Key terms in the NTCER

Here is an explanation of key terms in your employment terms and conditions

Remuneration

According to the NTCER, registrars should be paid a base salary, or a percentage of billings/receipts, whichever is greater. A base salary is a wage paid per hour worked. All registrars need to have a base salary in order to be remunerated appropriately for paid leave and to provide a reasonable base wage in case of low workload. The percentage of billings/receipts payment is a percentage of what a registrar bills or receives (as recorded in the practice software). Keep in mind that billings can be calculated immediately, whereas there will be some delay calculating receipts. These arrangements should be clarified with your employer and documented in your employment agreement. Your base salary increases each term from GPT1 to GPT3, however, your percentage does not increase. These factors are all negotiable. Higher incomes become possible when your billings for the practice exceed the NTCER base salary. Typically, the transition point comes when you are seeing an average of three patients per hour in eight or more sessions per week. Other factors also contribute, such as whether the practice bulk bills or charges higher private patient rates. Remember that the NTCER is intended to be the basic terms and conditions of employment. You are free to negotiate improved terms and conditions. To assist you in this process, GPRA produces a benchmarking report detailing the terms, conditions and remuneration of registrars around Australia. Check the report to ensure the remuneration you have in mind is reasonable at gpra.org.au/employment

Financial incentives: PIPs and SIPs

The Practice Incentive Program (PIP) and Service Incentive Payments (SIPs) are financial incentives paid by Medicare Australia to achieve specific national health outcomes. Many registrars are unclear about whether they, or the practice, should receive these payments.

PIP payments are paid to the practice. Apart from the anaesthetic PIP and obstetric PIP, individual GPs and registrars do not receive PIP payments.

SIPs are usually paid to the individual GP or registrar performing the service. However, it is common for the payment to be shared between the registrar and the GP or practice if, for example, the GP supported the registrar or specialised equipment was required to deliver the service.

Details of PIP payments and SIPs should be written into your employment agreement. The NTCER document states that SIPs are to be included in your gross billings/receipts.

Subsidies and expenses

Rural or remote placements may include accommodation or rental subsidies. Discuss with your training organisation what you may be eligible to receive. Your employment package may also include travel allowances or reimbursement for certain expenses. These are outside the NTCER and may be negotiated on a case-by-case basis. Find out whether you will be expected to provide any of your own equipment.

 

Leave entitlements

As an employee, you are entitled to leave arrangements as set out under the Fair Work Act and the National Employment Standards. This includes annual leave, personal/carer’s leave (including sick leave), compassionate leave, study leave and parental leave. The minimums for some of these types of leave are non-negotiable and the employer must offer the legislated minimum leave, just like any other business. If you would like to take annual leave during your training, it is wise to discuss this with your supervisor or relevant practice staff member as early as possible, especially if the leave you require falls during a busy period for the practice.

All employees must receive entitlements as set out under the Fair Work Act including superannuation and annual leave. Note that according to the Fair Work Act, leave is not transferable between employers. Therefore any leave you have accrued at one practice will most often not be recognised by another practice (and in the case of annual leave, any accrued leave should have been paid out at the end of your employment term).

Annual leave

The Fair Work Act, Division 6, states: ‘For each year of service with his or her employer, an employee is entitled to 4 weeks of paid annual leave. An employee’s entitlement to paid annual leave accrues progressively during a year of service according to the employee’s ordinary hours of work, and accumulates from year to year. Paid annual leave may be taken for a period agreed between an employee and his or her employer. The employer must not unreasonably refuse to agree to a request by the employee to take paid annual leave. If... an employee takes a period of paid annual leave, the employer must pay the employee at the employee’s base rate of pay for the employee’s ordinary hours of work in the period. If, when the employment of an employee ends, the employee has a period of untaken paid annual leave, the employer must pay the employee the amount that would have been payable to the employee had the employee taken that period of leave’.

Personal leave

For each year of service with his or her employer, an employee is entitled to 10 days of paid personal/carer’s leave. An employee’s entitlement to paid personal/carer’s leave accrues progressively during a year of service according to the employee’s ordinary hours of work, and accumulates from year to year.

Study leave

There is no automatic entitlement to study leave, however, some practices may allow you to take unpaid leave to prepare for exams or pursue other studies. You should negotiate this with your practice as early as possible.

Parental leave

Parental leave is handled slightly differently to the Fair Work Act within AGPT. The reason for this is that the Fair Work Act states:

‘An employee… is not entitled to [parental] leave… unless the employee has, or will have, completed at least 12 months of continuous service with the employer...’

