locuming made simple by drs. charlotte batchelor, alisha symons & ramesh mehay image-check done
TRANSCRIPT
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LOCUMING MADE SIMPLE
BY DRs. CHARLOTTE BATCHELOR , ALISHA SYMONS & RAMESH MEHAY
image-check done
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WHY LOCUMING?
WHY NOT?
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Feeling like this?
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Wanna feel like this?
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Aims
• Gain insight into:
• preparation needed to
become a successful locum
• financial issues and record-
keeping
• how it can be enjoyed
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Objectives
• Get a better idea of:• steps required to set up as a locum
• what administration work is involved and how to keep on
top of it
• how to keep records for the tax man and whether to self
assess / recruit an accountant
• financial issues e.g. income protection, superannuation
• pitfalls common to locums
• benefits of locuming
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PREPARATION
MAKING CONTACT
BOOKING
ON THE DAY
INVOICING
OTHER THINGS
Record keeping
Fees
Tax
Summary of locuming
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Preparation 1 – Change your mindset• Don’t think for a second that all practices that you locum in will be like
the training practices you have been in as a GP trainee.• Practices differ in so many ways.
• Infrastructure and design• Design of building• Computer systems• Appointment systems (5min, 7min, 10 min etc)• On Call, Home Visit Procedures
• Patient population• Ethnic makeup• Age range• How well trained patients are (in terms of self-care)
• Whether teaching practice or not• Relationships
• Between doctors• Between different teams
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Preparation 1 – Change your mindsetBecause practices differ in so many ways…• It’s illogical to have ‘one rule for all’• Don’t be so rigid about things - yes, there is a business relationship
but that doesn’t mean you can’t bend the rules and be flexible.• Although you need to be business like, there is no need to be
autocratic – like an Alan Sugar like person. • Practices are likely to use you again if they like you – so be
personable.
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Preparation 2 – Work out your work
Start early!
• Where do you want to work? Which regions?
• When do you want to work? Everyday?
• How much do you want to work? 2h surgeries, 3h
surgeries?
• What type of work do you want to do? Just
surgeries, on-call, home visits? OOH?
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Preparation 3 – Certificates & Registers
Start early!
REGISTERS TO GET ON
• Performer’s List (WYCSA)
• Information Commissioner (for handling personal data & information):
https://ico.org.uk/for-organisations/register/
• HMRC as ‘self-employed’ - HMRC business taxes, Self assessment, Class 2 NIC
CERTIFICATES TO GET TOGETHER
• CCT certificate
• GMC certificate
• BLS certificate
• Safeguarding certificate (Child & Adult)
• Indemnity cover certificate
• DBS certificate – do it online: https://www.gov.uk/dbs-update-service
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Preparation 4 – The Doctor’s Bag
Start early!
• Stethoscope, Auroscope, Ophthalmoscope, Thermometer, BP &
BM machine
• Headed note paper (of the practice you are working for)
• Prescription pad for the practice you are working for (or print
off ‘blank prescription’ through the surgery’s computer system.
• What emergency drugs do you need to carry?
• Do you need to carry any?
• Get them from a pharmacist (write a private prescription out)
• Aspirin, GTN spray, Salbutamol inhaler, Benzylpenicillin, Water for injections
and syringes.
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Preparation 5 – Your thingsStart early!
VACCINATIONS
• Are you up to date? If not, get boosters etc.
CAR INSURANCE
• Need to update to ‘Home & Business’ use.
GET YOUR CV READY
• Needs to be short and concise – max 2 sides of A4 for locums.
GET A COMPUTER AND FILING CABINET
• To start doing your invoices and things. Try and use an electronic diary like the one
that comes with Outlook for booking sessions in. Develop a website to advertise your
services and perhaps even an online booking system?
OPEN A NEW BANK ACCOUNT
• For locuming work
GET SUPPORTED AND INFORMED
• Sign up to an accountant and seek advice.
• NASGP – National Association of Sessional GPs – sign up https://www.nasgp.org.uk/
• Join a local locum group – if not one available, start one up.
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PREPARATION
MAKING CONTACT
BOOKING
ON THE DAY
INVOICING
OTHER THINGS
Record keeping
Fees
Tax
Summary of locuming
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The Curriculum Vitae• Be concise• Be precise• No more than 2 sides of A4 with a personal statement
• Referees• Clear contact details
• Sent to Practice Managers with a covering mail shot email.
