Here are some common misunderstandings and misconceptions about the NTCER, and the facts that you need to know.
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Misunderstanding & Misconception #11
“I have completed all my training requirements and passed all my exams. This means that I am able to work in general practice as a GP contractor immediately.”
Until you are formally vocationally registered (VR) you can not work as a contractor in general practice.Read GPRA's answer
Vocational registration is a part of your College’s fellowship process. This process can take six to 12 weeks to complete following the submission of all your application paperwork.
When the process is complete, you will receive your VR Medicare Provider Number and will be able to work as a GP contractor.
Working in general practice before you receive your VR Medicare Provider Number
To continue working in general practice you will be required to practice in an accredited training facility with your RTO under an “Extension Awaiting Fellowship”.
Extension Awaiting Fellowship is a once-off extension on your GP training of up to 12 weeks, arranged by your RTO.
This extension is arranged so that you can access an AGPT Medicare Provider Number (as per clause 5.2.7 of the AGPT Extension to Training Time Policy 2019.
During this extension you will continue to be employed as a GP registrar and your employment terms and conditions will still be subject to the NTCER.
While on your Extension Awaiting Fellowship is entirely reasonable for you to renegotiate the terms and conditions of your employment during this period to be more aligned with what would be offered for consultant GP.
This is because you will no longer have supervision requirements and adjustments in your share and/or frequency of payment of percentage billings (and/or other terms and conditions).
Renegotiation is also consistent with provisions in the NTCER (section 2), in that the: “registrar and employer may negotiate terms and conditions different from those outlined [in the NTCER] by mutual agreement, provided they are no less favourable to the registrar”.
Alternatives to consider while awaiting your VR Medicare Provider Number
Alternatively, if you do not want to apply for an Extension Awaiting Fellowship, you can undertake medical practice in a setting that does not require access to Medicare (for example, a hospital locum position). You may even choose not to practice at all during this period.
Misunderstanding & Misconception #10
“As GP registrars are employed on fixed-term agreements they cannot resign from their training placement but must complete the duration of their contract”
In general, as an employee GP registrars are able to resign during a training placement, but there is an expectation in the NTCER that discussions should have occurred between the registrar and training practice on the issues leading to the decision to resign. The RTO would also need to support the registrar's intention to terminate their employment with their training practice.Read GPRA's answer
Terminating an employment agreement before completion of a training term is a serious matter.
This is reflected in clause 19 of the NTCER:
"The employment of a registrar should not be terminated before the completion of the term by the registrar or employer, other than in exceptional circumstances (e.g. serious misconduct) and only where there has been extensive discussion between the employer, practice, supervisor, the registrar and the training provider.”
This situation is very stressful for all parties and has practical implications for the registrar, in terms of progression through the training program and feeling they are leaving patients “in the lurch”. So registrars should seek support and pastoral care from their Registrar Liaison Officer, Medical Educator, RTO and/or GPRA in this difficult time. But also be aware of the effects on the training practice, in terms of losing clinical workforce and the patients’ access to care.
In general, as an employee GP registrars are able to resign during a training placement, but there is an expectation in the NTCER that discussions should have occurred between the registrar and training practice on the issues leading to the decision to resign. The RTO would also need to support the registrar's intention to terminate their employment with their training practice.
The registrar’s employment agreement with the training practice should include clause(s) in relation to termination of employment and this would guide the process for resignation (e.g. return of equipment, payment of entitlements, etc). Importantly it is expected that appropriate notice of termination should be given. Ideally the period of notice should be determined by mutual consent, but the minimum notice period required is not less than one week (NTCER cl. 19)."
Misunderstanding & Misconception #9
“I only get paid for being on-call if I attend a consultation, despite taking work phone calls”
An allowance for “being available” is optional and is set by the practice. If other doctors of the practice are paid an "on-call allowance", then the registrar should also receive payment.Read GPRA's answer
Generally, if you are on-call for the practice, there may or may not be an allowance paid to doctors of that practice for "being available" on-call. As per the NTCER, if other doctors of the practice are paid an "on-call allowance", then the registrar should also receive payment. See clause 10.11 below:
The registrar may be rostered to be on-call. This is considered to be a normal part of general practice. These arrangements shall be no more onerous than those of other full-time doctors in the practice (pro rata for part-time registrars). If other doctors at the practice receive payment for being on-call, the registrar should also receive payment when they are rostered on-call."