This eligibility criterion excludes most general practice registrars. AGPT policies allow for parental leave (without pay). Contact GPRA or your training organisation for more information.

Registrars may be eligible for payments via the federally funded parental leave scheme. For more information, visit familyassist.gov.au

Generally, you should notify your training organisation and your employer of your parental leave requirements as soon as is reasonable.

 

 

Employment terms and conditions in detail

This section discusses the specific employment terms and conditions that should be covered in the negotiation process. It allows you to easily follow the order of the GPRA Employment Agreement Template. To get the most out of this section, follow this order in your employment agreement. The GPRA Employment Agreement Template can be found at gpra.org.au/employment The full NTCER document can be found at gpra.org.au/employment.


Hours of work
Reference: NTCER section 10

The NTCER defines ordinary hours as the time between starting and finishing work each day between 8 am and 8 pm Monday to Friday, and 8 am and 1 pm Saturday. This definition is consistent with the Medicare Benefits Schedule (MBS) definition of attendances after hours. You must work in blocks of between three and 12 hours duration. Ordinary hours include:

  • normal general practice activities including – scheduled consulting time (whether seeing patients, or not)
    • home, hospital and nursing home visits
  • including travel time
    • administrative time (ie. writing notes,
  • telephone calls, reports)
    • practice-based teaching time
    • educational release time.

Meal breaks and on-call time are not included in ordinary hours.

Ensure your ordinary hours are agreed on prior to the start of the term. Your ordinary hours should be itemised and detailed in your employment agreement. Generally, your roster should be similar to other GPs in your practice.


Reference: Full-time versus part-time
NTCER section 10.2 and 10.7

Before negotiating your employment agreement be sure that you are clear on your training and employment load. Full-time employment is defined as 38 hours per week, averaged over a four-week cycle with no less than 27 hours per week averaged over four weeks of patient contact time. A full-time salary is based on a 38-hour week. Full-time equivalent (FTE) is a workforce calculation detailing a working load compared to a 38-hour week. Part-time employment is any number of hours less than 38 hours per week averaged over a four-week cycle. A part-time salary is pro-rata based on a 38-hour week. Full-time training is determined by ACRRM and the RACGP. Part-time training is based on the number of hours less than those specified by the respective college(s) (ACRRM and RACGP) of patient face-to-face time. Check with your college and current AGPT policy regarding any specific requirements for part-time training. For example, whether the patient contact hours must be spread over a minimum number of days per week, and what the educational release and training time is for part-time registrars. Training and employment are separate considerations when it comes to full-time and part-time definitions. Registrars should be more concerned with their training status than their employment status.

Example: A registrar works a total of 35 hours per week (10 x 3.5-hour sessions) at the practice. They are considered a part-time employee of the practice, however, they may be considered to be training on a full-time basis, depending on their training pathway. Part-time hours and conditions apply on a pro-rata basis. The exception to this is educational release, which is calculated at half that of full-time registrars, irrespective of the hours worked.

Additional ordinary hours are not generally listed in your employment agreement but may arise throughout the year. Additional ordinary hours may be worked by the registrar by negotiation with the practice.

For example, a part-time registrar may be asked to fill in for a colleague who needs a couple of days off. Where this occurs during regular hours, it is not considered overtime, and no overtime is payable on those hours. However, registrars may decline practice requests to work additional ordinary hours without penalty or disadvantage.

According to the NTCER there is no overtime rate payable on additional ordinary hours and so the pay rate for ordinary hours applies.


On-call and after-hours
Reference: NTCER section 10.11 and 10.10

The NTCER states that where a practice is normally open outside of ordinary hours, the registrar may be rostered to work. The registrar may also be rostered to be on-call at various times. These hours are considered a normal part of general practice, although registrars’ working arrangements should be no more onerous than those of other GPs at the practice. This means that you should be working similar weekend hours to the other supervisors, GPs and registrars at your practice.

If the GPs in your practice usually work after hours, then there may be an expectation that you also contribute. You should ensure that these expectations are explicit in your employment agreement and that you are comfortable with these expectations. If working after hours is not something you can commit to due to personal reasons, this should be discussed and must be explicitly included in your employment agreement. Keep in mind commuting requirements between workplaces (including educational releases) during these discussions.


