Abstract
Introduction
Like all businesses, a general practice is a business that needs a supportive organisational structure. GPs must ensure that their organisational structure is underpinned by qualified and professional clinical and administrative staff who are not only responsive, but adaptive to their needs. Staff should be seen as being an investment in the business and clinical side of general practice.
Attached to investment there is responsibility. Apart from the legal responsibilities, there are also the demands of human resource management. If it is accepted that staff are one of the most important assets in general practice, then it is essential that they are able to work to their full potential, whilst fulfilling the role that the GP expects of them to the standard that the service demands.
This chapter will cover the essential points relating to employment law and give some specific guidance on elements of human resource management, which hopefully will go some way towards assisting the GP and/or practice manager to develop a support team that will meet the ever-increasing demands of such a dynamic area of the health service.
Due to the complexity and variety of employment law and aspects of human resource management it is not practical to give specific examples in many areas. It is worth commenting, however, that in all situations the measure of good practice will always be that which is deemed ‘fair and reasonable’. If ever you are in doubt as to what course of action to take, always stand back from the situation and objectively assess which action would be considered by all parties involved to be the most fair and reasonable approach. The authors cannot accept any liability for information supplied in this section, as complete or dependable interpretation of the law can only be offered by a lawyer or another suitably qualified individual or organisation.
We have attempted to address the areas that form the very broad heading
Please also note that this chapter has been related to the English system. The authors are not aware that there are any significant differences between the employment laws and practices in England, Wales, Scotland and Northern Ireland. However, practice managers in the latter three countries may prefer to check just to be sure. If any differences are noted, the authors would be grateful for feedback.
Role of the GP within the management structure
There are now many different models of primary care operating within the UK. However, the traditional practice owned and run by GPs, usually with the assistance of a practice manager, is still the most usual model of primary care provision. In some cases the practice manager is also a stakeholder in the business (e.g. business partner), in others simply an employee. This section focuses on the management roles of the GPs within traditional-style practices.
Every practice is different and so the management roles of the GPs within the practice will differ considerably from practice to practice. Whatever management roles the GPs within a practice have it is important that:
each individual’s role, responsibilities and limits are clearly defined
there are good lines of communication between those with management responsibilities.
Management roles and responsibilities of GPs
In most practices the management tasks are broken up, with the practice manager having day-to-day responsibility for every aspect of the smooth running of the practice, and GPs taking responsibility, in cooperation with the practice manager, for specific aspects of management (Figure 4.1). For example, one partner may be responsible for training and education within the practice, another for dispensing (if the practice is a dispensing practice), and another may be involved in staff relations. Where things have begun to change, especially in England, is where GPs and some practice managers have taken on additional responsibilities both within and outside the practice:
outside the practice: Clinical Commissioning Group (CCG) Leads (Governing Body, special interest directors), primary care roles within provider organisations; federation/network/syndicate lead roles (with practices working as a collective), Local Medical Committees
within the practice: additional roles to link the practice into wider locality-based initiatives (linked to the CCG or the network).
Division of management tasks in the Rainbow practice between the practice manager and GPs.
This is leading to the emergence of some portfolio working, and additional management training for the respective GPs and managers.
In some practices a GP (partner or salaried) takes responsibility for one part of the management of the practice and remains in that role permanently. In other practices roles are rotated at regular intervals to ensure that all GPs (often partners, but also salaried GPs in some cases) who are involved with management have knowledge of every aspect of the practice.
In almost every case, the practice manager supports the GP manager in his or her management role, whatever that is. The degree to which GPs take on management tasks varies considerably from practice to practice. It is important for practice managers to have written agreements about what decisions they need to involve the managing GPs (likely to be partners) in. Allowable financial expenditure is an example. For instance, the practice manager might have permission to spend up to a certain amount of money for practice needs without specific consent from the managing GP, but expenditure above a certain amount may need to be agreed by the managing GP or even the whole partnership.
The majority of GPs have very little formal management training. Some enjoy their management responsibilities, whilst others find them a chore. These factors will affect the management style of the GP and also the degree of autonomy that a practice manager is allowed when running a practice, or even just specific aspects of a practice. For a practice manager, judging the level of involvement to have in any particular management task can be difficult, particularly if roles are rotated.
Pat has been practice manager at the Rainbow practice for 3 years. The practice has five GP partners and is situated in a busy market town. The partners all have clearly defined areas of responsibility that they had before Pat joined the practice.
Dr Brown really enjoys the management side of the practice. She is the lead partner for clinical commissioning and Pat has found that she can leave her to that task, with very little assistance. However, Pat also knows that she cannot assume any responsibility for tasks in this area herself without first discussing and clearing it with Dr Brown.
Dr Green hates anything to do with management. He is responsible for recruitment and staff relations. Pat constantly has to chivvy him to get tasks done and it is often easier to do tasks herself than to badger him to do them. He is happy for her to do that and shows no interest at all when she consults him on staffing issues.
Communication
Because the management tasks are usually broken up between the managing partners of a practice, it is vital that everyone in the management team has a common vision of how the practice should be run and is working towards shared goals. Depending on the size of the practice and the relationship between the partners in the practice, this can be achieved in many ways. However, it is becoming more and more common for all those involved with the management of the practice to hold a strategy meeting at least annually to review their progress over the past year and formalise their goals for the future (Figure 4.2). It is good business practice for practices to produce a formal business plan (sometimes known as a Practice Development Plan) as a result of that meeting to ensure that everyone has agreed on the targets that they are working towards and on their individual roles and responsibilities, and to help keep everyone on track.
Ensuring coordinated action of the practice management team.
Once a business plan has been formulated, ongoing monitoring of progress is essential in order to:
ensure that everyone is following the business plan
coordinate the actions of the practice
provide flexibility to manage unforeseen events.
Usually this monitoring takes the form of a weekly practice business meeting. All meetings should be minuted. When keeping records of such meetings, it is important to record who is responsible for any tasks allocated and a time frame for each task to be completed within. This evidence can also be useful for regulatory inspections by organisations such as the Care Quality Commission (CQC), and payers, such as NHS England.
Management disputes
In any practice there will be times when the practice manager will not agree with the GPs, or individual GPs will disagree on the right course of action. Such disagreements can be a source of significant discord within the practice and even lead to partnership breakdown.
The way in which disagreements are dealt with varies from practice to practice, but it is important that there is a clearly defined way that practice management policies are agreed upon. Different policies will suit different practices. Commonly used policies include the following:
Majority decision – this is probably the most frequently used method of decision making. However, factions commonly form in practices, and majority decision making can result in decisions always going the way of the bigger or dominant faction.
Veto – the decision cannot go through if one or in some cases two individuals vote against the proposal. This prevents individuals from being sidelined, but can stifle development, particularly in bigger practices.
Another common source of discord occurs when decisions are made in the absence of the practice manager or one of the managing GPs. For a large proportion of each year, one or more of those involved with the management of the practice will be away. The decision making process of the practice cannot stop when the full management complement is not there, so there must be a policy in place to deal with decisions made at these times. Again, different policies will operate at different practices. Options include proxy voting, allowing decisions to go through where the majority decision is present whatever the vote of the absent manager, or classifying decisions as minor or major and allowing minor decisions to go through without everyone’s opinion being known. Each has pros and cons.
The weekly business meeting at the Rainbow practice has become very heated. Dr Brown and Dr White think that the practice should employ an additional salaried GP to make workload lighter. Dr Green and Dr Redman do not want to invest any more money in staff salaries. Dr Black is on holiday.
Pat, the practice manager, steps in and points out that, as this is a major decision affecting income and expenditure of the practice, no decision can be made until Dr Black’s opinion is known.
The following week, Dr Black is back. He has been lobbied by both factions and is already fed up with the argument about employing an extra salaried GP. He is approaching retirement and really doesn’t care whether a new GP is employed or not as it will not really affect him. He abstains from voting, leaving a split decision.
Pat consults the practice agreement, which states that, in the case of major decisions, where a decision is split, a power of veto applies. She puts this to the meeting and Dr Green vetoes the proposal.
Relationship between the managing GPs and the practice manager
Being a practice manager is a very challenging role. Not only are you the manager of a hectic business, but you must also manage the GPs who own the business – who are often also your employers. Those individuals know the practice well and often have very strong views about how the practice should be run. On the other hand, they may have limited experience of how to run a business and it is in their interests that the business should be run well and at maximum profit. Successful practice managers are those who are respected by the managing GPs as the overall coordinators of management activity within the practice, and can tread the fine line between accommodating the wishes of the managing GPs and knowing when to exert their own authority.
Preparing for new members of staff
Once the need to recruit a new member of staff has been decided, you have an ideal opportunity to review the essential requirements of being an employer, some of which are considered below.
Employers’ liability insurance
Employers are required by law to insure against liabilities arising from bodily injury or disease sustained by their employees in the course of their employment. Failure to obtain insurance can result in:
prosecution for breach of statutory duty to insure
an employer having to bear the full cost of a successful court action brought against them by an employee.
An Employers’ Liability Certificate of Insurance must be displayed in the practice.
Health and safety
As an employer, the health and safety of your workforce should be paramount. There is a great deal of legislation in relation to health and safety at work. There is general legislation that defines the broad obligations of every employer, and specific legislation applying to prescribed premises or processes. Legislation that applies includes the Health and Safety at Work Act 1974, Management of Health and Safety at Work Regulations 1999, Health and Safety (Consultation with Employees) Regulations 1996, Safety Representatives and Safety Committees Regulations, and in addition there are a number of considerations every organisation, however small, must take into account:
providing a safe and secure working environment
protecting the public from workplace dangers
providing Employers’ Liability Insurance (minimum cover of £5 million from 1st January 1999)
displaying health and safety posters and signs
reporting of injuries, diseases and dangerous occurrences.
The Health and Safety Executive (HSE; www.hse.gov.uk) provides publications to give additional help and guidance in all areas.
Employers’ duties
It is the duty of every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees. The Health and Safety Executive (HSE) states:
All workers have a right to work in places where risks to their health and safety are properly controlled. Health and safety is about stopping you getting hurt at work or ill through work. Your employer is responsible for health and safety, but you must help.
It also outlines the responsibilities of the employer and the employee:
The employer
Consider any harm that could affect your employees during the course of their work and take the appropriate precautions to stop it. This is part of risk assessment (see below).
Explain to staff how risks will be controlled and who is responsible for this.
Consult and work with your staff and any health and safety representatives in protecting everyone from harm in the workplace.
Provide health and safety training.
Provide equipment and protective clothing to employees where appropriate.
Provide toilets, washing facilities and drinking water.
Provide adequate first-aid facilities.
Report injuries, diseases and dangerous incidents at work to the HSE via their Contact Centre: Ⓣ 0345 300 9923 Ⓦ www.hse.gov.uk.
Have insurance that covers your staff in case they are hurt at work or ill through work.
Display a hard copy or electronic copy of the current insurance certificate where it is readily accessible.
Work with any other employers or contractors sharing the workplace or providing employees (such as agency workers), so that everyone’s health and safety is protected.
The employee
Follow the training you have been offered when using any work items the practice has given to you.
Take reasonable care of your own and other people’s health and safety.
Cooperate with the practice as the employer on health and safety.
Tell someone (manager, supervisor, health and safety representative) if you think the work or inadequate precautions are putting anyone’s health and safety at serious risk.
The Management of Health and Safety at Work Regulations (1999) lay out the expectations required in managing health and safety in the workplace. In summary, practices that employ five or more employees should have both a written health and safety policy and a written risk assessment.
Risk assessment
A risk assessment is just that: an assessment of the risks that may cause harm to your staff or anyone else who accesses your premises. It is a careful examination of what can cause harm to people and how. The assessment should be a simple process supported by any actions you have taken to alleviate the risks you have identified. The HSE provides a simple tool and a form to record your findings (the assessment has to be in writing if you employ more than five people). You should also update your assessment on a regular basis as the organisation evolves. If you should identify too many risks to deal with immediately, the HSE would be happy to see an action plan for making the improvements defined as necessary.
Health and safety policy
Your health and safety policy should be a simple document that sets out how you manage health and safety at the surgery and who is responsible for doing so. Again, if you employ more than five people it is compulsory that you have a policy in place and act within it. As mentioned earlier, the HSE will supply sample documents to guide you.
Anyone starting out in practice management or simply wanting to refresh their knowledge on health and safety will find the HSE’s website very helpful: http://www.hse.gov.uk/toolbox/managing/index.htm
Employees’ duties
It is the duty of every employee while at work:
to take reasonable care for the health and safety of themself and of others who may be affected by their acts or omissions at work
as regards any duty or requirement imposed on their employer or any other person by or under any of the relevant legislation, to cooperate with them as far as is necessary to enable that duty or requirement to be performed or complied with.
No person, including an employee, may intentionally or recklessly interfere with or misuse anything provided in the interests of health, safety or welfare in pursuance of health and safety legislation.
Control of substances hazardous to health
The Control of Substances Hazardous to Health (COSHH) Regulations 2002 (as amended) (Ⓦ www.hse.gov.uk/coshh) provides a legal framework to protect people against risks from hazardous substances used at work. In general practice examples include liquid nitrogen for benign lesions and oxygen cylinders for emergency situations.
All employers have to consider how the COSHH Regulations apply to their work. The Regulations set out essential measures that organisations have to take. It is a useful tool for good management, and failure to comply can leave an organisation open to prosecution.
Complying with COSHH involves:
assessing the risks to health arising from your work
deciding what precautions are needed
preventing or controlling exposure
ensuring that control measures are used and maintained
monitoring exposure
ensuring that employees are properly informed, trained and supervised.
Assessing risks and deciding on precautions
First look at the work to decide whether any hazardous substances are present. If substances are bought in, check the safety data sheet.
Think about the risks presented to people’s health. If there are significant risks, decide on appropriate action to remove or reduce risks to suitable and practicable levels. If risks are trivial no action is required.
Responsibility for the assessment rests with the employer, but the task may be delegated to a member of the team. Whoever carries out the assessment will need to:
have access to and understand the requirements of the COSHH Regulations and appropriate Approved Codes of Practice
have the ability and authority to acquire all necessary information and the skills and knowledge to make decisions regarding risks and precautions needed.
Identifying hazardous substances
If the substance is bought in, check the safety information (suppliers are required by law to include this on labels and in safety data sheets).
Use existing knowledge of the work done in your workplace and any health problems related to it.
Ask other practices for their experience and advice.
Check whether any substances are mentioned in the COSHH regulations, HSE guidance (e.g. Chemicals [Hazard Information and Packing for Supply] Regulations [CHIP]), etc.
Check any other available literature or documentation.
Significant risks
To identify any significant risk presented by any substance in the workplace, consider the following:
How much is used? Small quantities of toxic substances, used in normal circumstances, may present no significant risk (e.g. solvent-based marker pens).
How often is the substance used?
How hazardous is it?
Who might be affected? Consider employees, contractors, patients and the public.
What is the exposure risk? Could the substance be breathed in, swallowed (via
contamination of fingers, etc.) or absorbed through the skin?
Are effective measures already in place to prevent or control exposure?
