The National Terms and Conditions for Employment of Registrars (NTCER) currently provides the basic framework for describing the employment arrangements for registrars in GP training settings. This framework has been used, with various revisions, for two decades.
Despite the enduring nature of this framework, there have been recurring concerns amongst GP registrars about a number of issues with their employment arrangements and the NTCER.
Key issues of concern for GP registrars include:
- The low base rate of pay compared with hospital-based medical officers and other registrars training in other specialties.
- Limited employment entitlements, in particular access to paid parental leave and study leave, and the lack of portability of entitlements when moving between training placements and the ability to retain entitlements (e.g. long service leave, sick leave) accrued prior to commencing training in community settings.
- Inconsistencies and inequities in remuneration for hospital-based after-hours and oncall work that GP registrars undertake in relation to how this is incorporated into the calculation of their GP practice income.
- Hours taken as leave are not calculated separately but included in percentage billings calculations, effectively reducing the bonus payment received.
- The maximum length of the billing cycle (13 weeks) allowable before the registrar’s bonus payment is calculated. While many registrars appreciate, and financially benefit from, receiving a share of their billings earnings as a bonus payment on top of their base-salary, a delay of up to 13 weeks to receive a component of remuneration can have a significant impact on cash flow for the registrar who will only receive the base-rate salary during this period.
The process for negotiating revisions to the NTCER along with the current funding model for general practice and GP training, as well as systemic and structural constraints, all contribute to the inability to resolve the key issues raised by GP registrars.
While being aware of the specific context of the general practice training environment, there are a range of alternative employment models, which may alleviate the key issues raised by GP registrars; this includes:
- Single Employer
- Training Incentives
- Portable Leave Schemes
- Underwriting the NTCER
- Hybrid Systems, incorporating aspects of the above models.
In considering any substantive change to the current employment arrangements or introduction of a new employment model for GP registrars it is an absolute imperative that the advantages and benefits along with potential downside risks and unintended consequences be identified and addressed. Financial modelling and associated evaluated trials must be undertaken prior to any large-scale implementation.