Fatigue management

It is important to consider your personal wellbeing and fatigue management. Ask the practice if they have policies on fatigue management and safety (see NTCER section 16.2 and 16.3). These policies should be referred to in your employment agreement. Read the Fatigue Management in Vocational General Practice Training document at gpra.org.au/training


Supervision and education

Reference: Australian College of Rural and Remote Medicine and The Royal Australian College of General Practitioners training standards

Training requirements
Reference: NTCER section 9

Your employment agreement should include the times, dates and any other details about your in-practice teaching where possible. A useful tip is to schedule dedicated teaching first thing in the morning or immediately after lunch to ensure that your time is not compromised by patient consultations running late

Depending on the level of training and which college the registrar is training with, the allocation of time dedicated to in-practice teaching will vary. Supervisors have a range of teaching styles and registrars have a range of learning styles. GPRA has produced an in-practice teaching guide to help maximise your in-practice teaching experience. This guide is available at gpra.org.au/training

We encourage that in-practice teaching is discussed and mutually agreed, with times agreed upon in advance. Educational release mandated by the college and training organisation must also be considered.


Your supervisor’s obligations
Reference: NTCER section 9.1

Your employment agreement should include details of your supervision and teaching arrangements, including the makeup of your supervision team, their contact details and the supervision and teaching time arrangements.


Leave entitlements

Annual leave
Reference: NTCER section 6.1 and 6.2

Registrars are entitled to two weeks paid annual leave every six months, or four weeks per year. The exact number of hours of leave accrued is based on your ordinary hours of work. On termination of employment, an employer must pay an employee for any untaken annual leave that has accrued.

Example: A full-time registrar working 38 hours per week will accrue 76 hours leave (ie. 10 days) after 26 weeks of employment. A part-time registrar working 20 hours per week on average will accrue 40 hours leave after 26 weeks of employment. Both registrars have accrued two working weeks of leave.

The National Employment Standards state: ‘Annual leave is paid at the employee’s base pay rate for all ordinary hours worked, not including extra payments such as: overtime rates, penalties, allowances, bonuses’.

You need to clarify in your employment agreement how annual leave is to be paid. Many practices will simply pay your base rate and include periods of annual leave in your billings/receipts. Another method might be to calculate your billings/receipts during the hours that you have worked, excluding all types of leave that are then paid separately at your base rate. Ensure that your employment agreement is clear on which calculation method is used.


Personal/carer’s leave
Reference: NTCER section 6.3

Personal/carer’s leave is leave taken due to personal illness or injury (sick leave) or to provide care to an immediate family or household member who requires care or support due to personal illness or injury or an unexpected emergency (carer’s leave).

Personal/carer’s leave is accrued at half the rate of annual leave, ie. at one working week per term, or two working weeks per year.

Example: A full-time registrar working 38 hours per week will accrue 38 hours personal/carer’s leave (ie. five days) over a 26-week term. A part-time registrar working 20 hours per week will accrue 20 hours personal/carer’s leave (ie. 2.5 days) over a 26-week term.

Both registrars will accrue two weeks of personal leave per year. Personal leave is paid at your base rate.


Study leave
Reference: NTCER section 6.6

There is no automatic entitlement to study leave. Some practices may allow you to take unpaid leave to prepare for exams or other study. Think about when you intend to sit your exams or might need study time, and negotiate any study leave that you may require prior to starting the term. Include any details of your negotiated study leave arrangements in your employment agreement.


Educational release
Reference: NTCER section 9.2

Educational release typically does not occur every week, and depending on your training organisation, you may attend these weekly, fortnightly or monthly. Educational release varies between training organisations, and may be face-to-face or online, and during or after business hours. Overall, educational release time can be averaged over a relevant time period. This is useful for when you are doing more consulting in certain weeks and more formal education at other times. Mandated educational release is paid at your base rate in GPT1 and GPT2 if you are typically rostered to work during release times. After hours or weekend educational release when registrars are typically not rostered to work will not be paid. Some training organisations run extra educational workshops beyond the minimum requirements. Your employer is not obliged to fund this time.

Part-time training registrars are paid for educational release at half the rate of fulltime training registrars, regardless of the number of educational release sessions they attend.

For full-time training registrars that work 38 hours over four days and attend an educational release on the fifth day in a normal working week, then those educational release hours may be taken as equivalent time off in lieu on the day immediately preceding or the day immediately following the educational release day in order to comply with clause 16.2 of the NTCER, Fatigue Management. It is important to ensure that both you and your practice are aware of the educational release requirements of your training organisation, and that these have been recorded in your employment agreement.