You should find out what the on-call policy is in your practice. If none of the other doctors are paid for being available on-call, then unfortunately, you do not necessarily receive any payment.
Misunderstanding & Misconception #8
"A practice can deduct GST from a GP registrar's billings."
GP registrars employed as per the NTCER should not have GST deducted from their Medicare billing payments or salary.Read GPRA's answer
GP registrars employed as per the NTCER should not have GST deducted from their Medicare billing payments or salary.
There are a small number of placements that do not fall under the jurisdiction of the NTCER (if you are in such a placement and GST is being deducted from your payments it is recommended that you seek advice from an accountant). However, for the majority of registrars, where employment is in a private community general practice, a GP registrar's employment will be subject to the minimum terms and conditions set out in the NTCER.
The reason for this misunderstanding is that fellowed GPs who are sole trader contractors pay their practice a 'facility fee', which attracts GST (which the sole trader contractor GP then claims back through their quarterly BAS).
According to the NTCER, GP registrars are considered to be employees (not sole trader contractors) and should be paid at a base hourly rate and then a "bonus" amount is paid if the percentage of billings exceeds the amount already been paid at the base rate.
As Medicare Benefits Scheme payments are GST free, GST should not be deducted from MBS billings when calculating the bonus.
Misunderstanding & Misconception #7
"I’ve only just started at my practice and needed to take a personal leave day because I was ill. Will this have to be leave without pay because I haven’t accrued any sick leave?"
Personal leave can be taken in advance, with up to six months of paid personal (sick/carers) leave entitlements (pro rata for part-time) available from the start of the training term.Read GPRA's answer
This is described in NTCER Clause 6.3 states:
“Registrars are entitled to an advance of 38 hours paid personal/carer's leave for each 6 month period of employment upon commencement of the term, pro-rata.”
In contrast, annual leave generally has to be accrued before it can be taken; however, due to the nature of general practice training, registrars can request access to annual leave that has not yet been accrued, by negotiation with their practice (as per NTCER cl. 6.1).
It is important to note that in the event that a registrar has taken unaccrued personal leave and/or annual leave and terminates his/her employment, then the employer is entitled to withhold an amount equivalent to those hours taken (NTCER cl. 6.2 & 6.3) in determining termination payments.
Misunderstanding & Misconception #6
"I am a full-time GP registrar so why am I being paid as a part-time GP registrar?"
The short answer is that full-time training is not necessarily the same as full-time employment.Read GPRA's answer
Misunderstanding & Misconception #5
"GP registrars are not required to work weekends."
Weekend work is considered to be a normal part of general practice and Saturday morning (8am - 1pm) is actually within the ordinary span of hours (as per NTCER cl. 10.5).Read GPRA's answer
Weekend work is considered to be a normal part of general practice and Saturday morning (8am - 1pm) is actually within the ordinary span of hours (as per NTCER cl. 10.5). So, if weekend work for the registrar is within the 38 hrs full-time, or part-time pro-rated, load (or has been mutually agreed as additional hours or overtime) and other GPs in the practice are also working to a similar roster, then this is allowed under NTCER provided that there are appropriate arrangements in place for supervision.
In fact, there is no clause within the NTCER that explicitly excludes registrars from being rostered to work every weekend. However, the findings from the 2017 GPRA benchmarking survey indicate that this is uncommon, with less than 3% of registrars working every Saturday and less than 0.5% working every Sunday.
While noting that after-hours work is "considered to be a normal part of general practice" (NTCER cl. 10.10), it is important to recognise that for after-hours work (i.e. outside the ordinary span of hours of between 8am and 8pm Monday to Friday and 8am and 1pm on Saturday), the clear expectation is that rostering arrangements for registrars "shall be no more onerous than those of other full-time doctors in the practice (pro rata for part-time registrars)" (as per NTCER cl. 10.10). The specific intention is to prevent registrars being overused for, or carrying a disproportionate load of, the weekend and after-hours rostering. As such, there should be other GPs who are also rostered to work weekends at the practice on similar schedules to the registrar(s).
