In our 116th edition, Judith and Louise reveal how candy floss and balloons could be saving lives. Liz helps you save money on tax if you've moved to a lower income, Kirsten has some important information about income protection, Caroline has some career for the time of Covid, and Richard has some ideas about starting off as a locum.
The Sessional GP
We are the local community and national voice for GP locums and salaried GPs.
image © Claire de Mortimer
December 2020
Locuming is not a leap of faith; there's plently you can – and need – to do to prepare for the job
NASGP community
Starting out as a locum back in 1995, I soon came across all sorts of obvious hurdles and barriers, and plenty of not-so-obvious ones as well. I’d not been trained for the complexities of locum work; I had no idea or experience of practices being all so inexplicably varied and complex; at that time, us locums were not entitled to access the NHS pension scheme, and I had no idea how to manage all my bookings and tax. I also realised how incredibly isolating it was working from practice to practice, sometimes not meeting another GP for days on end, and having absolutely no one to turn to for support, leading me to quickly set up a local support group for my locum friends. When Major Dick Winters, leading a regiment of US paratroopers called ‘Easy Company’ during the second world war – made famous by the TV series Band of Brothers – was told that he was surrounded by enemies, he simply replied, “We’re paratroopers, we’re supposed to be surrounded”. As GP locums, in each practice, we’re surrounded by practice-specific, highly complex, usually complicated, sometimes sophisticated, and often chaotic processes, policies and guidelines. But unlike Easy Company, this isn’t a war, (although it sometimes feels like it); this is general practice, and there’s an awful lot we could, and should, be doing to mitigate that chaos and complexity. I’ve put together a short video for newly qualified GP or GPs in training who are thinking of working as a GP locum, and for any GP locums who are just starting out. We need to be prepared for the job, so it’s important to think of ourselves not as victims, but as professionals who have agency and control over how we work; we can make a real difference to support practices, especially if they’re struggling, especially if they don’t even know they’re struggling. Dr Richard Fieldhouse NASGP chairman richard.fieldhouse@nasgp.org.uk
‘WE’RE PARATROOPERS, WE’RE SUPPOSED TO BE SURROUNDED’: STARTING OFF AS A GP LOCUM
"We need to be prepared for the job, so it’s important to think of ourselves not as victims, but as professionals who have agency and control over how we work"
As a psychiatrist and a career coach who specialises in the wellbeing of doctors, I have never felt more needed than over the past year.
Health and career
Before the Covid-19 pandemic, many doctors were struggling to maintain a healthy work-life balance, that didn’t leave them feeling depleted and burnt-out. Then Covid-19 came along and gave healthcare professionals an additional unwelcome challenge to face. The pandemic has had a profound effect on the working lives of doctors across the globe. Those working in locum positions have unfortunately not been spared from the extraordinary levels of uncertainty and the never-ending cycle of change. Contracts have been terminated prematurely. Sessional work has been harder to find. Financial insecurity and levels of general uncertainty about the future have increased. Some doctors have found themselves forced into, or out of, portfolio careers sooner than they had previously planned. At the same time, some have felt extremely grateful for the greater level of autonomy and freedom that locum work has brought them. I have been working tirelessly this year, along with my wonderful team of coaches and wellbeing trainers at The Joyful Doctor, to help stressed-out and conflicted doctors from all fields of medicine find a way through the uncertainty and change. Our experienced team of career coaches have been supporting GP locums to adapt and regroup in the face of these challenging times – helping them to put their own wellbeing first, so that they can continue to help others to the best of their ability. After all, as doctors we are deeply driven by meaning. Most of us just want to do a job that brings us a sense of reward without breaking us in the process. Coaching questions If you have found yourself, like many of the doctors we help, feeling run down, demotivated, confused, anxious or just not sure about your next career move, you might have considered working with a career coach to help you shift into a more positive, confident headspace. You could start by asking yourself some of the following coaching-style questions: If you took a blank piece of paper and could design your ideal working week, what would it look like? Imagine you have chosen to take the job on offer to you, how will you feel about it when you wake up tomorrow? How will you feel about it one week from now? How about one year from now? If you are deciding between two or more posts, imagine they paid the same or were