Do you have appropriate protocols/guidance in place to avoid exposure due to worker error?
Follow manufacturers’ advice on storage, use and disposal. Do not forget cleaning and maintenance activities. If you have employees who work away from the premises, include their work activities in your assessments.
Prevention, control and monitoring
Wherever practicable, prevention of exposure is the best option. Change the process or activity so that the hazardous substance is no longer required.
If prevention is not reasonable, ensure adequate controls to minimise exposure. Reduce to the absolute minimum the number of people exposed to the risk. If necessary, provide personal protection to achieve the control (e.g. surgical gloves, sharps bins, etc.). Ensure that substances are only used for the intended use and that their use is controlled as recommended.
Record and review all aspects of the assessment. Unless it is so simple that you can easily recall and explain your conclusions at any time, it is advisable to have a written or computerised record. Use common sense and include enough information to show how decisions about risks and precautions were arrived at. Use the assessment as a ‘living’ document and feed in practical experiences as they occur. Review it at least every 5 years, whenever any part of it is no longer valid, and whenever there is a significant change to the work or work practices.
Informing, instructing and training employees
COSHH places a requirement on all organisations to ensure that all employees are informed, instructed and trained in the following areas:
the nature of substances they work with and the risks associated with exposure
any necessary precautions
control measures, their purpose and how to apply them
the use of protective clothing or equipment provided
results of any exposure in monitoring and health surveillance
emergency procedures.
Further information and a free online tool is available from Ⓦ www.hse.gov.uk/coshh/essentials/index.htm.
Asbestos at work
The Control of Asbestos Regulations 2006 require employers who have responsibility for the maintenance and repair of their buildings (even if they don’t own them) to find out whether there is asbestos in their premises, how much of it there is and what sort of condition it is in. If asbestos is identified, a record of the place and condition of the asbestos must be maintained. As with a standard risk assessment, a plan should be made as to how the risks created by asbestos will be managed. Again, further information can be obtained from the HSE.
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)
RIDDOR is the law that requires employers, and other people in charge of work premises, to report and keep records of:
work-related accidents that cause deaths
work-related accidents that cause certain serious injuries (reportable injuries)
diagnosed cases of certain industrial diseases, and
certain ‘dangerous occurrences’ (incidents with the potential to cause harm).
Fortunately, for most organisations a reportable accident, dangerous occurrence or case of disease is a comparatively rare event. There are, however, some incidents that must be reported (if connected with work or at the place of work):
Death or major injury to an employee, a self-employed person or a member of the public. In these instances the notification must be made to the enforcing authority without delay (e.g. by telephone). This must be followed up within 10 days by a completed accident report on form F2508, available from the HSE, or it can be completed online at ® www.hse.gov.uk/riddor.
Accidents involving an employee or self-employed person that result in incapacity for normal work for more than 3 days (including non-working days). Notification is to be in writing.
Reportable diseases (these are all related to particular work activities), including: — certain poisoning — some skin diseases (e.g. occupational dermatitis, skin cancer, chrome ulcer, oil folliculitis/acne) — lung diseases (e.g. occupational asthma) — infections such as hepatitis, tuberculosis and tetanus — other conditions, such as occupational cancer and certain musculoskeletal disorders.
A full list of reportable diseases can be found in the regulations, or simply ring the HSE to check. Notification is to be in writing.
Dangerous occurrences. If something happens which does not result in a reportable injury but clearly could have done, then it may be a dangerous occurrence. Again, these are listed in the regulations, or ring the HSE for advice. The notification must be made without delay (e.g. by telephone) and followed up within 10 days by a completed accident report.
You must keep a record of any reportable injury, disease or dangerous occurrence. This should include the date, time and place of the event; personal details of those involved; a brief description of the event or disease; and the date and method of reporting. The record could be copies of report forms, a computerised summary or a written log.
A comprehensive guide is available from the HSE’s website (www.hse.gov.uk). Current addresses of the HSE are included in the Useful Contacts section of the Appendices under ‘Employment Medical Advisory Service’.
Infection control is important for the safety of patients and staff (see page 6-32).
Health and Safety (Display Screen Equipment) Regulations 1992
These regulations cover a new area of work activity under the health and safety at work legislation.
Minimum requirements and risk assessment
Every employer must perform a suitable and sufficient analysis of every workstation to ensure that they satisfy minimum requirements (e.g. tilt-and-swivel screens, moveable keyboards, adjustable chairs, etc.). This analysis should provide an assessment of any health and safety risks to which people using the workstation may be exposed.
The assessment should cover the following aspects:
equipment (display screen, keyboard, any optional extras to the display screen equipment, any disk drive, telephone, modem, printer, document holder, work desk/surface, work chair or other item peripheral to the display screen equipment)
environment (space, lighting, reflection/glare, noise, heat, radiation, humidity)
interface between computer and user/operator (systems and software ergonomics).
Any risks identified should be remedied as quickly as possible. The components that make up a workstation are the display screen equipment, any optional extras to the display screen equipment, any disk drive, telephone, modem, printer, document holder, work chair, work desk, work surface or other item peripheral to the display screen equipment; and the immediate environment surrounding the display screen equipment. All workstations must meet the requirements.
Daily work routine
The regulations place on the employer the duty to ensure that the activities of users are planned such that daily work on display screen equipment is periodically interrupted by breaks or changes in activity to prevent fatigue.
Eyes and eyesight
The employer also has the duty to ensure the provision, on request, of an appropriate eye and eyesight test carried out by a competent person. The employer must provide any special cor- rective appliance (spectacles) that is found to be necessary in order to undertake work with display screens. The provision of the eye and eyesight tests and of special corrective appliances is at the expense of the employer. Employers may specify a particular company or professional to undertake the tests and provide the appliances. The employer is only liable for the cost of the basic appliance (i.e. of a type and quality adequate for its function). If the user wishes to have an appliance more expensive than the basic option, he may be liable for the extra cost involved.
Training
The employer must provide users with adequate health and safety training in the use of any workstation upon which they may be required to work. Such training should cover:
the user’s role in correct and timely detection and recognition of hazards and risks
a simple explanation of the cause of risk and the mechanisms by which harm may be brought about
user-initiated actions and procedures that will bring risks under control and to acceptable levels
organisational arrangements by which symptoms or problems with the workstation can be communicated to management
information on the regulations
the user’s contribution to assessment.
Information
Operators and users should be provided with adequate information about all aspects of health and safety relating to their workstations. They should be advised of the measures that the employer has taken as a result of risk assessment and compliance with the minimum requirements for workstations. They should also be advised of measures that have been taken in relation to daily work routines and regarding health and safety training in the case of substantial modification of the organisation of a workstation.
Fire safety
The Fire Safety Order (2005) (for England and Wales) came into force in October 2006 and supersedes much (but not all) of previous legislation regarding fire safety management.
If the partners of your practice own the premises that you work from, then they are responsible for the fire safety of that building and as such must carry out a detailed risk assessment particularly relating to fire. This should be in addition to your standard risk assessment. The assessment should be carried out by a responsible person who will be named as such.
Your local Fire and Rescue Service will be happy to provide advice for you on any aspects of fire safety.
It is recommended that you have a separate fire safety policy to sit alongside your health and safety policy.
Further information regarding fire safety, fire drills, fire evacuation, fire prevention and the fire team can be found within section 11.
In summary, the preceding paragraphs provide just a short overview of the key areas of health and safety law and management. This is by no means exhaustive. Readers are advised to contact their local HSE office or refer to its website to ensure they remain up to date with current requirements or legislative changes.
Corporate manslaughter/culpable homicide
Individuals whose actions lead to the death of another person are liable under Health and Safety legislation and the law of manslaughter. However, it has proved difficult to secure convictions in several high profile cases, e.g. rail crashes, where there were clear organisational failures that led to deaths but the organisation was so large that no one person could be identified as responsible for negligence. The 2007 Corporate Manslaughter and Corporate Homicide Act, which became law in 2008, enables courts to look at how organisations manage health and safety and allows organisations to be held to legal account where failures of their systems have lead to a person’s death. The offence is called corporate manslaughter in England, Wales and Northern Ireland; in Scotland it is called culpable homicide. The current penalties are an unlimited fine, a remedial order – i.e. an obligation to resolve the management failure, and an order to publicise the offence.
The 2008 law does not replace existing laws: individuals can still be prosecuted for gross negligence or manslaughter/culpable homicide or health and safety offences.
Deaths due to infections such as MRSA.
Deaths related to maintenance work on the premises.
Deaths due to jumping from unsecured windows.
The law does not change the obligations of general practices or the health and safety standards they are obliged to meet, but it does provide a new way for them to be held to account. The practice owes a duty of care to all who use its facilities and will be guilty of an offence if failures of its systems of management amount to a gross breach of its duty of care and lead to a death.
In the light of the 2008 legislation, practice managers may wish to review with their practices the way risks are managed and ensure that practice systems are adequate.
Health and safety procedures and practices
COSHH
staff job descriptions, induction, education and training
identification of a health and safety officer
reporting, analysis and follow-up of significant events
insurance policies.
Further information:
The text of the law is available from the Office of Public Sector Information: Ⓦ www.legislation.gov.uk
Guidance is available from the Ministry of Justice, Ⓦ www.justice.gov.uk, or the Northern Ireland Office, Ⓦ www.nio.gov.uk, and from the HSE, Ⓦ www.hse.gov.uk and the HSE for Northern Ireland, Ⓦ www.hseni.gov.uk
SETON (Signs, Labels and Solutions for a Safer Workplace) offers guidance and links: ® www.seton.co.uk
Recruitment and selection
Identifying the need
This may sound overly simplistic; however, it is often the area most overlooked. If development has created a new post then the need is usually established; if an employee is leaving, all too often the reaction is simply to replace them.
A vacancy presents a valuable opportunity to look at the needs of the practice and how the present workforce meets those needs. Is the job currently being done actually necessary, and if so how does it fit in with or complement the work done in other areas? Have changing work patterns, organisation or technology produced a different need – is it the same job? Are there any future changes anticipated that will require additional or different skills?
Perhaps the answer is not to replace but to restructure. Can another post be enhanced or modified to cover the work needed? Would an internal transfer or promotion be more effective?
The easiest and most effective way of evaluating the job needs is to produce or review the ‘job description’ (Example 3.1). To provide a good job description the following points should be covered:
The purpose of the job – what is the objective of this particular post?
Position – what are the reporting relationships?
Main duties of the post – a list of the key tasks that will form the parameters of the job.
Specific tasks – outline of specific tasks within the main duties and the way in which they should be done.
Working relationships – the personnel both within and outside of the practice who the post holder must liaise with to accomplish the job.
Any specific characteristic or requirement not apparent from the title or main duties of the post.
To enable the job description to be accurately compiled there must be a clear understanding of the needs of the job. How does the job relate to other positions within the practice and how does it contribute to the overall objectives of the practice?
The length and complexity of job descriptions will vary according to the job involved, but a good, simple description is valuable even when recruiting for the most ‘straightforward’ position. It will also minimise potential difficulties and confusion as to the exact duties of the post.
Once the job description has been completed, an interpretation of the kind of person needed can be drawn up – the ‘personnel specifications’ (Example 3.2).
It is necessary to look at the physical and social environment in which the job will be done – what benefits will apply, salary, transfer and promotional prospects, etc. should be considered.
Utilise number system to ensure efficiency of appointment system and monitor flow of patients into consulting and treatment rooms. Ensure that patients without appointments but who need ‘urgent consultation’ are seen in a logical and non-disruptive manner. Explain practice arrangements and formal requirements to new patients and those seeking temporary cover; ensure procedures are completed. Advise patients of relevant charges for private services; accept payment and issue receipts for same. Respond to all queries and requests for assistance from patients and other visitors. Enter requests for home visits into visit book stating time received and including all relevant information and where necessary refer to the duty doctor. In conjunction with the repeat prescription officer ensure that requests for prescriptions are actioned where possible within one working day. Action requests for ambulance transportation and enter details in appropriate book. Ensure reception and waiting areas are kept neat and tidy.
Where they are used, ensure total familiarity with all appointment systems in effect including regular and incidental variations. Book appointments and recalls ensuring sufficient information is recorded to retrieve medical record. Monitor effectiveness of the system and report any problems or variations required.
Ensure that all records are accurately assembled in advance for each consulting session. Ensure that the record is available for the doctor in the instances of urgent consultation. Retrieve and re-file records as required, ensuring that strict alphabetical order is adhered to. Ensure correspondence, reports, results, etc. are filed in correct record. Ensure records are kept neat and tidy and in good repair with all necessary information recorded correctly on the outer cover.
Ensure that the consulting rooms are prepared in readiness for each consulting session, checking full range of forms and requirements and re-stocking as required. Ensure that the consulting rooms are checked at the end of each consulting session and left tidy and secure.
Receive and make calls as required. Divert calls and take messages as appropriate. Ensure that system is operational at the beginning of each day and switched over to night service and answerphone operational at the end of each day.
Open up premises at the start of day, set alarm to day function and make all necessary preparation to receive patients. Secure premises at end of day, ensure the building is totally secured, internal lights off and alarm activated.
An understanding, acceptance and adherence to the need for strict confidentiality. An ability to use own judgement, resourcefulness, common sense and local knowledge, to respond to patients’ enquiries and requests. Excellent communication skills.
The level of skill, knowledge, experience and performance required would all be areas covered in a useful personnel specification. It should describe the ideal person to fill the job, giving a profile of personal skills and characteristics to look for in the recruitment and selection process. It should also overcome one of the most common weaknesses of interviewing – lack of common understanding of exactly what is sought in a candidate. The personnel specification becomes the tool for finding the most suitable person to fill a job. It should set a standard against which all candidates may be judged. When setting such a standard there are two issues that should be considered:
Attributes that are included should only be those that are relevant to the ability of the person to do the job. There must be no unjustified discrimination.
When setting standards it is important that they are reasonable and flexible enough to be able to recruit to the specification. Essential attributes and contraindications should not be over-specified to avoid the risk of making it impossible to find an applicant with a rare combination of attributes. It will be hard work finding a graduate if the post and salary equate to those of a cleaner.
Remember also that when setting standards for qualifications and experience or personal qualities there is a requirement that you ensure that there is no unfair discrimination against racial groups, a candidate’s sex, age (from October 2006), any disability, etc.
Standards set should be considered under three headings:
Essential attributes – without which the job could not be performed to the standards required.
Desirable attributes – preferences that would enhance the post holder’s ability to ‘fit in’ or be trained more easily.
Contraindications – any characteristic or circumstance that would be unacceptable in a prospective post holder.
Always use precise wording when setting standards; words such as ‘good’, ‘average’, ‘reasonable’, may be interpreted very differently by different people. Only if the person setting the standards will also be interviewing and selecting can such vague definitions be acceptable.
Pleasant reception office in modern, purpose-built medical centre. Brisk and friendly atmosphere. Busy and constant patient contact both in person and by telephone. Direct supervision from senior receptionist.
Weekly staff terms.
Grade defined for the post (if appropriate).
Neat, tidy appearance.
