Frequently asked questions for implementing the new contract in general practice settings.
Working hours / work schedules / exception reports
Guardian of safe working hours
Less Than Full Time (LTFT)
Q1: Is there a generic template contract available for practices to use?
A: Yes, there is. You can find the generic contract on the NHS Employers website.
Q2. The contract refers to the Terms and Conditions of Service a lot. Where can we find these?
A. The terms and conditions of service are on the NHS Employers website.
Working hours / work schedules / exception reports
Q3. Is there a MS Word version of the work schedule template available anywhere for us to customise?
A. Yes, the work schedule template is available on the NHS Employers website.
Q4. GP trainees in practices are required to complete 72 hours of out of hours work while in a 12-month placement, or 36 hours in a six-month placement. How is this to be arranged and included in the work schedule?
A. The way in which this is managed differs in different parts of the country, so the contract is not prescriptive about it. However, it does need to be arranged in such a way as to avoid breaking any of the safe working rules (schedule 3 on the terms and conditions of service) so trainees need to be mindful of the rules when they arrange their out of hours sessions. There are three key things to bear in mind.
- The out of hours work needs to be offset by time off in lieu from the normal working week. For example, if a trainee works six hours out of hours, then they need to take six hours off from other clinical duty to keep the average hours within the 40-hour limit. This is because HEE will only reimburse the practice/ employer for 40 hours per week.
- The out of hours work must not in itself cause a breach of the safe working rules. If, for example, the trainee works out of hours in the evening after a normal day, it is possible that they may need to start later that day to avoid breaching the 13 hour maximum shift length; and/ or may need to start later the following day to ensure 11 hours minimum break between shifts.
- Within the 72 hours total, the model work schedule allows for up to 22 of these ours to be at night (after 9pm) and for the work to be spread across no more than six weekends per year. The out of hours work therefore needs to fit into this breakdown to avoid having an implication on the trainee's pay. Should a trainee work more than 22 hours at night over the course of a year, or on more than six weekends in a year, then their pay will need to be increased, but the practice will not be able to reclaim this from HEE.
Q5. Does the trainee have to tell us when they undertook out of hours work? Do I need to check up that they have actually done this?
A. Yes, the trainee must discuss their plans for out of hours work in advance with the trainer and/or practice manager so that you can be assured that they will not be breaching safety rule, that appropriate time off in lieu is given, and that there is no impact upon pay.
Q6. Is the out of hours work on top of the 40 hours?
A. No, it falls within the 40 hour average, so any work done out of hours not otherwise included in the work schedule will need to be given back as time off in lieu (TOIL).
Q7. Can we just make a work schedule for 38.5 hours and let the trainee sort out the out of hours on top to get back to 40?
A. Not really, as you'd need to be sure that the trainee didn’t arrange the out of hours work in an unsafe way. Setting the work schedule for 40 hours and arranging time off in lieu for any out of hours work gives you a better assurance that the trainee is continuing to work in a safe and sustainable manner.
Q8. How many breaks should a trainee get in a day?
A. It depends on how long the trainee is working on the day. Any shift of more than five hours or more must include a 30 minute paid break. If the shift exceeds nine hours, then it should include two paid 30 minute breaks. In the latter circumstance, you could agree with the trainee to combine these into one 60 minute break.
Q9. Is it possible to build a compliant work schedule across only a four day week?
A. Absolutely. If a trainee works for ten hour days, instead of five eight-hour days, then this would still be compliant, although the trainee would have more time allocated to breaks. There would also be an impact on annual leave entitlement, which would need to be managed in hours instead of days.
Q10. How exact does the timetable in the work schedule need to be? Can we round things to the nearest half-hour?
A. The work schedule should replicate as near as possible what the trainee is expected to do. Start and finish times should be as exact as you can make them, and should include handovers (where relevant), post-clinic admin and so forth within the working times. If you do need to round things off, you should round up, rather than down.