in the exact same location, which would you choose? If you fast-forward to the end of your life, looking back to this moment in time, what would you say to yourself about this current decision? How will you feel if you don’t take this opportunity? Asking yourself coaching-style questions like these can help you think of possibilities that you wouldn’t otherwise have considered. However, you might find you get tangled up with limiting thoughts like: “what if X happens?” or “I can’t do that, it’s not possible.” This is when working with a career coach can really help. What to do next A career coach can help you decide on the next right step for you – by focusing on your strengths, options and possibilities and helping you get clear of your limiting beliefs. Unlike a mentor or therapist, they won’t give you advice or try to influence your decision in any way. Their role is to help you focus on the future more than the past – on what is possible rather than what is holding you back. A coach’s role is to listen carefully, in a non-judgemental way, to reflect back to you your own thinking and ask helpful questions to help you reach the best possible decision for you. At The Joyful Doctor, we have been helping doctors through individualised one-to-one coaching sessions to explore all of the options available to them and to make decisions in line with their values and aspirations. (And if you need another great reason to give coaching a try, remember it’s also a tax-deductible expense). Dr Caroline Walker teamjoy@joyfuldoctor.com NASGP members can contact our team today at teamjoy@joyfuldoctor.com to book a free 20-minute coaching strategy call with myself or our head of coaching, Dr Sarah Goulding, to find out how coaching could help you in 2020 and 2021. Dr Caroline Walker is the founder of The Joyful Doctor. She specialises in helping overworked and under-appreciated doctors to move towards a happier, healthier, more fulfilled life and career. To book coaching, workshops and online courses with Dr Walker and her team visit thejoyfuldoctor.com
How to make the best of a career coach
"If you fast-forward to the end of your life, looking back to this moment in time, what would you say to yourself about this current decision?"
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Changing sugar's crystaline structure can make it less calorific
Judith Harvey
"Taste is the public’s first criterion, but price comes a close second, well before health or fair trade."
On family outings to the seaside I always looked longingly at the candy floss stalls. But my mother wouldn’t let me have any, even in exchange for my daily sweet ration of seven Smarties. When, eventually, I was in charge of my own pocket money and away from maternal opprobrium, I treated myself to some of the pink froth. Yuk. Fun to eat, but too, too sweet. And yet, candy floss may hold the answer to the obesity crisis. A couple of years ago I went to the V&A’s Pink Floyd exhibition. It included films of the group ‘off duty’, and I was struck to see how lean they were. And their fans, too. But in the 1960s, that’s how we were. Few then had the fleshy layer which insulates people who count as slim in the 21st century. A diabetologist friend says that patients no longer apologise for their weight. What was once overweight is now the norm. Expectations, changed social habits, a food industry more than willing to foster demand for instant meals: many factors have put the UK near the top of a world-wide health time-bomb. Seven cubes is the recommended maximum daily sugar limit. That’s what’s in one can of traditional Coke. Maybe picturing sugar content in terms of the familiar cubes would bring home how much sugar people are feeding themselves. But sugar has always been irresistible – hunter-gatherers laboured to extract honey from almost inaccessible nests – and sweet treats are hard to give up, especially when life is hard, money is short and smoking is frowned on. When Boris Johnson discovered that his weight increased his C-19 risk he declared war on obesity. That’s a critical change in the political rhetoric: from sneering at the ‘nanny state’ for depriving ‘hard-working families’ of treats, to acknowledging that those treats are depriving them of years of active life. But action requires organisations to work together to tackle our obesogenic environment, and currently we don’t even have joined-up government. The DHSC has a policy of sugar reduction while DEFRA supports the production of sugar which is so inexpensive that there is little economic pressure on manufacturers to switch to cheaper alternatives. Cutting back When it comes to tempting treats, self-denial is difficult. And charging premium prices for products advertised as ‘healthy’ doesn’t work. And a supermarket chain’s priority isn’t public health; it’s profit. But can we make the healthy choice the cheap choice? Taste is the public’s first criterion, but price comes a close second, well before health or fair trade. That’s why VAT is used to encourage healthier choices. Plain biscuits are judged necessities and so are VAT-free. But add chocolate to Hobnobs or icing sugar buttons