Able to move briskly between desks and records storage.
Dexterity of hands to enable filing of records and retrieval and re-filing of record envelopes.
Clear, legible handwriting.
Ability to communicate verbally both face-to-face and by telephone. Preferably some previous receptionist or clerical background. Preferably some keyboard skills or knowledge.
Ability to use own judgement, resourcefulness, common sense. Ability to recognise and adhere to need for strict confidentiality. Preferably some local knowledge.
Self-reliant, helpful, friendly.
Within easy reach of the medical centre or with own reliable transport. Reliable and flexible.
Obvious shyness.
Attracting candidates
If one position is available, then in theory it is only necessary to attract one candidate. The object is to prompt someone who meets the personnel specifications to apply for the job. A deliberate appraisal of the prospective candidate market must be made to decide on the most appropriate form of attracting the right person. Recent successful recruitment may already have identified the most appropriate source. External sources worth considering may also include the local job centre, careers offices, employment agencies, professional journals and local newspapers. The relevance of external sources will vary according to the type of post to be filled.
If the post is to be advertised, then ensure that the advertisement will attract only those candidates who are able to do the job and are willing to do it for the terms and benefits offered. To this end it is preferable to either identify the hours and salary etc. offered, together with a good general description of the job available, or use the advertisement to prompt contact ‘for further information and job description’. Advertising can be an expensive commodity, especially if it does not produce the desired result. It should therefore never be rushed into but given the same amount of consideration as all other areas of recruitment.
8.30 a.m. to 1.30 p.m. Monday to Saturday inc. £8,450 p.a. (subject to annual review).
This is a permanent position in a brisk, friendly medical centre and would suit a capable, reliable person with plenty of common sense. Previous reception or clerical experience would be an advantage but full training will be provided. If you enjoy lots of personal contact in a responsible job, a job description and application form (to be completed and returned by 14 April 2021) are available from the Practice Manager, Mrs H White, at the above address.
Assessing candidates
Assessing the candidates presupposes that the person assessing is competent to do so. That competence should come from training and practical experience. There are many tools and techniques available to support the assessor, but skill and discretion are needed in their application.
The application form
This immediately raises the question: why do we need an application form? There are several benefits of an application form:
it makes it easier to compare like with like
the practice, not the applicant, determines what information is provided
the application form can provide the basis for interview
the standard of completion may be used as a guide to suitability for the post
a record of education, qualifications and work experience avoids disagreement over information given prior to selection
it is often easier for applicants to answer specific questions than to frame an application themselves.
For many jobs it is possible to eliminate a number of applicants without even interviewing them, if there is sufficient written information to make a reasoned judgement. An application form, if properly designed, administered and interpreted, will provide a wealth of relevant information. Its purpose should be to ask pertinent questions to elicit relevant answers in order to enable the assessor to identify whether the candidate meets the requirements of the personnel specification. Subsequently it is a valuable framework around which to base the interview. It will also provide the basis for a record of the reasons why particular applicants were unsuccessful.
Aptitude tests
There are many aptitude tests available, which vary from simple mechanical tests to sophisticated personality profiling. It is essential that any aptitude testing is demonstrably relevant to the job offered and that the person administering the test is competent to do so.
References
There are also many and varied forms of references available and the value of them is just as varied. Often the information gleaned is more a reflection of the person giving the reference than of the candidate. Factual references giving such information as attainments, skills and experience are of obvious value. Personal references and opinions on attitudes and the potential of candidates should be carefully considered as to their actual worth in the selection process. It is worth phoning for references.
SURNAME: FORENAMES:
ADDRESS:
POSTCODE:
TELEPHONE NO:
PRESENT EMPLOYMENT
PREVIOUS EMPLOYMENT Please list most recent first, maximum of past 10 years only
Name and address of employer From/To Reason for leaving
Please give details of any skills, experience or qualification that you feel would especially suit the job you are applying for.
Please give details of any medical condition or treatment that has caused you significant loss of working time in the past 3 years.
Do you, or have you ever, suffered from any physical or psychiatric condition that could prevent you from carrying out the full range of duties of this post? YES/NO (delete as appropriate).
Please give details of two referees willing to give work references:
Name: Name:
Address: Address:
Occupation: Occupation:
Referees may be contacted:
BEFORE INTERVIEW / AFTER INTERVIEW / AFTER APPOINTMENT (Please delete as appropriate)
I declare that the information given on this form is true and complete to the best of my knowledge.
SIGNATURE:___________________________ DATE:____________________
Disclosure & Barring Service (DBS, previously known as CRB: the Criminal Records Bureau check)
Disclosure of convictions is becoming part of standard recruitment practice, and it is now mandatory for those whose work may bring them in contact with children and vulnerable adults. In England and Wales, the Disclosure & Barring Service (DBS), an agency of the Home Office, provides checks (disclosures) of police records to employers who need verification that potential employees do not have criminal records that would render them unsuitable for work with children and vulnerable adults. Applications for disclosure are made through employers or potential employers. Standard disclosure provides a check of the Police National Computer and government department lists. Enhanced disclosure includes, in addition, a check of local police force records. In Scotland, Disclosure Scotland provides a similar service.
Doctors applying to join an NHS performers list are required to provide enhanced disclosure. The doctor receives the certificate and the primary care organisation (PCO) receives a copy. DBS checks on staff other than doctors are not yet mandatory, but practices can decide to obtain standard disclosure as part of their routine recruitment procedure for staff who have access to patients in the normal course of their duties. Note that the CQC will expect to see a policy showing who needs DBS checks and justification if not. (For further information on who needs DBS checks in terms of CQC guidance, please see the following CQC myth buster: https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-2-who-should-have-disclosure-barring-service-dbs-check.) Note that disclosure will not provide much reassurance about applicants from overseas. If the practice decides staff can work before their check comes through, a mechanism for handling an unsatisfactory disclosure is required.
Further information:
More information on DBS checks:
Ⓦ https://www.gov.uk/government/organisations/disclosure-and-barring-service
Interviewing candidates
This is the most important area of recruitment and selection and the one that is most often ineffectively done. Interviewing should be a two-way process. It is a means for the practice to decide on the suitability of the candidate and for the candidate to decide whether you are the right employer offering the right job for them.
Interviewing has but one purpose; however, there are two ways of failing to achieve it:
Picking the wrong person – poor interviewing will fail to expose contraindications and weaknesses that could be cause for disqualification, or potential problems best avoided.
Missing the right person – poor interviewing can result in failure to draw out details of experience, attitudes and personal qualities that should have been elicited, or losing the right person because that person did not get a good impression of the post, of the terms and conditions of service, or of the interviewer or the practice itself.
A well-organised and well-conducted interview should meet the following objectives:
establish whether the candidate is suitable for the job
ensure that the candidate has an accurate picture of the job
ensure that the candidates are left – whether employed or not – feeling that they have had a fair interview by a practice that would be worth working for.
Interviews should not be rushed either in preparation or in process. Consideration should be given to who is involved in the actual interview (one interviewer who knows what he is doing can be more effective than several interviewers without a plan) and when and where it should be held, and the organisation of the whole process should be carefully planned. If the application form has been properly prepared and completed then all necessary information will be to hand.
The interview provides the opportunity to confirm that the practice interpretation of that information is accurate. Plan questions to probe knowledge, ability, aptitudes, etc. Avoid personal questions not relevant to the job. If there is to be more than one interviewer, allocate subjects to cover different areas.
The interview should also give the candidate an opportunity to cover areas that are not clear or that need further explanation, or to offer such further information as they feel is appropriate for their application for the job. It is also an opportunity for both parties to form an impression of the other and to decide whether on a personal level they can work together.
Interview courtesies
Give all candidates written confirmation of the date and time of interview and clear directions on how to get to the place of interview.
Ensure that receptionists are aware of candidates’ names and times of interview so that candidates are expected.
Arrange for candidates to be offered a chance to take off outdoor garments, use the toilet, wash their hands and generally tidy up prior to the interview (provide a mirror).
Start the interview on time and arrange for the candidate to be escorted to the interview room and introduced to the interviewer(s).
Have the application form and any other relevant documentation available and make sure that everyone involved in interviewing has read and thought about it.
Have a clock visible to the interviewer(s) to avoid any need to glance at a watch.
Explain to each candidate the format of the interview and exactly what you intend to cover.
Make it quite clear when the interview is over and what the next step will be (e.g. second interview, letter within the week, etc.).
If it is obvious that the candidate is unsuitable, make it clear there and then using positive comments such as ‘I don’t think this is the right job for you’.
If the candidate – though wrong for the particular job on offer – is worth further consideration, ask whether they would be interested in any other post if one should arise.
If the candidate seems right for the post, advise them that they have made a very good impression and ensure that they still wish to be considered for the post.
Make the final decision promptly and notify all candidates swiftly.
Pitfalls of interviewing
There are generally three reasons why people make poor interviewers: (1) eyes, (2) ears and (3) tongues.
They don’t look at the information provided, job description, personnel specification, application form, etc. They don’t look at their diary to ensure that interviews are not interrupted. They don’t look at the candidate to assess body language and other non-verbal messages during the interview.
They don’t listen – a good interview will be one where the candidate does at least 60% of the talking. The 40% left to the interviewer should be predominantly offering information and answering the candidate’s questions. A good interviewer will get the candidate talking and then listen both to what is being said and how it is being said.
They don’t speak out in the appropriate places – the interviewer should direct the interview. If there are doubts, raise them; if there are clues, follow them up. Question, probe and guide, but never monopolise.
There are numerous ways of conducting poor interviews:
Lack of preparation, constant interruptions, making no notes, keeping no records.
Writing notes during the interview without first consulting the candidate, or taking long and copious notes during the interview.
Jumping on any inconsistencies or otherwise appearing to be trying to ‘catch the candidate out’.
Interrupting when the candidate is answering a question or making a point.
Aggressive or irrelevant questioning.
Leading the candidate to answers, finishing off the candidate’s answers or answering the question yourself.
Drifting off the point, embarking on boring anecdotes that have nothing to do with the interview or job in question, or allowing the candidate to do either.
Failing to ask relevant questions because they might be unwelcome or embarrassing to the candidate. An obvious gap in the employment history may need to be explored.
Challenging an answer or probing for more information may be necessary to enable the right choice to be made.
Effective interviewing
A delicate balance should be struck between formality and friendliness. The atmosphere should be one that is favourable to both the interviewer and interviewee. Interviews should always be confidential and it is helpful to tell the interviewee that it will be. The interviewee should be put at ease at the earliest possible moment.
If more than one person will be conducting the interview, then appoint a chairperson. The chairperson should welcome the candidate, introduce the other participants and explain their roles and how the interview will be conducted. A single interviewer should welcome the candidates and also explain how the interview will be conducted.
Interviewers should always listen carefully to the answers or comments made by the candidate and try to link further questions to asides and comments on previous subjects (‘You mentioned earlier that …’, ‘Can you tell me a little more about your experiences …’). Try to use comparisons to get the candidate to express opinions and attitudes (‘How do you think that work will compare with …’). This type of leading questioning will avoid a stilted interview and introduce a free flow of discussion and information.
Never close an interview without ensuring that the candidate has had the opportunity to ask questions and provide information that may not have been covered in the interview. Openings could include ‘Is there anything else you would like to know or any details we haven’t covered?’, and ‘Is there anything else you would like to tell us that would support your application?’.
By the end of the interview the candidate and the interviewer will each have formed impressions and accumulated information that was not available before. This new information must be digested and interpreted. If the interview was successful the candidate will have a detailed picture of the job, the practice, the people they could be working for and with, and the conditions of employment. The interviewer will have learned from both their own questions and those asked by the candidate. Throughout the interview they will have been thinking of the attributes needed and the contraindications that may have been identified. The interviewer will now know whether the candidate is suitable or unsuitable.
At the end of the selection process sufficient information should be available to:
eliminate candidates either because they were considered unsuitable or because they have withdrawn
compare suitable candidates to determine the person to be offered the job.
It is essential that records of the reason for selection or rejection are made and kept (perhaps for a minimum of 1 year), to satisfy equal opportunities legislation requirements. You may be required to justify your selection/rejection of candidates. The above provides a summary of the processes on recruitment and selection. These processes come under Regulation 19 (Fit and Proper Persons) of the Health and Social Care Act 2008. So essentially the CQC will be checking that these standards have been meet during recruitment. Essentially it follows best practice but documentation is key. Further information on the exact standards the CQC looks at can be found at https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-19-fit-proper-persons-employed#guidance
Placement and induction, and terms and conditions of employment
Placement
Job offers should always be made or confirmed in writing and should ensure that a candidate does not accept a job without a clear understanding of all its conditions. It is good practice to refrain from notifying unsuccessful candidates until a firm acceptance has been received from the successful candidate. It is also good practice to notify all candidates whether they were successful or not.
The job offer should include details of the start date, any terms and conditions of service not confirmed at the interview, and details of where and to whom to report on the first day. Details should also be given of any particulars they are required to bring with them on their first day.
Contract of employment
A contract of employment exists as soon as an employer makes an offer to a prospective employee and it is accepted. A verbal offer, if accepted by the employee, is deemed contractually binding. However, it is good practice to follow up any verbal offer in writing and ask the candidate to provide a written response. Once the response has been received, a personnel file should be set up. This can be a manual file containing all documents related to the new employee, or a computerised file. There are software packages specific for this purpose; however, some GPs, being small employers, may prefer to improvise using existing software packages. It is essential that any terms specified within the contract can in fact be complied with, or if such terms are offered ‘subject to’ that both parties are fully aware of the conditions and limitations of those offers. If, for instance, a prospective employee is offered a post subject to gaining a qualification it must be clearly understood, preferably with written confirmation, that if the qualification is not achieved then the offer of employment will be void.
Employers must give to the employee a written statement of terms and conditions of employment. Every employee is entitled to receive a written statement of employment particulars within 2 months of the start of employment. This provision also includes those on fixed-term contracts.
The written statement must include:
the names of employer and employee
the date on which employment began
whether any previous employment counts as part of continuous employment and, if so, the date on which such continuous employment began
the title of the job (or a brief job description) that the employee is employed to do
the scale or rate of remuneration or the method of calculating remuneration (including overtime pay)
the interval at which remuneration is paid (e.g. weekly, monthly)
hours of work, including normal working hours
terms and conditions relating to: — entitlement to holidays (including public holidays) and holiday pay — incapacity for work due to sickness or injury and any provisions for sick pay — pensions and pension schemes
the length of notice of termination of employment required from both the employer and employee, or in the case of a fixed-term contract the date on which the contract expires; where the job is temporary, the period it is expected to last
the place of work, or where the employee is to work at various places, an indication of that and of the employer’s address
any collective agreements that directly affect terms and conditions, including, where the employer is not a party to the agreement, the persons by whom they were made. If under any of the above headings there are no agreed terms then the written statement must say so.
Note: The statutory minimum requirement for length of notice of termination is: Termination of employment by employer:
if employed continuously for 1 month or more but less than 2 years: at least 1 week’s notice
if employed continuously for 2 years: at least 2 weeks’ notice
if employed continuously for more than 2 years: at least 1 week’s notice for each completed year of service to a maximum of 12 weeks’ notice.