To avoid any confusion or disagreement down the track, it is always best to discuss the weekend rostering arrangements with the practice prior to commencement (i.e. at the interview) and have this included as part of the employment agreement.
Misunderstanding & Misconception #4
“It is okay to start working at the practice now, we will sort out the paperwork (your employment agreement) later.”
GPRA recommends to always have a written employment agreement in place, signed and dated by you and your employer, BEFORE starting work with a copy retained for both parties for your records.Read GPRA's answer
Having all aspects of your employment arrangements (for example, leave, education release and in-practice teaching provisions; rostering; on-call, after-hours and home-visits requirements, etc) in writing is in the best interests of both you and your employer — it protects both parties, ensures you are on the same page, and provides clarity if there is ever a dispute about the terms and conditions of your employment. GPRA provides an employment agreement template that can assist.
It is also very important that you read and ensure that you understand ALL clauses and items in the employment agreement, BEFORE you sign off, as this is a legally binding contract. If you are uncertain about any item discuss and clarify this with the practice manager or supervisor. Do not make assumptions or gloss over things!
Even if the terms and conditions of your employment are the NTCER minimum, be sure to have this in writing. Read the NTCER document, when you reviewing the employment agreement so that you know what these minimum terms and conditions are, before you sign.
Remember, a signed employment agreement also gives you the opportunity to put any special items in writing, such as specific dates of annual leave or rostering arrangements (This may be important for you, if you have specific family needs or other commitments). It also gives you the chance to negotiate your terms and conditions above the NTCER minimum.
A helpful tip is to request a mid-term review of your employment agreement and include this in the written agreement. This allows for the possibility of renegotiating some of your terms and conditions and the practice may be more willing to consider this once you are better known and have demonstrated the value you bring to the practice. But be sure to get everything that is agreed upon included in your employment agreement and signed off by both parties.
Starting to work without a written employment agreement does not mean that a contract does not exist. Essentially every employment relationship involves a "contract" between an employer and an employee.
This contract may be verbal or in writing or may sometimes involve a mix of the two. It is not necessary to specifically agree on a contract for one to exist. If you agreed to start working (even though you do not have a written employment agreement) then this implies some form of "contract" is in place between you and the training practice.
The fact that an employee is working for an employer brings with it certain fundamental implied terms, such as the right to payment for work performed and a duty of mutual trust and confidence.
The inherent difficulty with verbal contracts or relying on implied terms (in cases where there is no specific written agreement or only a limited verbal agreement) is that there can be later disagreement about what was agreed in the first place. And this often comes down to one person’s word against another.
Misunderstanding & Misconception #3
"It is fairer for training practices to pay the registrar’s percentage billings on a 13-week cycle."
A common misconception is that it is fairer for training practices to pay the registrars percentage billings on a 13-week cycle. In fact, in relation to billing cycle interval, the 2017 GPRA benchmarking survey showed that less than 30% of training practices are using a 13-week billing/receipts cycle.Read GPRA's answer
The NTCER Schedule A Remuneration states that:
- “The registrar will be paid the base rate of pay … fortnightly, with the difference between the base rate of pay and the percentage (if applicable) paid at no longer than three monthly intervals“;
- “For the purposes of the percentage calculations … , the cycle is inclusive of any periods of leave taken, including annual leave”.
Paying the percentage at 3-monthly intervals (13-week cycle) has benefits for the training practice in that fluctuations in billing/receipts by the registrar, occurring for a range of reasons (including variations in patient load, periods of leave, public holidays or education release), are “smoothed” over a 13-weeks calculation.
However, this does not benefit the registrar as leave or public holidays within the 13-week cycle period reduce the amount of earnings returned in the percentage calculation.
I n addition, the delay of up to 13 weeks to receive a component of remuneration can have a significant impact on cash flow for registrars who will only be receiving the base-rate during this period.