to gingerbread men and they become luxuries incurring 20% VAT. (To escape the tax McVitie’s persuaded the VATman that Jaffa Cakes are in fact biscuits). Fizzy drinks are the obvious face of sugar excess – available everywhere, often drunk in public, and a suitable focus of middle-class moralisers who prefer more sophisticated treats. In fact, sugar-free versions have been gaining ground for some years, costing exactly the same as traditional carbonated drinks. The introduction of the Soft Drinks Industry Levy in 2018 opened up a price differential, making sugar versions more costly. Artificial sweeteners are very cheap, so it costs less to make sugar-free Coke. Manufacturers are sharing the extra margin with retailers, so sugar-free versions now substantially outsell their now more expensive traditional counterparts. All those calorific milky drinks are surely the next target. The experience with another compound with adverse health effects is instructive. Salt. Since 1984 the food industry has been reducing the amount of salt in processed foods very gradually. They didn’t disclose what they were doing, and neither consumers nor companies’ accountants detect a difference. The food industry has also been very gradually reducing the sugar in its products. Guess which popular, mass-market product has made the largest reductions in its sugar content, both in percentage terms and absolute amount, without the use of sweeteners. (Answer below*). Slow steps So far, so helpful. But because of the complexity of sugar it has to be reduced even more slowly than with salt, and much bigger cuts in our intake are urgently needed to make an impact on obesity. What about developing other kinds of sugar? Much of the sugar we consume is in baked goods and ready meals, and in chocolate, which is rapidly becoming the nation’s favourite sugar hit. The problem is that sugar is more than just a jolt of sweetness. It also gives cakes their springiness and chocolates, spreads and biscuits their texture. A cupcake made with artificial sweetener just isn’t the same. There are no direct, affordable substitutes for sugar which fulfil the many complex roles it plays in our food. And since sugars are central to our body’s biochemistry, any substitute might play havoc with our complex metabolic processes. Many substitutes are under trial: artificial sweeteners, other natural sweeteners, new sugars, other surprising compounds – celeriac! – which can affect flavour. After more than 100 years some people are still anxious that stirring artificial sweeteners into their coffee is potentially harmful. It isn’t – though adding sugar certainly is. But aspartame doesn’t work in cakes or sweet chilli sauces or ice-cream. Finding a substitute that gives foods the appeal we are used to means thousands of products have to be reformulated – a long and expensive process. One possibility is to use sugars which are not absorbed by the body. These sugars provide sweetness for fewer calories and they aren’t metabolised by oral bacteria, so don’t cause caries – a double benefit. One such is maltitol, which is not without its critics, though right-on parents are probably unaware of this when they spoon maltitol-containing sugar-free Calpol into their infants. Maltitol is used in some Spanish chocolate brands, but they’re not for sharing in the cinema – more than couple of squares can produce flatulence. And maltitol doesn’t substitute effectively in most foods. Allulose does better, but it isn’t yet in commercial use. There’s another strategy: to somehow make sugar less calorific. Which brings us back to candy floss. Imagine a form of sucrose which gives us that familiar sweet taste without the calories. Spun sugar, which is what candy floss is, changes the crystalline structure of sucrose so it hits the taste buds much more effectively, so far less is needed to convey the same taste effect. A start-up has developed Incredo, a form of sucrose given the candy floss treatment. Cakes and chocolate made with Incredo apparently stand up to the consumer taste test, and Incredo is coming to the market shortly with the support of major sugar refiners in Europe and north America. Now, Nestlé is joining the bandwagon with a product which it hopes will hit the same buttons. Ensuring that the next generation, and the generation after that, doesn’t suffer the health burden of obesity will take a long time and take more than candy floss technology. But in the field of sugar reduction that pink fluff that I finally tasted all those years ago is a game changer. *It’s champagne! In the late 18th century champagne was very sweet, with 300g of sugar in a standard 750ml bottle. That’s 40g/100ml, compared with 10.6g/l00ml for a traditional cola. Reformulating champagne has taken 200 years, but you can now buy an Ultra Brut which has no added sugar. With thanks to Jack Winkler, Professor of Nutrition Policy, London Metropolitan University (Retired), for his advice. Judith Harvey judithharvey12@gmail.com
Searching for the sweet spot