An employee is required to give an employer:
at least 1 week’s notice if employed continuously for 1 month or more.
If the contract of employment specifies a longer period of notice from employer or employee then the longer period of notice applies. This requirement does not apply where the employee is on a fixed-term contract.
In addition to the particulars identified above, the statement should also include:
details of any disciplinary rules (other than those relating to health and safety at work)
details of any grievance procedures
details of whether any contracting-out certificate under the Social Security Pensions Act 1975 is in force.
The authors have found the Department for Business Innovation and Skills website extremely useful when putting together this information; readers might like to see a sample contract/ terms and conditions of employment. This can be done by logging onto ® https://www.gov.uk/government/organisations/department-for-business-innovation-skills and following the link. The British Medical Association (BMA) also has sample contracts specifically for general practice staff on their website: ® https://www.bma.org.uk/advice.
All new employees must be provided with the new written statement. However, over a period of time it is possible that those terms and conditions may change with mutual consent. For example, a woman returning to work after maternity leave may ask to be considered for part-time work. Providing the employer can accommodate this request, this will be a change in terms. All changes to terms and conditions of employment must be notified in writing following the appropriate consultation process.
IR35 legislation for GP locums and sessional GPs
Many GP locums and sessional GPs have set up limited companies, and for these companies to be paid their gross income. This means such GPs are not on payroll and do not pay tax in the traditional way. They do this to minimise their tax burden as corporation tax through limited companies is lower. But Her Majesties Revenue and Customs (HMRC) has declared this is a form of tax avoidance.
Hence HMRC created IR35 legislation, which forces public authorities (including GP practices) to make an assessment of a GP locum or sessional GP to ascertain whether, taking into account the duties they provide the practice, they should be considered employed from a tax point of view. This does not mean such a GP cannot still be paid through their limited company. But it would be mean the appropriate tax would have to be deducted prior to any payment to that limited company.
Essentially, IR35 looks to rebalance the tax savings that can be achieved by self-employed GPs who use a limited company to provide their work. In the past it was down to the GPs themselves to assess whether or not they were caught by IR35; however, since 6 April 2017 it has been the GP practices that have needed to assess the position.
There is an online status checker which practices can use to assess the employment status of locum staff: https://www.gov.uk/guidance/check-employment-status-for-tax
The checker asks a series of questions through a decision tree to determine the employment status of the contract. The final output of the checker will show one of three outcomes: ‘unable to determine the position’, ‘classed as employed for tax purposes’ or ‘classed as self-employed for tax purposes’. If a GP providing their services via a limited company is deemed to be employed by the practice, then the practice must deduct tax from the payment to the locum GP’s company and pay that money to HMRC.
The result is that employers’ National Insurance Contributions are paid to HMRC and taxes are paid at personal tax rates rather than the lower corporate tax rates. This is a complex area and accountant support may be needed. The risks of continuing to engage a GP through a limited company, if the outcome of the checks is that they are deemed to be employed, include HMRC investigations and fines.
The above should not apply to sole traders, but accountant advice should be acquired to confirm this.
The same principals outlined above would also apply to non-clinicians engaged by the practice and paid through a limited company.
Further guidance can be found via the BMA: https://www.bma.org.uk/advice/employment/tax/ir35-advice-for-locums
Remuneration and benefits
An essential part of an employee’s terms and conditions will be the salary that they will be paid. Many, although not all, general practices have historically chosen to use Agenda for Change NHS terms and conditions; however, this structure is not mandatory for general practice staff. See Ⓦ https://www.nhsemployers.org/pay-pensions-and-reward/agenda-for-change.
Staff uniforms/dress codes
Although pay is the obvious benefit to employees, there are also other benefits that practices may offer to their staff.
One example is the provision of either a staff uniform or the provision of funding that staff may use to purchase their own work wear that would fit into a pre-established practice dress code.
Uniforms or standardised dress codes go a long way towards promoting a professional image for the practice. They ensure that staff are clearly identifiable to patients and visitors.
It is important that practices establish the importance of a standardised dress code, whether it be in the form of a uniform or in the form of a looser understanding regarding dress requirements. The practice should have a policy on dress. Prospective employees should be advised of practice policy on interview, which should be reinforced during induction.
Managers should be empowered to monitor the standard of the uniform worn by staff in their team to ensure that the staff present the required image of the organisation at all times.
When drawing up a uniform policy, you may like to consider the following points:
The point at which a new member of staff is expected to wear a uniform. Will it be immediate or following a period of induction?
Who assumes responsibility for purchase of the uniform? If you use a dress code, you may prefer that staff purchase items from specific outlets. If so this should be made clear.
How often uniforms will be renewed – annually, every other year?
Who assumes responsibility for laundering/dry cleaning? Staff could be eligible for tax relief on cleaning costs and may wish to discuss this with the Inland Revenue in the first instance.
Returning the uniform if a staff member leaves.
Replacement of uniforms if they become worn, torn or ‘outgrown’.
Who does the uniform belong to? Most practices are clear in that the uniform remains the property of the practice.
The consequences of not wearing the required uniform. What staff can expect to be supplied with, i.e. a list of items.
Practice’s view on hairstyles, jewellery, body art and piercings.
Practice’s view on the wearing of name badges.
Preferences of type of footwear.
Does the practice provide specific clothing for maternity wear?
The practice should also ensure that when drawing up their policy they do not fall foul of any of the legislative requirements relating to discrimination.
Many religious and cultural traditions, for example, require particular dress, i.e. wearing the hair in a certain way or wearing head coverings, such as the hijab or turban, or perhaps wearing long or modest clothing that covers the body – to name but a few. These should not generally conflict with practice dress codes; however, flexibility should be shown and efforts made to accommodate individual requirements where appropriate. The personal health and safety of the individual or of others working or visiting the practice should not be compromised; however, when considering this issue, neither should this occur in the case of the dress code of a doctor – the doctor–patient relationship may be compromised when a doctor is wearing a veil. The General Medical Council (GMC), although not wishing to advise medical staff on how to dress, has recently expressed concern that some patients may feel that the wearing of a veil, for example, presents an obstacle to communication and to the building of trust, and advise that if such an instance occurs a doctor should be prepared to respond to the individual’s needs, which may entail putting one’s own beliefs to one side.
Health and safety is an important consideration when deciding upon your dress code and policy.
A practice manager revised the practice dress code following a period of particularly hot weather. Many staff were turning up for work wearing flip-flop style footwear. Not only did this look unprofessional, but it also provided a safety concern as the staff were working in premises that were a converted house (Victorian at that) and were often required to run up and down stairs as part of their daily duties. The manager was concerned that staff would slip down the stairs, at worst causing injury.
Further information:
— Guidance on work wear – Ⓦ www.acas.org.uk
— Specific legislation relating to dress codes can be found by reading: Sex Discrimination Act 1975; Religious or Belief Regulations 2003; and Disability Discrimination Act 1995.
Guidance on staff grading
It is important that practices thoroughly consider their options when reviewing their pay structures as general practice will need to be able to compete with the terms and conditions within the NHS in order to recruit and retain staff. Practice nurses in particular will most likely have been trained within the NHS, and the Royal College of Nursing (RCN) considers that NHS salary levels should be reflected in the rates paid to nurses by other employers. Terms and conditions in hospitals, for example, may be on the surface more appealing than those offered in general practice.
Finally, it is important to bear in mind the cost implications attached to any grading or salary review, because whilst you may wish to offer the principles of Agenda for Change, you should be aware of the financial implications that the new structure will have upon the practice. Some staff (although not all) will be receiving enhanced salaries, and the better holiday entitlements will leave practices short of cover. Both of these issues will place constraints upon practices and should be costed carefully before adopting the structure.
Some practices have chosen to commit to paying staff the Living Wage. Details of this can be found at the Living Wage Foundation website http://www.livingwage.org.uk/
Pensions and benefits
Equally as important is an employee’s entitlement to pension benefits, particularly with the uncertainty regarding state pensions.
Under the Pensions Act 2008, every employer in the UK must put certain staff into a workplace pension scheme and contribute towards it. As GP practices have access to the NHS pension this may be the default offer to employees, but practices should also offer other private schemes if available. This should happen automatically so is called ‘auto-enrolment’. The employee can opt out of auto-enrolment. This is a complex area, and advice from the practice accountant or Human Resources service should be obtained if needed. Further information from the pensions regulator can be found here: https://www.thepensionsregulator.gov.uk/en/employers
Pensions for practice staff
The NHS Pension Scheme has been in existence for over 50 years, but has only been available to practice staff since 1 September 1997. Like the GP scheme, membership of the NHS Pension Scheme for practice staff is entirely voluntary, and similarly staff will automatically become members of the scheme from commencement of their employment unless they formally opt out by signing an ‘opt out form’ (SD502). Practices are obligated to provide both existing and prospective employees with the relevant forms and information so that they can make an informed decision regarding membership of the scheme. This includes those staff who work part time and casual workers.
Contributions
Both the employer and the employee make contributions to the scheme. Contribution rates have been amended, and although the NHS Pension Scheme is still a huge selling point to prospective employees, contribution rates will now vary. NHS pension contributions are subject to change, and the authors advise both practice managers and staff to carefully review the changes and direct readers to the following web link from the NHS Business Services Authority: Ⓦ www.nhsbsa.nhs.uk.
Source: Ⓦ www.nhsbsa.nhs.uk/pensions. See: Ⓦ www.nhsbsa.co.uk/ for current contribution rates.
Inducting staff
Induction pack
It is a good idea to send out the terms and conditions of employment, together with an induction pack, once the employee has formally acknowledged acceptance of the post in writing. The induction pack should provide a picture of the practice alongside any other information specific to the post. For example you might want to provide a new medical receptionist with the following information:
a practice leaflet
information about the structure of the NHS and how general practice fits into that structure a glossary of commonly used medical terminology
a list of current doctors and staff (organisational structure)
an individual induction plan
most recent CQC report.
The employee can then begin to get a feel for the organisation and look forward to starting work with some background information under their belt. This will help them settle in quicker and allow them to build up a rapport with existing staff.
Induction
A good reception for the new member of staff when starting their new job will help them feel welcome and valued. A good induction will provide a firm base for the newcomer to become a well-motivated, competent and effective member of the practice team, in the shortest possible time. The length of induction will vary depending on the needs of the job; it should never be hurried and should be designed to help familiarise the new member of staff with the work pressure and the range of internal and external contacts they will have in their work, and should give them help and guidance to settle into the job itself.
Induction is not only for people who join a practice for the first time, but might be appropriate for people returning to work after a break (e.g. maternity leave). Special attention needs to be paid to school leavers going to work for the first time as induction is about introducing them not only to the practice, but also to the world of work. Finally, it is a well-known fact that most people leave their jobs in the first few months – poor induction is often sited as the main reason for this. It is very important that induction is provided for all staff at all levels.
Induction should include:
an introduction to all staff and doctors
a tour of the practice (including cloakroom and toilet facilities, entrances and exits, staff room, etc.)
a review and explanation of terms and conditions of employment
health and safety procedures and protocols including fire and evacuation procedures
practice rules and procedures including disciplinary and grievance procedures
arrangements for staff involvement, e.g. practice meetings
welfare and employee benefits
a review of the remaining induction procedures, training plans and follow-up.
Special considerations for recruiting a new partner
A new partner is probably the most significant appointment a practice makes, but the recruitment procedure described in this section applies equally to partners and it should be read in conjunction with these additional notes, which are under the same headings.
Identifying the need
A possible change in the partnership is an opportunity for a review of the practice’s strategy and of existing partners’ plans. Both government and local policy must also be considered. See Section 2, Workforce planning, for an approach to this exercise (page 2-55).
When undertaking a review the outcome should be:
a vision of the future of the practice
a decision on whether to recruit a new partner
personnel specifications for the new partner, including the clinical, managerial and team roles envisaged
a job description, and an outline of terms and conditions and of the financial package that a new partner will be offered
a recruitment plan, with someone – probably the practice manager but possibly an outside agency – appointed to manage the process.
The decision to appoint a new or replacement partner is the practice’s own; however, an application to the PCO to vary the GP contract to add the new partner must take place. It is in the remit of the PCO to raise questions as they see fit. The CQC will need reassurance that the needs of the patient will still be met. The practice will need to remove the outgoing partner from the CQC registration page and advise how it intends to replace the services provided by the outgoing partner. Further guidance is provided at https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-18-registration-partnerships.
Terms and conditions, and financial package
Potential applicants will want at least an outline of these, and an offer of partnership or letter of engagement must include full details. It is also important to decide on what the partners are prepared to negotiate. Starting percentage, time to gain parity and buying into practice premises are often subject to negotiation, but hours and flexibility should also be considered as they are often more important than money. Clarity at this stage on these issues will avoid problems later. The following list of items to include is not exhaustive:
starting conditions
a period of mutual assessment
a percentage of profits for equity partner or fixed share partnership option (see ® https://www.bma.org.uk/advice/employment/gp-practices/gps-and-staff/focus-on-taking-on-new-partners
time to gain parity
buying into the practice/buying into practice premises if relevant
sale of goodwill (permitted only for enhanced services)
terms and conditions of work, i.e. hours, leave, etc.
Sources of information and advice:
The partnership agreement should address many of these matters. An agreement is an obligation under the General Medical Services (GMS) contract (see page 2-04). Movement within the partnership provides a good opportunity to review the partnership agreement.
Your Local Medical Committee (LMC) can give advice.
Attracting candidates
The popularity of general practice as a career and partnership as an option changes over time. In a buyers’ market all practices have to sell themselves, so it is worth taking a hard look at the practice and its image, and then making the personnel specification as flexible as possible, and identifying what you are, and are not, prepared to negotiate on. A new partner may be:
appointed without advertisement
found through advertisement
found by a recruitment agency or headhunter (rarely done in general practice).
There is no legal requirement to advertise partnership vacancies, and if you have former registrars or locums who look right for the post, it is tempting to save time and money and appoint them. However, the excellent registrar or locum is not always the dream partner, and submitting them to a competitive selection process not only gives the practice the opportunity to look at the field, but may reveal negative qualities in the internal candidate.
It is the advertisement that first attracts your future partner’s interest. It is worth paying to advertise in the British Medical Journal (BMJ) as that is where most potential applicants look. BMJ adverts are also available online. Other papers and journals may accept free advertisements, and consider advertising through your local postgraduate centre and CCG communications team or the Royal College of General Practitioners website.
The advertisement
Be imaginative but not dishonest:
Look at other practices’ advertisements – which appeal and why?
Make yours stand out – consider a box, make the practice sound interesting, identify your USP (unique selling point).
Check that the wording could not be interpreted as discriminatory.
Most people scan down to find practices in the area where they want to live. Put that up front.
All practices describe themselves as busy – it isn’t a selling point.
Most practices say they are friendly – it isn’t necessarily true.
A practice with many outside commitments may attract good applicants with wide interests. On the other hand, potential recruits may feel that the practice is looking for a workhorse to keep the practice going while the other partners are occupied elsewhere.