Q11. Some work is variable in terms of the time it takes - eg some home visits take longer than others. How do we put this into a timetable for the work schedule?
A. You should include what the norm is expected to be. It is accepted that on occasions, this may be different, but trainees would report those occasions via the exception reporting process and be compensated accordingly.
Q12. The contract is for an average of 40 hours per week. How long a period is that 40 hours averaged over?
A. If a trainee works the same hours every week, then it is a straight 40 hour week. If the timetable contains differences every other week, then it is averaged over the fortnight. If it is highly variable, then it is averaged over either then length of their placement, or 26 weeks, whichever is the shorter.
Q13. Does travel time to weekly teaching count as working time?
A. Yes, it does, provided that it is from work to place of teaching. Travel time from home does not count, in most circumstances. If in doubt, seek advice from NHS Employers or your local advice centre.
Q14. If a scheduled teaching session is cancelled, does the trainee have to make up the time?
A. Yes. Teaching sessions are part of the 40 hour week, so if the session is cancelled, the trainee will be expected to make up the time on other educational activities.
Q15. Can we include an unpaid break within the day as well as the paid break? For example, can we roster a trainee to work four hrs in the morning 8.30am - 12.30pm (inc. 30 min break), and then four in the afternoon 1.30pm - 5.30pm?
A. No, you cannot do this, as the contract would define that as one continuous shift. However, you can schedule some of the trainee's self-directed learning time, and the second meal break, into the gap.
Q16. Can we get advice from someone about our timetables?
A. If you are in a lead employer arrangement, you can speak to the employer. If not, then you can contact your local advice centre.
(a) For HEE Yorkshire and Humber trainers: YorksHumber.GPadvice@sthk.nhs.uk
(b) For HEE Thames Valley trainers: email@example.com
(c) For HEE Wessex trainers without a lead employer: firstname.lastname@example.org
Q17. Does the timetable have to be broken down into four hour sessions, or can it just be 28 hours of clinical work and 12 hours of educational time?
A. Either is acceptable as long as the total for each (28 hours and 12 hours) is delivered.
Q18. Are there contractual rules about appointment times (eg ten minutes slots) for trainees?
A. No, this is not a contractual matter. However, a trainee should only be allocated the number of patients that it is reasonable to assume they will be able to see in the time made available in the work schedule.
Q19. The working hours rules in the contract don't reflect what life will be like as a qualified GP. Why is this?
A. The contract is designed to ensure that trainees have adequate time to train, to acquire their competencies and to become qualified GPs. While service provision is a part of that, the emphasis is on training. The working hours rules are designed to protect that training element, and to ensure that trainees are not overworked.
Q20. Which elements of pay are pensionable?
A. Basic pay is pensionable, as is London weighting (where it is paid). Additional hours above 40, enhanced payments for nights, weekend and on-call payments and flexible pay premia are all non-pensionable. Transitional pay protection is also non-pensionable.
Q21. A trainee has asked about whether the 1 per cent pay increase is backdated to April 2017. Is this the case?
A. If the trainee was employed on the NHS national terms and conditions of service (either contract) in April, then they should already have received that pay award, which took effect in April. If they were employed on local terms not covered by the NHS pay review body recommendations, then that would be a matter for local determination.
Q22. Are breaks paid time or non-paid time?
A. The 30 minute breaks specified by the working time rules are paid time.
Q23. Will there be a pay uplift every April for those on the new contract?
A. Not necessarily. Trainees on the new contract will be covered by the pay review body recommendations Should the pay review body recommend a pay award, and should this be accepted and implemented, then it would apply to trainees in practice placements. Practices should watch out for the annual pay circular from NHS Employers, usually published in April, for any details.
Q24. Do trainees still get annual increments?
A. Trainees on the new contract will not get annual increments as pay is now based on grade rather than length of service. In future, pay will only change for GP trainees when they move from ST2 to ST3. However, for the next four years, some trainees may be entitled to transitional pay arrangements whereby they remain on the old pay system. in those cases, the trainees would continue to receive annual increments, however, the number of these in general practice will be very small.