NASGP chair Dr Richard Fieldhouse explains how chambers meetings work, where GPs meet, how long they meet for, and why discussing complaints is so important. What is an NASGP locum chambers meeting? To me, the two key components of these chambers meetings are ‘buzz’ and psychological safety. ‘Buzz’ is a rather cheesy term – it just means that people look forward to it. They enjoy the meeting, it’s energising, everyone has a laugh, eats nice food in a safe environment, talking about work and learning. So these meetings have a serious purpose, and are enjoyable. When we go to meetings like this, what we do professionally feels much more valuable, and attach more value to it – we have much more ownership of it. The psychological safety thing is where we get to know our other chambers members and we can talk to them about matters that’s sensitive to us as individuals – stuff that we feel vulnerable about. All of which is why a chambers meeting is for members only, allowing everyone to build meaningful professional relationships with each other. For example, we might have been involved in an error at work or been part of a complaint or something like that, and maybe we’re a bit embarrassed about it, or maybe what happened made us question our competence – really personal, almost existential, the sort of thing you only tell your spouse or best friend, that kind of thing. An NASGP chambers is a place where we can feel confident that other members are not going to make judgments about other people, it must be a trusting environment. At NASGP we refer to these as clinical governance meetings. We provide a loose agenda that does not in any way have to be stuck to, much more something to fall back on if the conversation dries up. One of the locums in the chambers is the nominated chambers lead, welcoming new members if there are any, sometimes even baking a cake for the new member, and if needed facilitate any clinical discussions or conversations about work, although as often as not the meetings flow very naturally once everyone gets to know each other. If not, that’s where the agenda can come in handy. It’s also sort of a pastoral role, keeping an eye out for any members who might need support beyond what the meetings offer. Resilience is also a really important aim of these meetings. It’s by no means they’re stated intention, as that might just put a bit of a damper on things and seemed a bit forced, but just sitting down with friends and colleagues once a month, face-to-face, having a laugh and seeing other colleagues smile, enjoying work and participating in the work lives of others, supporting and just being nice to each other, talking about new opportunities and seeing how other people enjoy their work, really engenders a wonderful sense of belonging and, almost by accident, underpins many of the recommendations of the Marmot Review. When we talk about significant events, we do not talk in terms of blaming the member or the practice. Instead, we always look at all the different parts of the system, the parts that worked and those that didn’t work. As a group of locums we discuss the issues, ask questions, and make suggestions that can be fed back to the practice as to what can be done better next time to prevent this happening again. It’s a systems-based approach to learning which emphasises the huge importance of locum chambers, both as a way for its members to help spread best practice and make real changes to the local health economy that benefit patients and practices. Where does each chambers meet? Usually in a typical chambers of no more than 15 locums, half of us tend to prefer not to host a meeting (we might not feel comfortable having people around the house, or we find it’s a faff, don’t know what to cook – all very valid reasons!). The rest of us almost scramble over hosting them, because we love to cook, or we’ve got a nice home that we’re proud to welcome others into, or perhaps it suits our lifestyle – for example we don’t have to get babysitters in. Sometimes a chamber manager will join the meeting just for the beginning, maybe half an hour. They will get feedback about bookings if there’s been any problems or issues or things happening that they really should know about, so that they can skilfully feed this back to the practice, having a really positive impact on where we work. Do GPs talk about work during chambers meetings? Yes! Chambers are here to help us love the work we do, and as often as not we leave each meeting feeling energised and positive about general practice. As many of our patients tell us, there is little worse than being in a job that we feel we can’t change, so knowing that we have a chamber manager and clinical director who can help us make change is so empowering. Sometimes locums will also bring interesting clinical cases to meetings, share clinical news or updates they might think others want to hear about, or share issues they just might want some help or support with. It’s also a good place to pick up soft intelligence about the local area, about a new service that’s being provided a practice that might be merging or closing, or a new type of clinical service. If any locums have concerns about a particular local practice, then, together as a team of locums (usually facilitated by