Say what you are looking for, but indicate how flexible you are prepared to be.
Assessing candidates and allowing candidates to assess you
The mutual assessment process involves an exchange of information. The practice needs to decide what is requested and offered at each stage.
Expression of interest
Doctors who enquire about the vacancy need information about the practice and the post, and details on how to apply. Staff need to know what the procedure is.
Consider what information you will provide; it can all be supplied electronically:
details of the practice website a practice leaflet
a practice profile and CQC report
information about the practice’s strategy and the post
information about local health services, e.g. websites of PCO and secondary care trusts
sources of information about the area, e.g. list of websites
a contact at the practice if further information is required at this stage
an application form, if you are using one, or information on how to apply, e.g. CV and handwritten letter explaining why the applicant is interested in the post
the date by which candidates will be informed of the outcome of shortlisting, and likely dates of interviews.
It is usual to request two clinical references not more than a year old, and one personal reference. A medical report may also be requested.
Informal visits to the practice
Candidates may ask to visit the practice before they decide whether to apply. The form of the visit needs to be decided and staff made available. This is the practice’s opportunity to showcase the practice, and as such, preparation is key. Your practice will not be the only one the candidate is interested in.
Shortlisting
All applications must be acknowledged. A practice that omits this courtesy risks its reputation.
It is suggested that all partners take part in shortlisting and interviewing if at all possible. It is not unknown for interviews to be videoed for the benefit of an absent partner.
All papers and notes that contribute to the selection process must be kept for a year, so that they are available should a rejected candidate bring a complaint of discrimination.
Shortlisting must be done against objective criteria. These will include clinical skills and experience, views that affect clinical practice (e.g. views on termination of pregnancy), manners, philosophy, and aspects of personality. Draw up a score sheet with a list of criteria regarded as essential and desirable, and tick-boxes to show whether the criteria are fully, partially, or not met, plus room for comment. Everyone who sees the candidates should use the sheet. At the end of the process the score sheets should be compared and an objective decision made about which candidates will be invited for interview. Specific areas to be explored with individual candidates should be noted.
Before contacting candidates who have been shortlisted, check their GMC registration, medical defence organisation, Certificate of Completion of Training (or older equivalent), Disclosure and Barring Scheme (DBS) clearance and that they are on the national performers’ list.
The length of the shortlist will depend on the number and quality of the applicants.
All applicants should be informed whether or not they have been shortlisted. The practice might consider giving rejected applicants an idea of why they were not suitable. Done sensitively and constructively, this feedback can be very helpful and may make rejection feel less like personal criticism.
Further information for shortlisted candidates
Consider the following if not already supplied:
financial information including the last three sets of practice accounts
buying in to the practice. In general practice there is no good will to buy. However, depending on the partnership, there may be an obligation to inject money into the practice for working capital. In addition there may be an obligation to buy equity in the practice premises is owned. This is a complex area and practice accountant support should be obtained.
likely practice developments and the role the new partner is expected to play
proposed terms and conditions and financial package
information on premises
likely opportunities for professional development, e.g. trainer, GP with a Special Interest (GPwSI).
Interviewing candidates
There is no foolproof way of selecting personnel, but it is important to design a manageable process and to make the most of the methods you choose. Almost always there will be a formal interview, and often it is badly done. See page 4-21 for guidance on interviewing.
Given below are some options from which several can be combined:
Formal interview by partners, each partner having an agreed topic to probe. The practice manager may take minutes of the interview and ask some questions.
One-to-one interview with partner, practice manager or outside assessor.
Some practices may consider inviting a patient to sit on the interview panel. A patient can provide a different perspective on the candidates.
Psychometric testing. If this is being used, the partners should go through the process too so that it is clear what team roles the successful candidate should ideally be equipped to play. Or consider having an external assessor with a psychological background on the interview panel.
A scenario sent to the applicant in advance, to which they will be expected to present their solutions at the interview, e.g. what factors do you consider to be important to motivate a practice team?
Invitation to attend and participate in a practice meeting.
A social occasion, with or without spouse.
Consider arranging for candidates to sit in on partners’ consultations, or for them to see a few patients on their own, or even ask them to take a surgery as a locum (paid). This gives both sides an idea of whether candidates fit into the practice’s clinical style.
Take note of comments from everyone who sees the candidates, including patients if appropriate.
References
Potential employers have a contractual obligation to take up references, and fail to do so at their peril. It is usual to take up references of shortlisted candidates with their permission, since the referee may be unaware of their application. Referees rarely offer negative comments, and recent litigation has made some employers unwilling to give references containing information other than the most factual. The key to interpreting references lies in what they do not say, so be prepared to identify areas of concern and phone the referees with a list of questions, asking for examples of situations that have prompted comments.
Partnership offer
A verbal offer of a partnership is legally binding, but may be difficult to prove, so ensure that a written offer is sent as soon as possible. This document is very important, as lack of detail at this stage is a common cause of subsequent partnership breakdown. Include:
terms and conditions for the period of mutual assessment
the procedure to be followed should either side feel at the end of the period of mutual assessment that the appointment is not working out
terms and conditions for the partnership, assuming that the mutual assessment is satisfactory.
Prospective partners will want to scrutinise the practice accounts, with both the practice’s accountant and their own. They will also want to study the practice agreement.
Negotiation
In a buyer’s market, the chosen candidate is likely to wish to negotiate, perhaps hard, on aspects of the partnership offer. The partners should have already decided how far they are prepared to go, and it is best if one partner conducts the negotiations so that a consistent line is taken. If the candidate is requesting better terms than those of the existing partners, all partners need to be consulted.
Rejected candidates
It is courteous to let candidates know they have been rejected as soon as possible after interview, with or without reasons; but if you have a second choice, wait if possible in case your first choice declines your offer.
Placement and induction
Once an appointment has been agreed, the following needs to be done:
inform the PCO that there is a variation in the practice’s contract
inform the PCO superannuation office
transfer the new partner to the performers’ list
update your CQC registration with the new partner’s details
make the necessary alterations to the practice agreement (and again at the end of the period of mutual assessment)
change practice information (leaflet, website, etc.)
change stationery, etc.
change nameplates and door signs: having them ready when the new partner starts work helps to make them feel welcome
amend practice stamp
set up computer passwords, etc.
NHS Net address
inform the National Health Services Business Authority (NHSBA) so prescribing details can be updated
update Data Protection Act registration
inform care homes, etc., for which the practice is responsible
inform local pharmacies and supply specimen signatures
inform local pathology and radiology services so that electronic results/reports are correctly addressed
inform local hospitals, neighbouring practices, local pharmacies (with a specimen signature) and the out-of-hours organisation.
Informing patients
If the partnership vacancy is due to a resignation, the partners should agree a form of words describing why the previous partner resigned, and staff should know how to respond to inevitable queries. Information about the new partner should be on the practice website and available at the practice. If you have a patients’ group, inform and involve them.
If the new partner is taking over a personal list, consider writing to all the departing GP’s patients to introduce his/her successor. Longstanding patients may need help with accepting the change.
Supporting staff
Many aspects of change prove difficult for staff. A new partner in the practice is no different and can be stressful for staff. Practices should manage the change carefully and give staff the opportunity to discuss any concerns they may have.
The first month
There is further reference to advice on inductions for employed doctors in Section 2 (page 2-19), which is also applicable to new partners. Investment of time in a proper induction will pay dividends.
The first weeks should include:
time with receptionists
time with all employed and attached staff
introductions and an opportunity to talk to people who use the premises to provide services to patients, e.g. visiting consultants, smoking cessation advisors, Citizens’ Advice Bureau (CAB), drugs workers, community practice nurses (CPNs)
visits to local care homes, hostels, community services, e.g. centres for young people, drugs and alcohol services, day care units, etc.
a visit to the local hospitals (if the doctor is new to the area) and if possible meet the consultants to whom the GPs regularly refer
educational events at which the new doctor can meet local practitioners
a meeting with the Patient Participation Group
a meeting with the practice accountant.
End of the period of mutual assessment
The outcome of the period of mutual assessment may be evident to both sides, but it is worth staging a well-managed review. If the partner is not going to stay, aim to part on good terms with both sides having learnt useful lessons. If they are staying, again consider what has been learnt. There will be unexpected strengths and weaknesses, unexpected opportunities to be considered. Roles and responsibilities can be clarified. The practice agreement will need updating.
The first year
This is a period of adjustment for everyone, but most of all for the new partner. A frequent source of stress in the new partnership is the new partner’s expectations. Common problems with new partners, especially those who are fresh from training, are:
they are so anxious to make their mark that they tread on people’s toes
they may have unrealistic ideas of what they can achieve
they may expect more financial reward than is forthcoming
they may expect more time than is available to pursue their own interests outside the practice, clinical or non-clinical
they may be unprepared for the responsibility and time consumed by managing the business.
Unrealistic expectations can be reduced by offering honest terms and conditions and by open discussion both before and after the partnership has been accepted. A mentor may help a new partner with the adjustment process; Higher Professional Education programmes (aimed at new GPs) and local informal support groups for those new to partnership can all be valuable. Local training hubs should supply information on all these.
If you fail to appoint a new partner
Failing to find a partner is very dispiriting. There are a number of steps that will reduce the strain on the practice and improve your chances of finding a new partner next time around.
The practice is in a double bind: the burden of work has to be done without the planned extra pair of hands to share it. The most important thing is to ensure that existing partners and your salaried doctors do not suffer burnout or depression from overwork. Employing additional help may be costly but lifesaving. If the situation is becoming desperate, contact the PCO and the LMC to discuss the practice’s options.
Consider contacting doctors who requested information but did not then apply, or good applicants who withdrew, and asking them why. Correct any misapprehensions. If they had valid reasons, is there something the practice should consider changing?
Find out what your reputation as a place to work is locally. If local GP registrars are not keen to apply, find out why. Meanwhile, go back to the beginning of the recruitment process and review every stage. Reconsider your advertisement. Where can you be more flexible? The more flexible the practice can be, the better the chances of making an appointment.
Special considerations for recruiting nursing staff
An increasing number of practice nurses are being employed and certain considerations must be observed when recruiting. The Nursing and Midwifery Council (Ⓦ https://www.nmc.org.uk/) requires that all employers of nurses, midwives and health visitors ensure that each such employee possesses a currently valid registration. (Confirmation of this should be sought prior to employment by searching the NMC register; https://www.nmc.org.uk/registration/). It is also essential that every practice nurse maintains membership of a professional organisation that provides for individual legal representation through a professional indemnity insurance scheme, to cover the nurse for any accident arising out of their professional duties for private work carried out by the practice. NHS work will be covered by the national indemnity scheme. It is equally as essential that any doctor who delegates any treatment or procedure to a practice nurse must be satisfied that the nurse concerned is (and agrees that they are) competent to carry them out. The ultimate responsibility for the management of their patients rests always with the doctor, and they are vicariously liable for the acts and omissions of an employed nurse.
Nurse prescribers
More and more nurses are now able to qualify to prescribe. Nurse independent prescribers are trained in diagnosis and management of disease, and can prescribe almost all medications. They have therefore moved from a role complementary to that of doctors to one that overlaps what was once purely doctor turf.
A practice reviewing its clinical workforce should take the trouble to find out what nurse independent prescribers can offer. When interviewing independent prescribers, whether they be doctors or nurses, it is important to assess their areas of competence and to ensure that their job description is tailored appropriately. Because nurse independent prescribers are a relatively new element in the workforce, a review of roles and careful planning is needed to ensure that their role is understood and respected by the practice team, clinical and non-clinical, and by patients.
See Section 10: Managing drugs in the practice and a dispensary, for further information on nurse prescribers, and Section 5: Education, for information on their education and training.
Pharmacist independent prescribers
Some practices are now beginning to expand their multidisciplinary teams, and are looking to independent prescribing pharmacists as potential team members who may prescribe autonomously for any condition within their clinical competence. A range of schemes have rolled out from NHS England to aid practices in hiring and training such pharmacists. From 2019 it has been through the new GP contract and Primary Care Networks.
In order to qualify as an independent prescriber, pharmacists must complete a General Pharmaceutical Council (GPhC)-accredited programme. On successful completion of the programme, they will receive a practice certificate in independent prescribing.
Further information: https://www.rcn.org.uk/get-help/rcn-advice/non-medical-prescribers
Physician associates
This is an emerging role within both primary and secondary care settings. Physician associates support doctors in the diagnosis and management of patients. They are trained to perform a number of day-to-day tasks including:
taking medical histories
performing examinations
diagnosing illnesses
analysing test results
developing management plans.
Further information: https://www.bma.org.uk/advice/employment/gp-practices/general-practice-forward-view/workforce/employing-physician-associates-in-general-practice
Nurse revalidation
In the same way as doctor revalidation has been introduced, nurse revalidation will be required by the NMC (Nursing and Midwifery Council) for nurses to maintain and renew their licenses. The principles are that nurses should be equipped to practice safely and effectively.
Further information: www.nmc.org.uk, and http://revalidation.nmc.org.uk (this resource has specific information for employers to consider).
The good employer
We have considered the processes required to recruit, place and induct a new member of staff, and the terms and conditions of employment. These processes should not stand alone, but should form part of a package of fair and consistent employment policies and procedures that are complementary to the ethos of the practice. These procedures should be open and transparent, and staff should be invited to contribute to their content so that they gain ownership wherever possible. This openness makes employees feel valued and motivated, and may help maintain staff retention.
Staff handbook
A staff handbook is a great way of exhibiting practice policies and procedures, and may also provide information supplementary to the individual’s terms and conditions of employment.
There are no hard and fast rules about how it should be laid out, but the following are areas that you might include:
Contents and introduction – include a brief history of the practice and the local area.
Information relating to an employee’s terms and conditions of employment, e.g. — annual leave/sick leave/compassionate leave — pay and reporting processes/pay day — maternity rights/other parental rights — flexible working arrangements — timekeeping, time off and unauthorised absence — appraisal/training and promotion — redundancy/resignation.
Practice policies and procedures, e.g. — health and safety — accidents and first aid, and reporting procedure — stress — confidentiality/Caldicott/data protection — smoking at work — drugs and alcohol policies at work — AIDS/HIV — disciplinary and grievance procedure — discrimination and equal opportunities — bullying and harassment/relationships at work — security/alarms/key holders/personal property and safety — use of practice resources — use of email and the Internet — mobile phones — personal appearance/dress code — car parking arrangements — significant event procedures.
This list is not exhaustive and can be adapted to the needs of each practice.
The staff handbook can be supplied as a hard copy with your induction pack, and also to every other individual. If that seems too onerous a task, a centralised hard copy or accessible computerised copy will suffice providing that access to it is discussed as part of the induction programme. As with all other practice policies and procedures, the staff handbook will require regular review to ensure compliance with local and legislative policy change. The BMA website offers comprehensive information relating to staff handbooks. Please refer to https://www.bma.org.uk/advice/employment/gp-practices/employer-advisory-service/handbook.