Expenses Travel expenses
Reference: NTCER section 12.1

Travel expenses should be discussed, and usually apply to use of your private motor vehicle for work purposes. Reimbursement rates are paid at the standard rates available from the ATO.


Relocation expenses
Reference: NTCER section 12.2

Unless otherwise agreed, the employer is are under no obligation to meet a registrar’s relocation expenses. Registrars should check if they are eligible for relocation subsidies from their training organisation.

GPRA and GPSA agree that neither the employer nor the registrar should be financially disadvantaged in supporting a registrar’s accommodation. Any accommodation subsidy shall be distributed appropriately to either the registrar or the employer, depending on who incurs the cost of provision of accommodation. This should be stipulated in your employment agreement. If a registrar is undertaking a general practice term in a rural area, the employer will support the registrar in accordance with training organisation terms and conditions. This may include assisting the registrar to find accommodation to suit their needs (eg. self-contained, fully furnished with kitchen facilities) and is in accordance with the standard approved by AGPT policies. The registrar will be responsible for payment of gas, electricity and private telephone usage. Rural or remote placements may include accommodation or rental subsidies. Talk to your training organisation to see what you might be eligible to receive.


Registrar requirements

Medical registration and indemnity insurance
Reference: NTCER section 14.1 and 14.2

As a general practice registrar, you must hold an appropriate level of medical indemnity insurance for the work you carry out. You must also have current registration with the Medical Board of Australia. Your prospective employer is entitled to ask for evidence of these.

The employer will ensure it has insurance to cover workers’ compensation for the registrar. You must inform your employer

immediately if: your medical registration is withdrawn or conditions are imposed on it; or your medical indemnity insurance changes or is terminated for any reason.


Personal safety
Reference: NTCER section 16.3

It is the employer’s responsibility to provide a safe working environment. As employers, practices are liable if they fail to provide such an environment, regardless of intent. Similarly, it is the duty of registrars as employees to raise any occupational health and safety issues that they become aware of, and to comply with the existing OH&S policies of the practice and employer. The employer will ensure it has insurance to cover workers’ compensation for the registrar. GPRA strongly encourages early and transparent discussions on any issues related to personal safety. We also encourage that these discussions should be entered into in good faith and with a genuine regard to safety. Ask the employer for any practice policies that you need to be aware of and make reference to them in your employment agreement.

If you experience any threats to your personal safety, raise and discuss these with your employer immediately, and, where possible, put them in writing. You may wish to keep a diary of events. Being able to show a history of behaviour is often far more powerful evidence than a single incident.

Depending on the severity of the risk, the registrar may choose not to work until the issue is resolved, or the employer and registrar may agree to an action plan and timeline to resolve any issues.


Termination of employment
Reference: NTCER section 19

Employment should not be terminated by the registrar or employer before the completion of the term other than in exceptional circumstances. There should be extensive discussion between the employer, practice, GP supervisor, registrar and training organisation before such action is taken. Termination notice periods should be discussed and stated in the employment agreement and both parties should adhere to these. Exceptional circumstances where patient safety is at risk or extenuating personal circumstances may allow for termination without any notice by either party. This should be discussed and legal advice sought as appropriate. Any relevant accrued entitlements must be paid to the registrar following termination of employment.


Geographic restrictions on future employment
Reference: NTCER section 17

Restrictive covenants that prevent a doctor from practising in the future within a certain geographic range from the employer’s practice are designed to protect the practice’s client base. GPRA has obtained preliminary legal advice to indicate that restrictive covenants are unlikely to stand up to scrutiny for registrars in the training program, as registrars typically don’t control their placements and are often required to move practices to meet their training requirements. However, we are not aware of case law on this issue. To get a firm ruling, this issue would need to be tested in a court of law. GPRA believes that restrictive covenants have no place in a training program and would be very difficult to uphold within the training context. Registrar placements should always be driven by the registrar’s learning plan and training needs. GPRA recommends that registrars in all terms of training should attempt to remove restrictive covenants from their employment agreements. Enforcing a restrictive covenant would be extremely expensive, and the benefits to the practice would be limited. GPRA recommends that registrars with ongoing concerns as to restrictive covenants should seek professional advice on the matter.