the chamber lead or the chamber manager) there’ll be a short anonymous survey done, asking some very simple questions about the practice. The chambers manager will then liaise with the chamber’s clinical director to provide a short constructive report based on the feedback to help that practice make any necessary improvements. How often do GPs meet? We usually meet monthly or every other month. In normal times, all the locums in the chambers in a local area meet up – usually in someone’s home because it’s just convenient, safe, unimposing, and it’s sort of an informal setting. Usually they’re evening meetings, often scheduled at the sort of same time every month, i.e. alternating months, on the second Tuesday or second Thursday in case people had other commitments, which would mean that they at least get to go to half of them. Are chambers meetings professional, or social? Outside of the ten or so clinical governance chambers meetings, chambers also usually add a few social events, and they are really important. For example there is always a Christmas party and a summer party, plus family barbecues and beach parties. I’ve been to pub quizzes with my chambers, gone bowling at pubs. At social events, that’s when you can really let your hair down and get to know people. Over time, as more locums join a chambers, they might need to be split into two separate chambers, simply to make sure each one doesn’t get too big. So although the clinical governance meetings are separate, we will often combine forces with other local chambers for the social events. How long are NASGP chambers meetings? Meetings usually last a couple of hours but they can over run, it depends how much everyone’s enjoying catching up with friends and colleagues! In future, will NASGP chambers meet in person? Yes. At the moment chambers meet virtually and usually only for an hour. Obviously meeting virtually is very new for us. In the Oxford chambers, we’ve now done seven or eight of these virtual meetings now. To begin with, we were all a bit nervous, I certainly was! It’s not like what an in-person chambers meeting is like, because when we’re are all in the same room, as people arrive, you can have a little chat and get to know each other. You just can’t do that with video – when someone talks on a video it cuts everyone else off, and everyone else listens in. As the months have gone on, people really seem to have warmed to each other and getting to know each other. It’s also means that when we meet each other In person in a practice, it means we have have something already in common and it’s a great ice breaker. We’re definitely laughing more and people seem to be more open to talking about things that they weren’t necessarily talking about initially, which is again really good. But you can’t beat a meeting in person! So, yes, as soon as we can, we’ll be taking turns meeting up in each other’s homes again. Is there anything you never do during a chambers meeting? We never seek to be judgemental, instead taking a very systems-based, formative approach to significant events rather than a summative one. It’s all about support. All GPs work in settings where mistakes occur, so it’s recognising the challenges of these systems and settings, and helping to improve them. We all work in very complex systems, which is not perfect by any means and it has all sorts of constraints within the NHS – particularly funding and manpower. We also tend to have a month off in the summer, and in December, to give members time off during those busy periods. Do complaints about GP locums get discussed in meetings? Yes, wherever possible we encourage members to share their complaints with their chambers colleagues, when the time feels right. It’s important that they are with colleagues who they know and trust. By talking about it as a team it means that the ownership is somehow taken off the individual and gives us all an opportunity to come up with solutions that can then be taken back to the practice to reduce the chance of it happening to anyone else. For the individual, talking about it their complaint to friends offers an opportunity for catharsis, not just for the individual but for everyone. Can I drop into a chambers meeting before joining? Unfortunately non-members can’t attend established chambers meetings, but we are holding monthly national support meetings for anybody who’s already in one of our ‘startup’ chambers and doesn’t yet have many colleagues, or is in the process of signing up to a new one. GPs who are interested would speak to Steve or Ali to get an invite – we have a contact form on the website for that – and I chair them. Dr Richard Fieldhouse chairman@nasgp.org.uk
There's something unique about working as part of a team whilst still being self-employed
"But you can’t beat a meeting in person! So, yes, as soon as we can, we’ll be taking turns meeting up in each other’s homes again."
Q&A: What is a chambers meeting?
Swallowable gastric balloon capsule for weight loss
Currently only for patients who need to loose weight in the short term
"There does seem to be some very promising evidence of efficacy at the four month mark."