Legislation
Legislation (the law) will underpin many (but not all) of our employment policies and procedures. There will be some aspects of legislation that you will need to be specifically aware of as a good employer. Some of these carry penalties if you are not compliant. Other areas are simply good practice.
Legislative style tends to change from one election to the next and can be dependent upon which political party is in power. In recent years there has been the introduction of many family-friendly policies designed to improve working conditions and offer more flexibility for the employee. We have outlined some of the areas of legislation that impact upon our lives in general practice. We recognise that these areas are being amended and added to at a rapid pace, therefore we have provided only a brief explanation of each area and have made reference to further reading.
Working Time Regulations 1998
The Working Time Regulations came into force in 1998, and as the title suggests, make provision for protection of the employee with regard to their working hours. The main regulations were updated by the Working Time (Amendment) Regulations 2007, the main purpose of which is to offer provision for the protection of young people in the workplace.
The main principles are that:
the average weekly working time is limited to 48 hours
night workers’ normal daily working time is limited to 8 hours
there is now a requirement to offer health assessment to night workers
employees should be offered minimum daily and weekly rest periods
there should be a minimum amount of paid annual leave.
For full interpretation and guidance refer to:
NHS Employers guidance on this issue: https://www.nhsemployers.org/~/media/Employers/Documents/SiteCollectionDocuments/WTD_FAQs_010609.pdf
National Minimum Wage
The National Minimum Wage is aimed at providing employees with decent minimum standards and fairness in the workplace. It applies to nearly all workers and sets hourly rates below which pay must not be allowed to fall. It helps business by ensuring companies will be able to compete on the basis of quality of the goods and services they provide and not on low prices based predominantly on low rates of pay. The rates set are based on the recommendations of the independent Low Pay Commission. Rates have tended to increase on an annual basis. The current standards can be found by following the link at www.gov.uk/national-minimum-wage-rates.
Running alongside this is The Living Wage. The Living Wage is a non-mandatory suggested minimum rate of pay championed by a voluntary organisation called The Living Wage Foundation. It has calculated what it feels is the wage required for people to lead a reasonable standard of living. Its view is that this is good for society, and that in its experience organisations who have adopted the Living Wage principles have enhanced recruitment and more motivated employees. In areas where it is difficult to recruit good-quality and experienced staff, practices may wish to consider adopting these principles. More information is available from http://www.livingwage.org.uk.
Paid study leave for young employees
Effective from September 1999, any 16- or 17-year-old who is in employment and has not achieved an NVQ level 2 standard of educational achievement (i.e. has not achieved A to C grades in five GCSEs) is entitled to paid study leave. Where an employee is 18 and undertaking such a qualifying course of study or training which began before they reached the age of 18, they are also entitled to paid study leave. Such leave will be for the sole purpose of undertaking study or training that will lead to qualifications that will in turn improve their future employment prospects. Time off should be reasonable with regard to both the requirements of the employee’s study or training and the circumstances of the business. Should an employer unreasonably refuse time off, or fail to pay the employee for that time off, the employee will be able to present a complaint within 3 months to an employment tribunal.
Further comprehensive information is available from ® www.education.gov.uk.
Sickness absence and pay
Employees off sick may be entitled to statutory sickness pay (SSP), although it is recognised that some practices have an occupational scheme which may prove more favourable. An employee must satisfy a number of qualifying conditions to be entitled to SSP from you. The Inland Revenue offers comprehensive guidance and a series of leaflets outlining what the employer should do when they have an employee off sick and what the employee is entitled to. If you are a small practice you may also qualify as a small employer, in which case you may be entitled to claim back elements of the pay made to an employee during periods of sickness. Further information is available at Ⓦ www.hmrc.gov.uk.
Family-friendly policies
There have been a lot of advances in legislation in recent years designed to improve working conditions and associated rights, enhancing family life through the introduction of family-friendly policies. These new pieces of legislation require the employer to offer more flexible working arrangements to all members of the workforce. Special consideration has been given to the following circumstances.
Female employee maternity rights
Statutory provisions for maternity leave/pay have advanced very quickly. Practices are advised to ensure that the information they hold is current, and it is suggested that staff handbooks have references to the provisions offered by the practice, i.e. whether the practice offers occupational maternity rights (as it must with salaried GPs employed under the model contract) or whether the practice offers the statutory provisions only, but that not too much detail is applied as this is an area that requires regular updating and may appear misleading to individuals if information provided is not current.
Maternity dismissals
Practices should be aware that it is automatically unfair to dismiss a woman (or select her for redundancy), irrespective of length of service, on grounds relating to pregnancy, childbirth and taking maternity leave.
In summary
The authors recognise that the guidelines surrounding maternity leave and pay are continually being updated, and as such have opted to provide only an overview and summary of entitlements on this particular subject.
There is guidance about:
notification of pregnancy
when an employee can commence their maternity leave
keeping in touch when on leave
terms and conditions of employment
returning to work
claiming back statutory maternity pay through national insurance contributions.
This list is not exhaustive.
Paternity leave
Men have basic rights to paternity leave and pay (statutory paternity pay) when their partners give birth to a child, when adopting a child or when having a child through a surrogacy arrangement. These rights also apply to same-sex couples.
As with maternity leave there are qualifying conditions. Again, due to the continual enhancements the authors advise practices to reference provision in their staff handbook, with more details to be provided on application. The terms of the GP model contract must apply for GMS practices employing salaried doctors. Again, as with maternity provisions, the practice may choose to offer occupational paternity leave/pay entitlements.
Adoption rights
When time off is taken to adopt a child or have a child through a surrogacy arrangement employees may be entitled to adoption leave and pay. Qualifying conditions apply to receipt of statutory adoption pay. The provisions differ slightly if your employee is adopting from abroad. More guidance is available via https://www.gov.uk/adoption-pay-leave.
Parental leave
From April 2015 employees may be entitled to shared parental leave and shared parental pay. This leave does not have to be taken in one block and may be staggered and split between parents. The leave must, however, be taken between the date of the child’s birth and their first birthday or within 1 year of adoption. Again, further guidance is available via https://www.gov.uk/shared-parental-leave-and-pay.
The right to request flexible working
All employees have the legal right to request flexible working - not just parents and carers (https://www.gov.uk/flexible-working).
Practice managers must seriously consider any requests for flexible working that are made to them. This legislation entitles the employee to the right to request flexible working. There may be instances whereby requests are difficult for practices to grant due to the constraints within which they work.
There are eligibility criteria to consider and various options available to employees that can be defined as flexible working. The practice should consider all options available to the employee. The employee is entitled to appeal any refusal.
Family emergency leave
All employees will have the right to take a reasonable amount of paid/unpaid leave (determined by your contract of employment), where it is reasonable for them to do so, in order to deal with incidents involving a dependant. A dependant is described as:
a spouse/partner
a child
a parent
a family member or friend who lives with you but does not pay rent
someone who relies on you to care for them (e.g. an elderly neighbour).
The employee has the right to time off to take necessary action:
to provide assistance when a dependant falls ill, gives birth or is injured
to make arrangements for the provision of care for a dependant who is ill or injured
when a dependent diesbecause of the unexpected disruption of arrangements for the care of a dependant
to deal with an unexpected incident involving a dependant child while an educational establishment is responsible for the child.
This leave is intended to be taken for emergencies only, not for pre-existing issues.
For full interpretation of and guidance on all family-friendly policies refer to Ⓦ www.gov.uk. ACAS also provide up-to-date comprehensive information – please refer to Ⓦ www.acas.org.uk.
Discrimination
The legislation covering this area is covered by the Equality Act (2010). In general, it is unlawful to treat one person less favourably than another, wholly or mainly on the grounds of that person’s sex, marital status, pregnancy, race, nationality, colour or ethnic or national origin, disability, age or religion (not exhaustive). It is unlawful to publish a discriminatory job advertisement, or treat one person less favourably than another on any of the grounds mentioned, for appointment, promotion, transfer or training.
There are four types of discrimination: direct discrimination, indirect discrimination, harassment and victimisation.
Disabled persons
The Equality Act (2010) makes it unlawful to ‘unjustifiably’ discriminate against an individual on the grounds of their disability in relation to recruitment, promotion, training, benefits, terms and conditions of employment and dismissal. ‘Disability’ is defined as ‘a physical or mental impairment, which has a substantial and long-term adverse effect on [the person’s] ability to carry out normal day-to-day activities’. Where any arrangement (e.g. recruitment and selection procedures) made by or on behalf of the employer or any physical feature of the premises (e.g. access to or exit from the building) places an individual with a disability at a substantial disadvantage in comparison with persons not disabled, the employer is legally obliged to make a reasonable adjustment.
Advice and further information is available from www.acas.org.
Staff training
All good employers will have a training and development policy for their staff as training is one of the most fundamental parts of the management process. It is the means to bridge the gap between what an employee is able to do and what the organisation requires of them either now or in the future. Training is such an important area to consider, and as such it has been included within Section 5, ‘Education’. Employees who work for large companies have had the right to request training (or time off for study). However, it would be short-sighted not to invest in the development of staff as this is key to the development of the organisation.
Performance appraisal
This area, which is developmental, has been covered in Section 5.
Jury service
Jury service is a citizen’s duty. Most members of the public are eligible for jury service, including – following a change in the law in 2005 – doctors in England and Wales.
Jury service generally lasts about 2 weeks, but can be shorter or much longer. Jurors are not required to serve more than once every 2 years. Jurors receive travel and subsistence allowance and some recompense for loss of earnings and other financial losses incurred.
Anyone summoned to do jury service is legally obliged to serve. Jury service is disruptive to professional and personal life, but getting out of it is not easy. Jury service may be deferred once for up to a year if absence would cause ‘substantial injury to the undertakings of the business’, but is rarely excused. An application for deferral or excusal must be made and received within 7 days’ receipt of the summons. It must state the reasons why the applicant cannot serve at that time, and in the case of deferral must list other unsuitable dates over the next 12 months.
Staff called to serve as jurors should be encouraged to discuss the summons with their employer, and if they decide to apply to defer, work-related reasons might include responsibilities affecting service delivery that no-one else at that time can undertake.
GPs applying for deferral may cite detrimental effects on patient care and service delivery, severe financial loss and responsibilities for training. GP registrars may cite serious interference with their training, examination schedule or interviews for new jobs. More information is available via https://www.gov.uk/jury-service.
When a member of staff leaves
Irrespective of the systems you have put in place to retain and motivate your staff, it is feasible that some members of staff will want to move on: some will resign and move on to new roles in other organisations, some will retire, and unfortunately some will either be made redundant or dismissed. We outline the considerations and procedures to be followed in each case.
Resignation
Perhaps the ‘easiest’ way to deal with staff moving on is when they voluntarily offer their resignation, providing of course that it’s not as a result of poor employment practice that would later result in a claim of constructive dismissal.
Any offer of resignation should be confirmed in writing by the employee. The employer should then respond again in writing, confirming acceptance (providing you have chosen not to try to persuade the employee to stay), and any details related to the resignation such as date of leaving, any outstanding holiday entitlement, final pay details and the required notice period, which will be outlined within the employee’s contract of employment. If there is no specified notice period in the contract, then
Practice managers should ask their employee how and when they would prefer to let other staff know of their proposed departure. A good employer will try to organise a handover process, and it is suggested that ideally there would be some overlap with the resigning employee and the new employee if time and finances allow. This ensures that all key tasks and responsibilities are understood and that the new employee has the opportunity to hear first-hand information. Bear in mind, though, that this could also have a downside, particularly if the employee who is leaving has been unhappy in their role.
Exit interview
A good employment tool is an exit interview. Exit interviews can provide a good source of feedback regarding your employment practice, ethos, and terms and conditions of employment. They are best carried out in a similar format to an appraisal interview, in the form of a one-to-one discussion supported by written documentation. Again, bear in mind that exit interviews are not for the faint-hearted, as a disgruntled employee may use the opportunity to get burning issues off their chests.
It is a good idea to wish the employee well when they move on, irrespective of the reasons behind the move. Many practices offer parties or gifts to employees when they leave, but remember than monetary gifts will more than likely carry tax implications.
Remember to retrieve all practice property such as uniforms, keys, computers, etc., on the day of departure, remove relevant information from computer packages as a security measure, and consider the possibility of changing entry codes if necessary and practical.
Retirement
The default age for retirement was abolished in October 2011. Practices can now only retire employees at a specific retirement age if they can legitimately justify it. However, practices will be able to apply exemptions that are triggered once the employee reaches 65 years old, for example the non-provision of life insurance and private medical cover, although the provision of such is unlikely to routinely apply to those working within general practice.
Again, information on retirement planning can be found at https://www.gov.uk/plan-retirement-income.
Redundancy
Declaring staff redundancies would be one of the most traumatic experiences for any practice to face. It can be disruptive, demoralising and potentially expensive, with far-reaching damage to practice morale. Unfortunately, a growing number of practices may have to consider this response to ever-changing demands and threats to resources. Changes in the nature of work undertaken by practice staff, or changes in the financial resources available, may require redeployment of staff, or reduction in the number of employed staff or their hours worked.
Careful planning of staffing requirements should help to avoid such drastic action as making staff redundant. However, if it becomes a necessity, then an agreed procedure for handling redundancies may prove invaluable. There must be a fair, objective and consistent method of selection. Employers who are aware of legal parameters and develop appropriate policies and procedures can minimise the adverse effects for all those affected by the changes. This section is not intended as a guide to current law on redundancy, but rather as an overview and guide to good practice. There is a wealth of information provided on the ACAS website in relation to redundancy rights and payments, with specific links to government guidance including the option to be directed to a ready reckoner, which gives employees an idea of their entitlements if they are to be made redundant.
Please refer to Ⓦ www.acas.org.uk or https://www.gov.uk/redundant-your-rights.
Definition of redundancy
The Employment Rights Act 1996 defines redundancy as the dismissal of an employee under the following circumstances:
• The employer has ceased, or intends to cease, to carry on the business for the purposes of which the employee was employed, either generally or at the place where the employee was employed (the practice permanently closes or moves to a different location)
OR
• the requirements of the business for employees to carry out work of a particular kind, generally or at the place where the employee is employed, have ceased or diminished or are expected to cease or diminish (the practice ceases fundholding, reduces the level of patient services, or closes a branch).
It is important that all staff are kept informed and fully understand the implications of any such planned changes. It is also essential that individuals affected are provided with all appropriate information as early in the process as possible.
Establishing a procedure
There are three ways in which to deal with redundancies:
ad hoc, i.e. no formally established arrangements, dealing with each redundancy according to the circumstances
a formal policy setting out the approach to be adopted in any instance of redundancy decided by the partners and/or manager
a formal agreement reached after negotiation with the practice staff, setting out the procedure to be followed when redundancies have to be considered.
There may be instances when an ad hoc approach can be adopted. However, a formal procedure can reduce the likelihood of conflict and the possibility of misunderstanding. If possible, the procedure should be drawn up at a time when redundancies are not imminent. This will allow those involved to address long-term considerations rather than being preoccupied with immediate issues. The procedure should be made known to all employees.
Regardless of which approach is adopted, it should be fair and reasonable, and every attempt should be made to adhere to it.