Q25. Is there still pay protection for doctors switching specialties or coming into training from career grade posts? How will this work?
A. Yes, there is. Details can be found in Schedule 2 of the terms and conditions of service, paragraphs 49-52. If in any doubt, you should seek advice from your lead employer/ local advice service.
Q26. Does the academic flexible pay premium (FPP) apply in general practice?
A. Yes, it does, for trainees meeting the qualification threshold set out in Schedule 2 of the terms and conditions of service. However, the number of trainees would meet this threshold is likely to be very small.
Q27. How does the general practice FPP work for LTFT, or for academic GP trainees, or those working in an ITP arrangement?
A. Each category is slightly different:
- LTFT trainees will receive a pro-rata allocation of the FPP; for example, a trainee working on 50 percent of full time would receive 50 per cent of the amount paid to a full time trainee.
- Academic GP trainees working 50 per cent clinical and 50 per cent academic do however receive the whole amount, as they remain full-time trainees.
- Trainees working in an ITP setting (part time in a practice, part time in a secondary care setting) only receive the FPP for the proportion of time they work in the practice setting.
Q28. Where can I get information about pay scales?
A. Trainees are now on spot salaries for the grade they are working in, not on salary scales. You can see the detail in in the relevant pay circular (M&D 2017/1) on the NHS Employers website.
Q29. If a trainee works extra hours and we want to pay them, what rate do they get paid?
A. The trainee would be paid at the standard rate for the time of day that the work is carried out, eg before 9 pm, at the same rate as all other work (1/40th of a week's basic pay for every additional hour); work carried out after 9pm would be paid at 37 per cent above the basic rate. However, practices should remember that pay for any such work cannot be reclaimed from Health Education England (HEE) and so it may be preferable to offer time off in lieu instead.
Guardian of safe working hours
Q30. How does a practice find out who the guardian of safe working hours is?
A. If you are in a lead employer arrangement, then contact the employer for details. If you are not in a lead employer arrangement, then contact your local advice centre.
(a) For HEE Yorkshire and Humber: YorksHumber.GPadvice@sthk.nhs.uk
(b) For HEE Thames Valley: email@example.com
(c) For HEE Wessex trainers without a lead employer: firstname.lastname@example.org
Q31. If we have not appointed a guardian, can we still offer the new contract?
A. Yes, although you will need to do so as soon as possible. However we believe that there are at least interim arrangements in place for all practices, so contact your lead employer (if relevant) or local advice centre for details on who this is.
Q32. Can the guardian fine a practice for breaches of safe working hours?
A. Absolutely, although in practice, this is very unlikely to happen. Guardian fines are only for the most severe breaches of the safety rules and these are very unlikely in a practice setting. The one most likely to occur is a trainee repeatedly missing scheduled paid breaks, but as trainee workload should be managed effectively to allow them to keep within their hours, even this should be easy to avoid. If however a practice is felt to be in breach, the guardian of safe working hours could levy a fine on the practice. In such cases there is no right to appeal (as the reasons for the fine are details in the terms and conditions of service) and the practice cannot be reimbursed for the cost by HEE.
Q33. Will all trainees starting new placements in August 2017 go onto the new contract?
A. It is the expectation that all trainees will transition to the new contract at the point that their contracts expire and new ones are issued. For most (but not all) GP trainees, this will be August 2017.
Q34. Some trainees with existing contracts think they might be better off on the new terms. If a trainee is currently under contract until February 2018, can they switch to the new contract in August 2017?
A. There is no expectation that any employer will offer trainees the option of switching between contracts. Trainees with existing contracts should remain employed under the terms of those contracts until they expire. Only then should they be offered the new terms, for any subsequent contracts. The cost modelling for transition, including the costs of transitional protection, has been done on the assumption that this is not a choice exercise, and it is unlikely that HEE will wish to fund the increased costs arising from allowing trainees to choose. However, practices may choose to offer trainees the safety provisions of the new contract in August, while leaving pay the same until the current contract expires.