• Via NHS Outlook – select PM group for your desired region
• Do NOT send to GPs re: e-overload
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PREPARATION
MAKING CONTACT
BOOKING
ON THE DAY
INVOICING
OTHER THINGS
Record keeping
Fees
Tax
Summary of locuming
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Booking Work• When & how long for?
• How many patients/visits?
• Any admin. work/other clinics?
• Any on-call?
• Details of surgeries, e.g. start times, breaks
• Fees
• What computer system?
• Do they have a Locum pack?
• Get confirmation in writing
Remember, you can choose what you want to do (even if a PM would prefer someone for visits and tasks but you would
prefer not to). You can cherry pick the nourishing bits of the job.
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PREPARATION
MAKING CONTACT
BOOKING
ON THE DAY
INVOICING
OTHER THINGS
Equipment
Tax & finances
Leave
Summary of locuming
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On the day• Self care – toilet, tea and coffee, panic button• Computer system• Phone system and numbers• Equipment, emergency meds and BNF• FP10’s/MED3’s • Investigations• Referrals• Appointments• Delegation
Say ‘no’ if not appropriate
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PREPARATION
MAKING CONTACT
BOOKING
ON THE DAY
INVOICING
OTHER THINGS
Record keeping
Fees
Tax
Summary of locuming
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Invoices• Use a computer • Keep layout simple
• Clear heading
• Legible figures
• Precise
• Superannuation• www.pennyperfect.co.uk (fab for finances)
messy or complicated - your payment may be delayed
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PREPARATION
MAKING CONTACT
BOOKING
ON THE DAY
INVOICING
OTHER THINGS
Record keeping
Fees
Tax
Summary of locuming
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Record Keeping
• Set time aside for this each week/month • work done
• mileage
• expense receipts
• KEEP ON TOP OF IT• makes invoicing, superann. and self assessment a lot
easier
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Fees• ‘BMA-suggested’ locum rates ruled anti-competitive in 1999• Locums and Practices must negotiate rates
• You must have a base to start from:• Sign up to NASGP.ORG.UK – they provide an audit of rates in
various regions (helps you decide what you might like to charge)• Speak to other locums• Ask the practice manager what they normally pay
• Vary rates• surgery only
• on-call Learn the art of negotiation
• hourly/sessional• You can even charge different practices different rates • As doctors we are not trained up to financially negotiate. But it
becomes easier the more your practise. We negotiate management plans with patients!
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Tax
• Self Assessment +/- accountant
• High interest savings account• Save about 1/3 of your monthly earnings
• Make payments twice a year (Jan & July)
• Don’t touch it until after you receive your tax bill!
• Don’t be fooled if low tax return in first year
PAY TAX ON TIME (31st Jan deadline) - otherwise you will be fined and charged
interest!
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Other Finances• National Insurance
• Class 2 contributions• Monthly direct debit
• NHS Superannuation scheme• Locum form A (give to practice with invoice) and form B• Personal pension contribution by cheque
• Income protection
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Extras
• Long-term locums
• Locum agencies/chambers
• Cancellation policy
• Details of other locums
• Continuing Professional Development
• Appraisal/Revalidation
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Potential pitfalls of locuming• Being poorly organised • Abuse by practices• Income
• unpaid leave/no sick benefits• hidden costs• appraisals
• CPD • Isolation (so join or form a local locum group)
• Not being able to say ‘NO’
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Enjoying it!
• Own boss
• Flexible & varied
• Cherry pick the things you like doing (e.g. can say
no to home visits)
• Income can be good
• Gain insight into workings of different practices
• Good way of finding the right practice for you in
the future - networking
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Useful websites & contacts• Institute of Chartered Accountants of England & Wales: www.icaew.co.uk
• HM Revenue & Customs: www.hmrc.gov.uk (registering as self-employed)• www.hmrc.gov.uk/selfemployed/register-selfemp.htm
• Register with the Information Commissioner (because you are handling personal data & information): https://ico.org.uk/for-organisations/register/
• NHS Pensions: www.nhsbsa.nhs.uk/pensions
• National Association of Sessional GPs: www.nasgp.org.uk
• Financial management software: www.pennyperfect.co.uk
• Example of a locum website: www.drilyons.com
• BNF: 01268 495600 [email protected]
• Newly Self-Employed Helpline (Inland Revenue): 0300 200 3504
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Locuming Made Simple
• Preparation is key
• Keep on top of finances & record-keeping
• Avoid pitfalls and enjoy the benefits!