GPRA notes that there is significant variation in training practices and the business models under which they operate.
In this context, the NTCER is correctly implemented as a “minimum safety net” with flexibility in employment agreements allowed; as per NTCER clause 2:
- “A registrar and employer may negotiate terms and conditions different from those outlined [in the NTCER] by mutual agreement, provided they are no less favourable to the registrar and are consistent with any applicable legislative instrument”
- and Schedule A: “By mutual agreement, registrars and employers are free to negotiate higher base rates or percentages, or shorter billing cycles.”
While there is no obligation on training practices to offer terms and conditions above the NTCER minimum, there are a number of business and other reasons that a practice may consider in doing so.
In fact, in relation to billing cycle interval, the 2017 GPRA benchmarking survey showed that less than 30% of training practices are using a 13-week billing/receipts cycle.
Possible reasons for training practices to agree to shorter billing cycles, include:
- Equity with other consultant GPs at the practice, who receive their percentage of billings on a fortnightly (or monthly) basis.
- Administrative ease in managing all payroll calculations at the same time. For example, on a fortnightly cycle registrar earnings is simply the higher of either (a) base rate of pay or (b) 44.79% of billings/receipts – there is no need to calculate a “percentage top up” at another time.
- It is fairer for the registrar and develops goodwill with the future GP workforce.
- Registrars, on 44.79% of billings, receive a lower proportion of their total billings earned compared with consultant GPs (who typically earn 65%+ as contractors). While this is considered in the context of a guaranteed minimum base rate of pay, the higher proportion of registrars’ billings retained by the practice can be used to offset employment costs, such as paid leave, for registrars rather than having leave periods “smoothed” out of the registrar’s share of their billings.
- Considering the percentage as an incentive payment, then a cycle that enables this to be paid on a more frequent basis is more likely to facilitate improved productivity of the registrar.
Misunderstanding & Misconception #2
"If a GP registrar is being paid above the NTCER, they are being overpaid."
A common misconception is that if a GP registrar is receiving terms and conditions of employment above the National Terms and Conditions for the Employment of Registrars (NTCER) minimum, they are being overpaid. This is not true.Read GPRA's answer
The NTCER states: "A registrar and employer may negotiate terms and conditions different from those outlined [in the NTCER] by mutual agreement, provided they are no less favourable to the registrar and are consistent with any applicable legislative instrument."
The NTCER outlines the MINIMUM terms and conditions of employment which GP registrars must receive. Accreditation standards for all training practices require that the terms and conditions in registrar employment agreements must NOT be less than the NTCER — this means that registrars can negotiate for terms and conditions above those set out in the NTCER and these may be achieved if a mutual agreement can be reached.
GPRA encourages all GP registrars to take an active role and a realistic approach to negotiating their employment agreement.
Once you have Fellowed, as a consultant GP, you will likely need to negotiate for work in general practice as a contractor. Being actively involved in negotiating your employment agreement and understanding the "business-side" of general practice as a GP registrar is a good experience for the future.
Misunderstanding & Misconception #1
"There is no need for a GP registrar to negotiate their employment agreement."
A common misunderstanding is that, because GPRA negotiates the National Terms and Conditions for the Employment of Registrars (NTCER) with General Practice Supervisors Australia (GPSA), there is no need for GP registrar to also negotiate their employment agreement with their training practice. This is not the case.Read GPRA's answer
Accreditation standards for all training practices require that the terms and conditions in registrar employment agreements must NOT be less than the NTCER minimum — this means that registrars can negotiate for terms and conditions HIGHER than those set out in the NTCER.
When aiming for terms and conditions higher than the minimum, registrars need to be realistic and negotiate based on the value you bring to your practice; you are more likely to be successful in negotiating terms and conditions above the NTCER when you are GPT3/PRRT3 terms and beyond.
The NTCER is not a registered award; your signed employment agreement is the legal document under which you are employed. Remember, whatever terms and conditions you and your practice agree upon — whether it is the NTCER minimum or above — get it written into your employment agreement and signed BEFORE you commence working for the training practice.