Q35. If a trainee who started in February 2017 on a 12 month contract wants to stay on the old contract, can they do this?
A. In this situation the trainee will stay on the old contract, as they should not switch to the new one until the current contract expires in February 2018.
Q36. I have a trainee who says they are already on the new contract? Can this be right?
A, Yes, it is perfectly possible. Trainees in hospital and other settings have been moving to the new terms at various dates since October 2016. A number of GP trainees in hospital settings are therefore already on the new contract. Where this is the case, you do not need to move the trainee onto the new terms as they will already have moved, but you should continue to employ him or her on the new terms to avoid any sudden downward shifts in pay or complaints about being offered worse terms (the old contract has none of the safety provisions set out in the new terms and conditions).
Q37. I have a trainee coming to us after a period of maternity leave. Which contract do I offer?
A. If the trainee is coming to you on a new placement, and their current contract has expired, you should offer the new contract.
Q38. How does pay protection work for transition?
A. This is set out in Schedule 14 of the 2016 terms and conditions of service. Trainees who were already at ST3 level on 2 August 2016, and who have remained in training since, will continue to be paid as per the old contract (basic salary plus a GP supplement of 45 per cent). Trainees who were in training on 2 August but below the level of ST3 and who have remained in training since, will have a cash floor calculated, setting a level of pay below which their pay cannot fall over the next four years. For details on how to calculate this, see Schedule 14 of the terms and conditions, alternately, contact your lead employer or regional contract advice service as appropriate.
Q39. Can doctors in training on the 2016 contract still claim mileage expenses?
A Yes, doctors in training will be reimbursed for official journeys that are in excess of their return journey from home to principal place of work.
Q40. At which rate is the mileage payable under the new contract? Is that the same as under the old contract?
A Mileage rates under the new contract are different from those under the old contract.
For doctors on the 2016 contract, the current mileage rates can be found in Section 17 of the NHS Terms and Conditions of Service Handbook in table 7, which is updated as agreed with the NHS Staff Council. These rates are obtained by referring to costs for the average private vehicle user included in the AA guides to motoring costs. A summary of motoring costs which are taken into account is contained in the NHS Terms and Conditions of Service Handbook at Annex 12.
For doctors on the old contract, the current mileage rates can be found in the latest medical and dental pay circular.
Q41. Can doctors on the 2016 contract claim for home to base travel?
A Only if they are required to return to work and therefore incur additional home to base expenses (for instance, when called out in an emergency when on call from home).
Q42. Are doctors in training eligible for reimbursement of travel costs incurred as a result of a home visit?
A Doctors in training will be reimbursed for miles travelled in the performance of their duties which are in excess of the home to agreed work base return journey.
Normally, the miles eligible for reimbursement are those travelled from the agreed work base and back. However, when the journey being reimbursed starts at a location other than the agreed work base, for example home, the mileage eligible for reimbursement will be as set out in the example in Table 8, contained in Section 17 of the NHS Terms and Conditions of Service Handbook.
Q43. Can trainees still claim back the cost of their Medical Defence Union (MDU) subscriptions?
A. This does not form part of the contract of employment. If this was an entitlement agreed by HEE before, then it will continue to be so; switching to the new contract does not change this.
Q44. How much annual leave does a trainee get on the new contract?
A. Leave provisions are set out in Schedule 9 of the terms and conditions of service. Trainees with fewer than five years' NHS experience are entitled to 27 days per year; trainees with five years' NHS experience or more are entitled to 32 days per year. Both of these amounts are inclusive of the two extra-statutory days previously awarded to trainees in hospital settings. All trainees are additionally entitled to the 8 public holidays, or days off in lieu thereof. Entitlements are pro-rata for placements of shorter than twelve months' duration, or for trainees working less than full time (LTFT). Trainees working non-standard weeks (e.g. forty hours across four days) should have their entitlement calculated in hours rather than days.