Online learning
‘Swallowable gastric balloon capsule for weight loss’ is a new guideline from NICE advising that swallowable gastric balloons can be used in certain conditions for weight loss, first published in November 2020. What is a swallowable gastric balloon? This procedure can take place in outpatients and doesn’t need endoscopy or sedation. Patients must also be enrolled in a programme for nutrition and behaviour change. The patient swallows a capsule which contains a balloon. The capsule is attached to a fine delivery catheter. On reaching the stomach the capsule dissolves. The catheter is used to fill the balloon with water. The catheter is then pulled out. Xray is used to confirm the positioning at various points in the procedure. After about four months, some material on the balloon dissolves, which allows a valve to open, gradually releasing the water in the balloon. The balloon then passes through the GI tract and is excreted. Who can a swallowable gastric balloon capsule be used for? Patients who need to lose weight in the short term (eg pre surgery). Although it can be used and has evidence of efficacy, there are infrequent but potentially serious side-effects, so there needs to be measures in place for ‘clinical governance, consent and audit’. This isn’t unusual when NICE is recommending a new technology. There does seem to be some very promising evidence of efficacy at the four month mark. Can the balloon capsule be used for patients wanting longer-term weight loss? No. There isn’t enough evidence to support its use for people who need longer term weight loss. One small study followed 12 patients up for 12 months after using the balloon. The balloon itself only lasts for 4 months. At 12 months: 55% of patients maintained more than 40% of their weight loss. 27% maintained less than 40% of their weight loss. 18% gained more weight than they lost. What are the risks? The risks seem to be infrequent. They include gastric or small bowel perforation, bowel obstruction and early removal or explant (eg removal because of side-effects, or being vomited out or deflating early). Vomiting, nausea and abdominal pain are frequent, though can often be managed with medication. Louise Hudman louisehudman@gmail.com
"If you earned over £100k and have now dropped below that level – then the tax-free childcare scheme could become available for you."
I have previously written about the SEISS (self-employed income support scheme) which provided funding for individuals who were self-employed in 18-19 and correctly submitted a tax return. However, the scheme will have excluded a lot of GP locums if they were not self-employed during or before the 2018-19 tax year. Hopefully those entitled to claim for the first tranche will have considered if anything is available for the second. But that is unlikely to be the case if there was work available from 14 July. What other help is there? HMRC had already agreed to defer the payment on account due in July 2020 to January 2021 without applying interest to the ‘late’ payment. They have since said that where the tax due in January is less than £30k payments may be made, on request, by monthly instalments over a year from January 2021, so this will help from a cash flow point of view although interest will be charged. This instalment plan will be available to be claimed online – it is likely that some proof of hardship will need to be shown. More information should be available before next January. Payments on account Where there is a 2019/20 tax liability, the same amount will normally be due for payments on account – so 50% of the 19/20 total liability will be payable in January 2021 and a further 50% in July 2021. But if income has been reduced in 2020/21 (as it appears it will be for most GP locums), then those payments on account can be reduced to the expected level for the tax year. Trading allowance For those who only started GP locum work late in the tax year 19/20, just before lockdown, the trading allowance may help. This rule says that ‘trading’ income less that £1,000 is not taxable – or if it exceeds that, you can deduct £1,000 rather than the precise expenses. For 2019-20 (20-21 shown in brackets) there are de minimis limits for Class 2 NIC and Class 4 NIC of £6,365, (£6,475) and £8,632 (£9,500) respectively, and student loan repayments start at £18,935 (£19,390) for plan 1 and £25,725 (£26,725) for plan 2 loans. The class 2/4 NIC will only apply to self-employed income; student loan repayments to total income. But consider Class 2 contributions carefully in the greater scheme of your national insurance credits and state pension entitlement before taking a short-term cashflow benefit. If your income has dropped below £60k and you are the higher earner of a couple one of whom claims or could claim child benefit, then you will be entitled to retain some of it where between £50k and £60k of income and all of it if income has dropped below £50k. Some careful planning about which of you works if one needs to be at home for child care, to keep both of you below the limits could save a material amount of money. If you earned over £100k and have now dropped below that level – then the tax-free childcare scheme could become available for you. New GP locums If you had planned to start work as a GP locum, but then found that no work was available, then you would not need to notify HMRC of your self-employment starting until it actually did. You do not need to notify HMRC of a cessation of self-employment just because you didn’t have any work for a short period, you will be treated as self-employed throughout. However, if you stopped GP locum work because there were no available sessions and started a salaried role, with no further GP locum work, you could treat your last session as your cessation date. If you have not completed your 19/20 tax return yet, try and get it done as soon as possible so you know where you stand with regards to your tax liabilities. If you don’t have an accountant, we can help. Liz Densley 01424 730345 liz.densley@honeybarrett.co.uk Liz Densley is a director of Honey Barrett, Chartered Accountants, and a founder member of AISMA (the association of independent specialist medical accountants). The information contained in this article is for guidance only, and does not constitute advice given by Liz Densley or Honey Barrett. No responsibility can or will be accepted for loss occasioned to any person or entity as a result of action taken or refrained from in consequence of the contents of this article. Professional advice should be obtained before acting on any information contained herein, from your own accountant, or by contacting Liz at liz.densley@honeybarret.co.uk for a free initial consultation.