Failure to follow appropriate and reasonable procedures could lead to claims of unfair dismissal even if there were potentially good grounds for dismissal. If an employee wishes to claim that selection for redundancy was on discriminatory grounds, then no qualifying service is needed to claim unfair dismissal.
Redundancy procedure
Full and effective consultation is recommended when drawing up a redundancy procedure. It can provide the opportunity to allay unjustified fears and suspicions. Allowing employees to contribute their views and ideas can provide a far more comprehensive view of opportunities and alternatives.
Depending on the size of the practice, the contents of a formal procedure on redundancy would normally contain the following:
an introductory statement of intent towards maintaining job security, including details of consultation arrangements
measures for minimising or avoiding compulsory redundancies
general guidance on the selection criteria to be used where redundancy is unavoidable
details of the severance terms (the period of notice or payment in lieu of notice to which the employee is entitled) details of any appeals procedure
policy on helping redundant employees obtain training or search for alternative work.
The procedure should not be too rigid, but should allow room to manoeuvre when applied to different redundancy situations. This will be particularly true in the choice of selection criteria, and in the design and implementation of measures to avoid redundancies. It is especially important to ensure that the balance of skills and experience within the remaining team is appropriate for the future needs of the practice.
Any change to the procedure should be agreed upon and communicated to all staff. Where possible, the procedure should specify the circumstances in which departure from the procedure may be considered necessary. The procedure should be reviewed from time to time to ensure that it is still relevant and fair.
For a small practice the agreed procedure may simply consist of an intention to consult individual employees. It should include stated aims of avoiding or minimising redundancy and adopting a fair and objective basis for redundancy selection.
Redundancy is not a pleasant procedure for anyone involved, and there are certain measures that should be considered before applying redundancy as forward planning may enable a practice to decrease the risk of redundancies by reducing or changing staffing levels in any of the following ways:
natural wastage
restricting the recruitment of permanent staff
reducing or ceasing the use of temporary staff
seeking applicants for early retirement or voluntary redundancy
filling vacancies from among existing employees
reducing ‘extra hours’
reducing the hours of work
training, retraining or redeploying employees for alternative work within the practice.
As this is such a complex area, the authors suggest that specialist advice is sought before embarking upon any redundancy process.
Voluntary redundancy
Voluntary redundancy is an acceptable method of giving the employer a list of employees willing to be selected for redundancy. This avoids compulsion, with less demoralising and disruptive effects on the workforce. Unfortunately, it is generally more expensive because the longer serving employees tend to volunteer, thus attracting higher redundancy payments. There is also the potential problem of more volunteers than the need for redundancies. Should this happen, you will need a procedure for dealing with rejected volunteers. There is also the risk that such voluntary redundancies may create an imbalance in the remaining skills and experience of the team. Any procedure should confirm the employer’s right to confine applications to selected categories of employee and the right to decide whether a particular employee should be allowed to leave.
Suitable alternative work
Whether alternative work may be considered suitable depends on many factors, including the following:
pay – wherever possible, earnings should be protected against a fall in the current rate of pay
status – any loss of status may be eased by allowing the employee preferential treatment should the original job become available again
location – the employer should consider the degree of disruption likely to be caused by a change of location and any additional expense incurred; any increase in travelling time should be considered in relation to age, health and domestic circumstances of the employee
working environment – this may be especially important for those employees who suffer a health complaint or physical disability
hours of work – any change in an employee’s hours of work, for example shift patterns, may be considered unsuitable if it fails to take account of the individual’s personal circumstances.
An employer may also consider the possibility of retaining the employee in a temporary capacity until permanent vacancies arise. This is particularly appropriate where vacancies arise regularly.
The employee should be given sufficient details and an adequate length of time to enable them to decide whether to accept the offer of alternative employment.
Industrial tribunals have ruled that it is the employer’s responsibility to show that an offer of alternative employment has been made. Any offer should therefore be put in writing, even where the employer believes that it may be rejected. The offer should show how the new employment differs from the old and, by law, must be made before the employment under the previous contract ends. The offer must be for the new job to start either immediately after the end of the old job or after an interval of not more than 4 weeks.
Employees who unreasonably refuse an offer of suitable alternative employment may lose any entitlement to redundancy pay. Unreasonable refusal may arise where the differences between the new and old jobs are negligible or where the employee assumes rather than investigates the changes that a new job might involve, for example in travelling times or working conditions. Refusal may be reasonable if the new job would cause domestic upheaval, for instance if there was a considerable change in working hours.
Trial period in alternative employment
Where an offer of alternative employment has been made that involves a different type of work or different terms of employment, the employee is entitled to a 4-week trial period. The intended effect of the trial period is to give the employee a chance to decide whether the new job is suitable without necessarily losing the right to a redundancy payment. Where the new contract requires retraining, the 4-week trial period can be extended by a written agreement between the parties. The agreement must specify the date on which the trial period ends and set out the employee’s terms and conditions after it ends. If the employee works beyond the end of the 4-week period or the jointly agreed extended period, any redundancy entitlement will be lost because the employee will be deemed to have accepted the new employment. Employers should communicate this to the employee when the alternative job offer is made.
The employer should also use the trial period to assess the employee’s suitability. Should the employer wish to end the new contract within the 4-week period for a reason connected with the new job, the employee will reserve the right to a redundancy payment under the old contract.
Consultation
The purpose of consultation is to provide as early an opportunity as practicable for all concerned to share the problem and explore the options. It can stimulate better cooperation between employers and employees, reduce uncertainty and lead to better decision-making. When faced with redundancy, staff may be able to suggest acceptable alternative ways of tackling the problem, or, if the redundancy is inevitable, ways of minimising hardship. The partners will then be in a better position to decide whether the needs of the practice can be met in some way other than dismissal.
Any employer who proposes to dismiss as redundant 20 or more employees at one establishment over a period of 90 days or less has a statutory duty to arrange collective consultation. The consultation should include ways of avoiding the dismissals, reducing the number of employees to be dismissed, and mitigating the effects of dismissals. Consultation must be undertaken with a view to reaching agreement on these issues. This duty applies even if the redundancies are voluntary. Consultation must begin at least 30 days before the first dismissal. (Longer lead times come into force if the dismissals will affect more than 100 employees.)
Although the legal requirement will affect very few practices, it remains as an example of good practice. It is essential that individuals who are to be made redundant are consulted. Failure to consult before making a person redundant can make a dismissal unfair, even if following the procedure would not have affected the final outcome. It would be very rare for an industrial tribunal to find that an employer reasonably believed that consultation would have served no useful purpose and therefore rule the dismissal fair.
In the consultation process the following areas are usually covered:
commitment to keep staff informed as fully as possible about staffing requirements and any need for redundancies
length of consultation period agreed
information on who will be consulted, and a commitment to consider any alternative proposals with a view to reaching agreement on ways of avoiding or reducing the number of dismissals, and on how to mitigate the effects of the dismissals
disclosure of information required by law: — the reason for the proposals — the number and descriptions of employees it is proposed to dismiss as redundant — the total number of employees of any such description employed by the practice — the way in which employees will be selected for redundancy — how the dismissals are to be carried out, including the periods over which the dismissals are to take effect — the method of calculating the amount of redundancy payments (other than statutory redundancy pay) to be made to those dismissed.
Additional areas on which to consider consultation are as follows:
effect on earnings where transfer or downgrading is accepted in preference to redundancy
any extension of the length of the statutory trial period in a new job
arrangements for travel and related expenses where work is accepted at another branch of the practice
how the selection of an employee for redundancy will be applied (e.g. selection across the whole practice or only on a sectional basis)
whether redundant employees may leave during the notice period, or postpone the date of expiry of notice, without losing any entitlement to a statutory redundancy payment
arrangements for reasonable time off with pay to seek alternative work or to make arrangements for training
assistance in job seeking.
Disclosure of information
There is a statutory duty to disclose, in writing, the following information concerning proposals for redundancies so that it can be used to play a constructive part in the consultation process:
reasons for the proposals
number and descriptions of employees it is proposed will be dismissed as redundant
total number of employees of any such description employed
the way in which employees will be selected for redundancy
how the dismissals are to be carried out, taking account of any agreed procedure, including the period over which the dismissals are to take effect
method of calculating the amount of redundancy payments (other than statutory redundancy pay) to be made to those who are dismissed.
Selection criteria
As far as possible, objective criteria, precisely defined and capable of being applied in an independent way, should be used when determining which employees are to be selected for redundancy. The purpose of having objective criteria is to ensure that employees are not unfairly selected for redundancy. Examples of such criteria are length of service, attendance record, experience and capability. The chosen criteria must be consistently applied.
An employee dismissed for reasons of redundancy will be found to have been unfairly dismissed if unfairly selected for redundancy. Employers need to show that in selecting a particular employee they have compared that person in relation to the agreed selection criteria with those others who might have been made redundant, and that, as a result, it emerged the employee was fairly selected. A claim for unfair selection may also arise where the employer has failed to undertake a reasonable search of alternative work throughout the practice.
Particular care should be taken to ensure that the selection criteria are not directly or indirectly discriminatory, e.g. on the grounds of sex, race, religious beliefs, age or disability. Dismissals can also be ruled as automatically unfair if they are for an inadmissible reason, e.g. related to health and safety or trade union membership or activities.
Compulsory selection criteria
Where voluntary redundancy or early retirement have not produced suitable volunteers, employers in consultation with the employees should consider the criteria to be used when enforcing redundancies. Where any agreed list of criteria is not exhaustive, this should be stated. The criteria must be used in an objective way and applied consistently.
Selection based on ‘last in, first out’ is objective and easy to apply and administer. A decision must be made on whether it will be operated across the whole practice or just selected areas (e.g. all employees, nursing staff or administrative staff only, reception staff only, etc.). Is the selection based on the length of service in a particular job (e.g. reception) or on the total length of service?
Selection based on skills or qualifications will help to ensure the retention of a balanced workforce appropriate to the future needs of the practice. Formal qualifications and advanced skills should be considered, but not in isolation. It may be appropriate for other aptitudes to be considered (e.g. the potential of the employee to be adaptable should alternative work be offered).
Selection based on the standard of work performance or aptitude for work depends on some objective evidence to support selection (e.g. performance appraisal).
Selection based on attendance or disciplinary records will require absolute accuracy of records. Before selecting based on attendance, it is important to know the reasons for, and extent of, any absences. There should be clear rules setting standards about discipline, absence, timekeeping and holidays.
Whatever selection criteria are chosen, care must be taken to ensure that they are neither directly nor indirectly discriminatory on the aforementioned grounds. It is usual to include in any procedure a statement giving a commitment to a fair, consistent, objective and non-discriminatory selection procedure.
Application of selection criteria
In seeking to agree selection criteria, the most important consideration for the future viability of the practice is to maintain a balanced workforce after the redundancies have been carried out. Specific skills, flexibility, adaptability and an employee’s approach to work may be the most relevant considerations for the future of the practice.
The drawing up of criteria, however, is not sufficient to guarantee fair and reasonable selection. Although the criteria may satisfy the test of objectivity, the selection will still be unfair if carelessly or mistakenly applied. Detailed records of the comparisons made and the method of choice are essential and should be made available to those selected.
The Equality Act (2010) makes it unlawful for an employer to treat a disabled person less favourably for a reason relating to their disability, without a justifiable reason. Employers will also be required to make reasonable adjustments to working conditions or the workplace where that would help to accommodate a particular disabled person.
Appeals procedure
It is advisable to consider the establishment of a redundancy appeal procedure to deal with complaints from employees who feel that selection criteria have been unfairly applied in their case. This can be achieved by the criteria being applied by a manager and the appeal being heard by one or more partners. An advantage of such a procedure is that complaints may be resolved internally, thus reducing the likelihood of a complaint to an industrial tribunal. An employee must have details of the selection criteria used and the method of application in order to be able to properly use any appeals procedure.
Helping redundant employees
Employees under notice of redundancy who qualify for statutory redundancy payments also have a statutory entitlement to a reasonable amount of paid time off to look for another job or to arrange training. Where possible, employers should extend such assistance to all employees who are affected by redundancy. The time off that is agreed must be allowed before the expiry of the period of notice.
Further optional measures the practice could consider making include:
contacting the local job centre
contacting other local practices to canvass for any suitable vacancies
giving redundant employees first option of re-employment to any suitable vacancy.
Redundancy can be a traumatic experience for employees, especially for those who have worked for many years in a stable environment. Some employees will have special difficulties to contend with, although they may have received payments in excess of the statutory minimum. Where practicable, employers should consider cases of hardship and, where possible, seek ways of helping.
Additional assistance
It is good practice to give redundant employees as much information as possible to help them at such a difficult time. Such information may include:
financial effects of redundancy on the individual (redundancy pay, pension payment and state benefits)
help with completion of application forms and presentation at interview
how to search for appropriate vacancies in the local area. In addition, where resources allow, employers may consider whether to help redundant employees by individual (and appropriately skilled) counselling. Where possible, some support and advice should remain available to redundant employees after their dismissal.
Assistance with job seeking
An acknowledgement should be included, recognising the statutory right of employees to take time off to look for work or arrange for training for new employment. Any intention of the practice to provide further facilities should also be included.
Counselling
Practices may wish to provide facilities for counselling services from skilled personnel to provide any or all of the following:
financial advice
guidance on how to find another job
advice on completion of application forms
guidance on attending interviews.
Qualification for redundancy payment
A payment is due only to an employee. Self-employed staff, locums or partners do not qualify. The qualifying criteria are readily available from https://www.gov.uk/redundancy-your-rights/redundancy-pay. The site offers details of the current payment entitlements and, as previously described, a ready reckoner to allow employees to calculate the number of weeks’ pay due. It is important to note that only those employees over the age of 20 will qualify for a redundancy payment. There may also be a variation for those aged between 64 and 65.
Disciplinary and grievance procedures
Handling a potential disciplinary issue
Handling a potential disciplinary issue is always a difficult task for an employer. It is important, therefore, that potential disciplinary issues are dealt with in a consistent and fair manner which is open, transparent and will stand up to scrutiny. It is vital that the practice draws up a disciplinary and grievance policy and that all staff have access to this policy, perhaps via their contract or staff handbook.
The ACAS Statutory Code of Practice on discipline and grievance came into effect on 6 April 2009 and supersedes any previous codes. It can be viewed online at Ⓦ http://www.acas.org.uk. They can also provide you with sample copies of suggested policies and procedures. We suggest that your policy outlines examples of potential disciplinary issues, along with issues that would be considered gross misconduct (i.e. likely to result in dismissal) as suggested by ACAS:
Theft, fraud, or deliberate falsification of records.
Physical assault on another person.
Deliberate damage to organisational property.
Serious incapability through alcohol or being under the influence of illegal drugs.
Serious negligence which causes unacceptable loss, damage or injury.
Serious act of insubordination.
Unauthorised entry to computer records.
