything from:

  • how to navigate CQC registration and fast-track your practicing privileges
  • detailed walkthrough of how to create your own website and embed an automated appointment system
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  • how to project your revenue and costs and maximise your profits
  • and much, much more

We look forward to seeing you there!

Giles and Tom

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