Less sessional work around this last year will have had an impact on many of us
Accountancy and tax advice
How a lower income affects your tax return
Financial planning
"There is a country mile between a basic policy and one that will offer you the financial security you need."
Maybe it’s the worrying times we live in but we have been receiving more and more enquiries about income protection. I believe protection is the most vital element of any financial plan and I have felt this way my whole career. Yes, it’s exciting to discuss and plan for the big ‘forever’ house, or retirement and the adventures it holds – but we need continuing income to fuel our aspirations. Worryingly there are some inaccurate myths about income protection that seem to be doing the rounds so I thought it was time to dispel a few of those. But first, back to basics. If you have either previously dismissed income protection as a waste of time and money, or felt that you would like to benefit from such a policy but don’t believe you could get cover, seek specialist advice. Likewise, if you hold an income protection policy but you haven’t reviewed it for a while, check it now. Every time I put income protection policies in place for clients, I hope it will be the biggest waste of money they ever spend and they never need to claim. But sadly I have seen many claims during my career. Not one of those clients regretted paying premiums. Q: What is income protection? Income protection is a policy that provides a replacement income if you’re unable to work because of injury or illness. If you become well and return to work it stops but if you are unable to return it will continue to pay you an income until your retirement age. This is not to be confused with critical illness, which is a lump sum paid if you fall seriously ill. The thing they have in common is they are both paid tax free. It is not a policy designed to pay you an income if you cannot find sessions as a locum. Q: Are all policies the same? Definitely not. There is a country mile between a basic policy and one that will offer you the financial security you need. At worst an income protection plan can be a monthly direct debit that is as much use as chocolate teaspoon on a claim. At its best, income protection will offer you the breathing space at the worst of times to pay for ‘life’, so you can concentrate on getting well again while safeguarding your future goals and dreams by guaranteeing an income stream until retirement age. The various options are too many to detail here without this rapidly becoming a short novel. Guaranteed or reviewable premiums? Own occupation or any? Two year payout or full term? Index linking? Options can quickly become confusing and a bit of a mine field without guidance. It’s an issue for all occupations, but particularly for medics. Your jobs are very specific. Your protection needs to be equally so or it will not be fit for purpose. Q: Who needs income protection? Many doctors benefit from sick pay. Hospital doctors work their way towards a maximum of six months full pay and six months half pay after five years of continuous service. Salaried GPs can negotiate the same sick pay arrangement. GP partners benefit from 12 months of guaranteed drawings minus the cost of a locum. But GP locums are not that lucky. You are on your own if you fall ill and cannot work. So while the other doctors need to consider a way of replacing income after a period of sick pay, GP locums need to think of it in a much more immediate time frame. You have the choice of ‘deferment’, meaning how long you want to wait after illness or injury before you start receiving the benefit from the policy. While other doctors can dovetail their income protection with their sick pay, locums need to consider how long you can live on savings without needing another form of income. Often it’s not long when you really think about it. Q: Can a GP locum get income protection at any age? Many income protection policies have a maximum age at which a client can start – commonly, this is 59 years old. Policies often state a ‘terminating age’ (i.e. the age you will be when the policy expires), as well – commonly, this is 79 years old. Q: Is it still possible to get income protection at the moment? Yes, totally possible. I’m not sure where the rumour came from that it was now impossible to get income protection, but we have been putting these policies in place throughout the Covid crisis. Yes there have been some changes to the questions asked at the point of application and slower access to GP reports, understandably, if you have something in your medical history that warrants further information. But the vast majority of applications are going ahead as normal. Depending on your level of cover and your health you may need a