Dispute resolution
Reference: NTCER section 18

Disputes rarely occur over the terms and conditions of your employment. However, should a dispute arise between you and your employer over the terms and conditions of your employment, you should inform your training organisation immediately, and contact GPRA and/or your RLO for assistance and advice. Each training organisation has its own process for dispute/grievance resolution. The NTCER states that during the dispute resolution process, both parties should endeavour to continue working in an appropriate and professional manner. It is a good idea to agree to a dispute resolution process and timeframes as part of your employment agreement. This should include issues such as serving a written notice of dispute by either party, and agreeing to a mediation process by nominating the training organisation or appropriate individual or organisation as a go-to point when there is a dispute. Having a clear process can often hasten the resolution process and provide win-win outcomes.


Remuneration
Reference: NTCER Schedule A

The annual base salary for full-time registrars is set out in the NTCER agreement in addition to the statutory rate of superannuation. Most practices will use the base rates set out in the NTCER. The statutory rate of superannuation is to be paid at the rate set by the Commonwealth Government. The rates can be found in the NTCER or by visiting the ATO website at ato.gov.au

Base salaries are reviewed yearly and indexed in accordance with Medicare rebates (see NTCER section 11.1). These are the agreed base rates for the 2017 training year. Higher rates can be negotiated at an individual level.


The frequency of billing and payment cycles
Reference: NTCER Schedule A

This is a very important discussion point for general practice registrars. Clarity on when and how often you are paid can minimise any issues that can later cause tension between the employer and registrar. Registrars should be paid at their base rate at least fortnightly. The NTCER states that your billing cycle, ie. the period after which the difference between your billings/receipts and your base rate will be calculated, should be a maximum of 13 weeks. Our recommendation is to attempt to negotiate a billing cycle that matches your pay cycle, ie. fortnightly. This is financially advantageous to you, and, in many cases, perhaps administratively easier for the practice. It is important to clarify the period after which your billings/receipts will be calculated, and record this in your agreement.

GPRA’s 2014 Terms and Conditions Benchmarking Report shows that fewer than 20% of registrars were on a 13-week billing cycle. If you are negotiating for a weekly or fortnightly billing cycle and the practice wants to use a 13-week billing cycle, it may be useful to advise them that most registrars are on a billing cycle shorter than 13 weeks. The billing cycle specified in the NTCER is no greater than three months (13 weeks), and GPSA and GPRA agree that it should never be longer than this period of time.

As per section 14.7 of the NTCER, practices should pass on billing information to registrars regularly, and at no less a rate than other doctors in the same practice. Most general practice billing software gives an up-to-date calculation; you may like to request access to this calculation so you can check it at any time.

GPRA highly recommends registrars understand and confirm billing and pay cycles in their employment agreement prior to starting employment. You should also be aware of the differences between being paid on billings versus receipts before agreeing to one or other method.


Payment by billings or receipts
Reference: NTCER section 11

A higher income becomes possible when a registrar’s billings or receipts for the practice exceed the base wages specified in the NTCER. A higher percentage of billings or receipts rate also makes a substantial difference to income. Although the NTCER specifies a percentage of billings or receipts plus the statutory rate of superannuation for registrars, some registrars are on higher percentages. This may be negotiable, and having more experience or special skills are good reasons to negotiate a higher rate. Bear in mind that it is unreasonable to be paid a higher percentage of billings than very experienced GPs working in the same practice.

Gross billings or receipts include all the fees you will generate working at the practice. SIPs are included in gross billings or receipts. The registrar is not entitled to PIP payments with the exception of the anaesthetic PIP and obstetric PIP. The agreed SIPs and PIP arrangements should be included in your employment agreement. The stated percentage of billings or receipts according to the 2017 NTCER is 44.79%.


Payment for overtime
Reference: NTCER section 11.2

Overtime can be taken as time in lieu at your base rate, hour for hour, within one month of accrual. Alternatively, overtime can be paid at 150% of the ordinary rate plus the statutory rate of superannuation. Discuss which arrangement will apply to you and ensure it is specified in your employment agreement.


Payment for after-hours and on-call work
Reference: NTCER section 10.10, 10.11 and 11.4

According to the NTCER, after-hours and on-call work is paid at the base rate. This applies whether the work is undertaken at the practice or off-site. If this includes hospital-based work, registrars should also receive the agreed percentage of on-call allowances paid by rural hospitals plus the statutory rate of superannuation.


Service incentive payments
Reference: NTCER section 13

The exact portion of SIPs the registrar is to receive should be included in your employment agreement. Usually SIPs are included in the registrar’s gross billings, however, registrars and the practice may wish to negotiate a higher rate.

Dr Kari Sims talks about what you need to know before signing your first contract as a GP registrar.

Have issues with your employment? Contact GPRA for confidential advice and support.