Q45. How much study leave does a trainee get on the new contract?
A. Professional and study leave is discretionary but should be granted where at all possible, provided the reason for the request is appropriate. Trainees can have up to six weeks (30 days) study leave in a 12 month period; this includes attendance at regular, scheduled teaching sessions.
Q46. Does the leave come out of educational or service time?
A. It can come out of either (scheduled teaching sessions obviously come out of educational time, but other leave may not), but should be properly balanced to ensure that the trainee can achieve the necessary competencies during the placement.
Q47: Are the trainees' educational sessions taken out of their study leave allowance?
A: Yes and no. Study leave allowance is specified within the contract and this now applies to GP trainees in the same way as it does to hospital trainees: up to a maximum of 30 days during any 12-month placement.
Half/full day releases to attend curriculum teaching / training come out of their study leave allowance. For example, a trainee who has attended 30 half-day sessions in a 12-month period would have used 15 days of the
study leave allowance. The remaining 15 days of the allowance can be applied for as leave for other educational purposes.
In the specific case of GP trainees, half/full day teaching sessions must be taken during the educational sessions set out in the trainee's work schedule. Education sessions used for this purpose - and only those used for this purpose - therefore come out of the study leave allocation. It therefore follows that, if a trainee is not on a half/full day release, then this session will still need to be used for other educational purposes, based on the requirements of the trainee, but would not come out of the study leave allocation.
Less Than Full Time Trainees (LTFT)
Q48. Does the new contract apply to LTFT?
A. Yes, it does. LTFT trainees should be offered the new contract in the same way as full time trainees.
Q49. How does pay work for LTFT?
A. LTFT trainees are paid exactly pro-rata to the contribution that they make to a full-time working pattern. They are paid for the hours that they work, the number of hours that they work at night, and a pro-rata proportion of the FPP. For assistance in calculating pay for an LTFT, contact the lead employer or local advice service as appropriate.
Q50. I have an LTFT whose contract does not expire until February 2018 but who wishes to change contracts now. Can (s)he do this?
A. There is no expectation that any trainee will switch between contracts before his or her current contract expires. If a trainee holds a valid contract until February 20018, then it is not expected that she would transition to new terms until that contract expires.
Q51. We are now a part of a lead employer arrangement that started in August 2017. Does this mean that I still need to offer the new contract?
A. No. If you are in a lead employer arrangement, the lead employer will offer the contract. This is however likely to be on the new, 2016 TCS so you will be asked to provide a copy of the work schedule to the employer.
Q52. We are not moving to a lead employer arrangement until February? Do we offer the old contract until that happens?
A. If you have trainees joining you on new placements in August, it is expected that you will offer the new contract. Trainees in lead employer arrangements and trainees without lead employer arrangements should not be treated any differently in this regard.
Q53. We are not part of a lead employer arrangement and there are no plans for this to happen. Does this mean we carry on offering the old contract?
A. It is expected that all trainees taking up new placements in August will be offered the new contract. Lead employer arrangements are not a pre-requisite for offering the new contract, which will work perfectly well without them.
Q54. Does the new contract change the arrangements for claiming reimbursements from HEE?
A. No. These arrangements have nothing to do with the contract of employment. Whatever arrangements have been put in place by HEE remain in place.
Q55. How do we know what we can claim back from HEE and how to do it?
A. You are entitled to claim back the salary paid to the trainee, provided that it is paid in accordance with hours set out in the work schedule guidance and with the transitional arrangements set out in Schedule 14 of the terms and conditions of service, where these apply. Any other items than can be claimed back are a matter for HEE and are unchanged by the new contract. Arrangements for claiming are for local determination with HEE and we understand that NHS England will be issuing advice on this shortly.