medical. As you can imagine in the midst of lockdown these were halted but they are operating once again. Most are carried out at your home or work to suit you and are brief. Many just need a summary of GP notes to give the underwriter sufficient information to make a decision. Q: Why hasn’t the price gone up for GP locums now sessions are scarce? The pricing for an income protection policy for a doctor is based on the provider’s mathematical calculation about how likely it is for you to claim – not how much work you can currently find. Q: What happens if I have a chronic condition or injury? A provider has the ability to take three routes if they think something in your medical history means you are, in the opinion of their underwriters, more likely to claim than the average person. They can: Decline to offer you cover. ‘Load’ the premium, i.e. charge you more for the cover. ‘Exclude’, meaning they will exclude a certain condition or part of your body due to your previous medical history. There are some conditions that make getting cover harder and occasionally impossible. This is quite rare. We have many years of experience of these sorts of issues. If you have a condition that you fear will prevent you gaining cover, speak to us. Q: Why would a locum buy income protection after their income has hit a low point, and they have cut back drastically on outgoings? I’m actually finding that this situation is a catalyst for many new applications. Before Covid-19, the thought of living on less income was perhaps easier to deal with in theory than practice. But having lived through a period of reduced income, it sharpens the focus and makes many realise this is not something they would want to cope with, as well as poor health, potentially until retirement. A policy that protects your income costs a relatively small percentage of your income. Also you don’t have to take the maximum allowable income protection (often 70% of your pre-illness earnings). You can take a policy you find affordable now, and when your income increases you could take the option to increase your level of cover, if you want. Q: What are the advantages of income protection over drawing the pension early? What penalties might a GP face from drawing early? Each version of the NHS Pension scheme has its own normal retirement age (NRA) and so the penalty varies with that. The NRA for the 2015 scheme is 67, for the 2008 scheme it is 65 and for the 1995 scheme it is 60. If you take your NHS Pension scheme early you will be penalised. This penalty is different depending on which scheme you are in. If you are too ill to work you may be eligible for Ill Health Retirement (IHR) from the NHS, but that has a tiered system that dictates the final figures you would receive and is not easy to achieve. A more certain way of planning for the unwanted possibility of either a short term illness that you will recover from and return to work, or a career ending illness or injury, is to hold a standalone, purpose-built income protection policy. Q: What key questions are asked when a GP locum applies for income protection? GP locums are asked the same questions as other doctors: simple questions about your height, weight, lifestyle, sports played plus personal and family medical history. Common myths about income protection, busted ‘GP locums only need income protection if they have kids.’ Kids are expensive, I grant you, but we all need money to live. Unless you have an alternative source of income, if you can’t work then you need income protection. ‘It’s only needed if GPs are in the last 10 years of their career.’ What if you never get to the last 10 years of practice? In the last 10 years of your career, although not ideal, you do have early retirement or ill health retirement options. But what about when you are younger? How will you fund the ‘future’ if you have zero income, let alone potentially fund a more complicated life caused by illness so severe it stops you from practicing? ‘Unless a locum’s income is over £100,000, there’s no point having income protection.’ The more you earn, the more income protection you can hold and this will cost you more each month. But the need and principle is the same irrespective of your level of earnings. GP locums who earn £30,000 or £50,000 or more will still face expenses that continue, no matter what. *We would always advise you to seek specialist financial advice to ensure cover is appropriate to your needs Kirsty McGaun is an Independent Financial Advisor (IFA) at Legal & Medical with over 20 years’ experience in financial services. Kirsty McGaun kirsty@legalandmedical.co.uk 07769 677505
What is income protection?
Kirsty McGaun from legal & medical explains all
© Claire de Mortimer, GP locum, acrylic
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