The authors at HOPM advise you to keep it simple and maintain a common-sense approach to handling a potential disciplinary problem. Most issues can be resolved informally; a quiet chat with the person(s) concerned to make them aware of any problems can often be enough. It may be worth noting down a summary of any such discussions in the employee’s personnel file in case you need to refer to it at a later date. It is important that you keep evidence that you have tried to resolve a problem in an informal and a supportive manner before introducing a disciplinary procedure. It is best practice to inform your human resources department (in-house or external) as soon as possible to get a sense check on the processes you are following.
If this approach is not successful, the disciplinary procedure should be invoked.
Establishing the facts
Prior to invoking any disciplinary process, it is important that all the facts of the matter are established beforehand and investigated. This may involve holding an investigatory meeting with the employee concerned before moving on to a disciplinary hearing. However, it could simply involve pulling together information that will be used during the disciplinary hearing. Holding an investigatory meeting does not mean a disciplinary hearing will follow. It is worth noting that the employee does not have a statutory right to be accompanied to an investigatory meeting; however, as a practice you may decide that it is sensible to allow accompaniment if the employee requests it.
You may decide that it is pertinent to suspend your employee while an investigation is taking place. Suspensions should be with pay, kept as brief as practically possible, and it should be made clear that suspension does not amount to disciplinary action.
ACAS suggests that where misconduct (as above) may apply, an investigation and a disciplinary hearing should be carried out by different people in order to maintain objectivity.
Notification
If, following an investigation, it is decided that there is a disciplinary case, you should inform the employee in writing, explaining clearly the nature of the problem and the potential consequences. It is suggested that you attach supporting documentation to your letter, for example you may provide a copy of the employee’s return to work interviews and their sickness record if the matter involves absenteeism. This will help you make clear to the employee the nature of the problem.
The letter must tell the employee the venue, time and date of the meeting and must also explain their right to be accompanied to the meeting by a colleague or trade union representative. The employee and their companion must make every effort to attend the meeting, which should be held without undue delay (but allowing for the employee to consider their case). Those accompanying a member of staff must not be legally qualified. The only exception to this is when a disciplinary hearing could lead to the loss of a professional’s ability to work again. An example of this could be a salaried doctor. It is best to take legal advice if the member of staff informs the practice they wish to be accompanied by a solicitor or another person with a legal qualification.
The meeting
The meeting should reiterate the reason for the hearing by the employer. The employee should then be given the opportunity to answer to any allegations that have been made. They should also be allowed to ask questions or call a witness, if appropriate. Employees should give notice to their employer beforehand if a witness is likely to be called. The colleague or official representative should also be allowed to address the hearing or summarise the proceedings (with the employee’s permission). They should not, however, be allowed to answer questions on behalf of the employee.
If an employee is consistently either unable or unwilling to attend a disciplinary meeting without an appropriate reason, a decision should be made using the information that is available. It is advisable to inform the employee of your intention to do this.
Deciding the outcome
Following the meeting you must decide whether disciplinary action is appropriate or not and inform the employee of your decision in writing. If misconduct has been confirmed (unless gross misconduct) or inadequate performance established, it is common practice that a written warning is applied (first or final*). The warning should indicate that a further act of misconduct or a failure to improve upon poor performance may result in a final written warning (or any other consequences that you feel appropriate, i.e. demotion). Any warning letter should set out the nature of the misconduct or poor performance issue and the expectation for improvement. You should also detail the timescale within which you wish to see that improvement and the period of time for which the warning will remain current. In addition you should advise them of their right to appeal, the time frame within which they can appeal and to whom their appeal should be addressed.
(*If sufficiently serious, it is possible to move straight to a final written warning.)
Decisions to dismiss should not be taken lightly, and should be undertaken by a person with sufficient authority to do so and generally following advice. The BMA can offer practices advice regarding these matters providing one of your partners is a member. They have a specialist employment department. It is important when making the decision to dismiss a member of your team that you have consulted with the partners and have their support as the owners of the business to do so.
The right to appeal
All employees have the right to appeal a decision that they feel is unfair or wrong. If possible, it is reasonable to expect the appeal to be held by a person who has not previously been involved in the case, in order to maintain impartiality.
Appeal meetings should be held quickly, and again the employee has the right to be accompanied to an appeal meeting by either a colleague or trade union representative. The result of the appeal should be provided in writing to the employee as soon as is possible after the hearing.
Handling grievances
Grievances can usually be resolved informally. If this is not possible, an employee may raise the matter as a grievance with a manager or partner who is not the subject of their complaint. Their grievance should be fully explained in writing so that a meeting can be held to discuss the matter further.
The meeting
As with the disciplinary hearing, the employee, employer and a companion (as before) – if the employee wishes to bring one – should make every reasonable effort to attend a meeting to discuss the employee’s grievance. A decision to adjourn the meeting may be necessary if it is decided that further investigation is required.
Making a decision
Once a course of action has been decided upon, this should be communicated to the employee in writing, clearly stating what course of action is to be undertaken. The employee should be given the right to appeal.
The right to appeal
If the employee feels that their grievance has not been satisfactorily resolved they have the right to appeal. Appeals should be set out in writing and heard without delay where possible. Ideally, the appeal will be held by a person who has not been involved with previous discussions. The employee has the right to be accompanied to an appeal. The outcome of the appeal should be communicated in writing to the employee without unreasonable delay.
Addressing disciplinary and grievance issues that are related
It is possible that an employee will raise a grievance when a disciplinary process is underway. If this happens, it is reasonable that the disciplinary process be temporarily suspended to allow the grievance to be dealt with. If the disciplinary and grievance cases are related it may be more appropriate to deal with the matters concurrently.
Dismissal
A dismissal is when you as an employer (or employer’s representative) propose to end the employment of a member of staff. This could be for a variety of reasons and not necessarily as a consequence of a disciplinary hearing.
See Ⓦ https://www.gov.uk/dismissal for different forms of dismissal, such as:
an ending of the employee’s employment, with or without notice
constructive dismissal (when the employee feels forced to leave because of their employer’s behaviour or breach of contract)
a fixed-term contract is not renewed.
Before you consider dismissing an employee you must be sure that you have a valid reason (e.g. the project that they were employed to work on has been completed) and that you have acted reasonably in the circumstances (e.g. considered other opportunities for work within the practice).
You should give the employee the relevant notice as outlined within their employment contract, unless the reason for dismissal is as a result of gross misconduct (summary dismissal) in which case the circumstances will have been investigated and clearly communicated via the disciplinary process. If appropriate procedure is not followed, the employee may cite wrongful or unfair dismissal, which may result in the practice being involved in an employment tribunal hearing (see below).
Remember that good documentation, clear communication and the application of the appropriate procedure will stand you in good stead should you be in the position where you are threatened with being taken to a tribunal.
Again, the BMA is happy to advise its members on matters of employment. ACAS also offers sound advice, as well as regional training courses on handling disciplinary cases and grievances within the workplace and dealing with an employment tribunal. Your medical defence organisation may also have a department that offers employment advice to its members. The authors of HOPM recommend that you explore the possibility of taking professional advice before undertaking the dismissal process.
Employment tribunals
Anyone involved in the employment or management of staff will be aware of the ever present threat of being taken to a tribunal by an employee or ex-employee. The information that follows does not cover the legal aspects of employment, but the process and procedures of a tribunal hearing. The legal aspects can be found at Ⓦ https://www.gov.uk/courts-tribunals/employment-tribunal and are current at the time of writing.
An employment tribunal normally consists of three people:
a chairman (who is a lawyer)
one member from a panel of members representing employers
one member from a panel of members representing employees.
It may, however, consist of a chairman sitting alone or with just one lay member. Tribunals hold most of the hearings in their own independent offices. They were set up in the 1970s as a framework for resolving disputes in the workplace without the need to resort to legal proceedings that would be costly and more stressful for those involved.
Unfair dismissal and discrimination are generally considered to be the most common reasons for application to a tribunal. A tribunal application should only be made once a grievance has been established and progressed through the employer’s disciplinary and grievance procedures. Make no mistake – the process is very stressful for everyone concerned. It is the management equivalent of a formal complaint against a doctor – it makes you question everything you do or have done and can ultimately undermine personal confidence if a claim goes against you. Therefore as an employer you should ensure that you have acted reasonably by following all appropriate employment procedures and in good faith before dismissing any employee.
Who qualifies?
Every employee has certain rights from day one, i.e. the rights not to be intimidated or discriminated against. Full employment protection rights apply after 1 year’s service and cover all the issues such as unfair dismissal, breach of contract or constructive dismissal. New employees employed after 6 April 2012 will only be able to qualify for a claim of unfair dismissal after 2 years of service.
How do you know that an employee has made a tribunal claim?
When an employee leaves and intends to go to an employment tribunal, a claim must be filed with the Employment Tribunals Office (within a specified period of time). The first notice is from either the employee telling you that they intend to make a claim or, more often, the official papers arriving from the Employment Tribunal, which you must respond to, again within a specified period of time. ACAS also has a role to play if an employment tribunal is to be considered. Indeed, ACAS must be notified before a claim is lodged. Their role is to act as a conciliator in an attempt to avoid the tribunal claim being pursed. This process is called Early Conciliation. A comprehensive guide is available via www.acas.org.uk.
Legal representation
If an employer decides to resist a tribunal claim, they will need legal representation. It is not essential (both parties can represent themselves in the hearing) but it is advisable. Most law firms have employment specialists who concentrate on this type of work. The easiest way to find a suitable solicitor is to telephone local law practices and ask whether they have an employment partner. Alternatively, use the network of local businesses to gain a personal recommendation. This is not the time to use someone just because they are pleasant to deal with – there is a real need for someone who is technically very sound and able to put forward a strong defence. In a complex case the solicitor may call upon Counsel’s opinion, i.e. a barrister who specialises in employment law cases. Most GP human resources companies have packages that include legal cover for such instances. So a practice may not need to find someone themselves.
Preparation for a tribunal hearing
Witness statements.
The solicitors will begin preparing witness statements from the key individuals after one-to-one discussions. These can be any length, depending on the complexity of the case.
Supporting documentation.
There may be a number of documents that prove relevant to the case, e.g. job descriptions, correspondence, financial calculations for leaving pay or bonuses, file notes, and summaries of formal disciplinary discussions. In some instances it may be helpful to ask colleagues to prepare personal statements or declarations.
‘Bundles’. The solicitor will decide which documents will be used in the hearing and declare them to the other party – these are known as ‘bundles’ and they are also circulated to the tribunal panel. When each side has seen the other’s case, a defence/counter-argument is prepared in readiness for the hearing.
The tribunal courts are very busy and there is often quite a delay before a hearing can be arranged. In a very complicated case there may be a Directions Hearing, held by the Tribunal Chair, to decide how much court time needs to be set aside and the terms of reference.
What happens at a tribunal hearing?
Essentially, it is very similar to proceedings in any law court. The room may be ancient or modern, but the layout will have the same components:
a tribunal panel
a desk for the person bringing the claim and their solicitor
a desk for the person defending the claim and their solicitor
a desk for witnesses giving evidence
a desk for the Clerk of the Court
public seating.
Before giving evidence, an oath to tell the truth must be sworn.
It is often acceptable for witnesses to read their statements from the bundle and then to be questioned by each solicitor in turn, plus answer any questions from the tribunal panel.
The judgment may be given on the day after the tribunal panel has retired to consider their view, or it may be sent through the post. The Tribunal Chair sends a written summary of their findings and verdict. It is possible to appeal and this would involve a completely new hearing with a new panel, but it is usually only allowed if there are factual errors in the judgment summary. The appeal is also time limited.
Dealing with the press
It is possible that the press may attend a tribunal hearing and ask for comments. The natural reaction is ‘no comment’, but this almost implies that there is something to hide. The solicitor should be able to advise you what to say, especially if it could be the headline in the local paper. The tribunal hearing is public.
Awards/costs
A tribunal hearing has various remedies and awards it can make, which will depend on the type of case. For example, if the tribunal decides an employee has been unfairly dismissed, the panel could suggest re-instatement, re-engagement or financial compensation, depending on the circumstances. Costs can also be awarded.
Consequences of not defending a claim
In a large organisation the consequences of not defending a claim but agreeing on an out-of-court financial settlement are more severe than in a small organisation. There are a number of reasons for this, the major one being the level of labour turnover. If a company gets a reputation for reacting to a claim with a chequebook it will attract more claims. In a small environment like general practice, labour turnover is lower and there is only one manager dealing with disciplinary issues. This tends to discourage a litigious attitude. There is no doubt that, these days, every employee is far more aware of their rights than was the case a decade ago, and the increase in the maximum compensation award can be tempting. If an employee has nothing to lose and if they are advised that they have grounds, why not file a claim? For the manager and doctors there is a natural inclination to pay up rather than go through a time-consuming and traumatic legal hearing.
Personal stress
The damage brought about by self-doubt and worry throughout the tribunal process should never be underestimated. Like GPs, managers need to be supported through the experience, both personally and professionally. Even in the most well-organised practice there are errors and omissions, such as not having enough time to confirm all discussions in writing or to make file notes of significant conversations. For a manager to declare such inefficiencies in a practice meeting may be quite daunting, especially if a culture of blame exists. It is better to nominate one partner to mentor the manager and feed back to colleagues the salient points.
Minimising the risk
The only sure way to defend the practice against a potential claim is to have clearly defined disciplinary and employment procedures and to follow them to the letter.
Always:
keep a personnel file for each employee with a copy of their contract, letters of employment, job description and copies of all correspondence including emails
make sure that the published disciplinary procedure is followed – inform staff in writing of their right to be accompanied in a disciplinary interview
confirm the summary of formal discussions in writing and place a copy in the personnel file
keep detailed notes of conversations
inform staff of their rights to appeal and of the procedure involved.
The biggest danger is in allowing situations to drag on for too long, as the behaviour becomes established. This is particularly true of poor performance and standards of conduct. An employee can feel quite justifiably aggrieved if they have been late twice a week for 6 months and then the first time it is mentioned is in a formal disciplinary hearing. Fostering an atmosphere of openness, in which an individual’s contribution is appraised regularly and informal feedback is normal, will be most beneficial to protect you and the practice.
If you receive notification of a tribunal claim, seek experienced and appropriate legal representation.
If you are to appear at a tribunal, think very carefully when giving evidence and do not rush into an answer before you have considered it carefully. Solicitors are skilled at phrasing questions to their advantage.
Keep detailed records.
Deal with any problem or attitude, behaviour or performance quickly and fairly.
Retain the services of an employment advice organisation. There are a number around the country who will offer unlimited legal advice on employment issues and represent you at a tribunal for a cost-effective annual fee.
Always seek legal advice before dismissing a member of staff.
To prepare to appear at a tribunal, try to attend one beforehand as an observer in the public gallery. To visit the actual room and observe the hearing will help to reduce the anxiety of the unknown.
References
Irrespective of the reasons why a member of staff has left your employment, you may find yourself with a request from a prospective new employer for a reference. Practice managers should ensure that they have a policy to deal with such requests and that the policy is accessible to all staff. Many employers are now advised to provide only factual references, such as date of employment and salary details, to avoid the potential threat of litigation and to ensure objectivity. Managers are advised to be consistent in their approach to providing references.