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Practice Structure and Organisation

An Introductory overview

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General Practice Independent Contractor Employed by LHA Provide “General Medical Services”

OR “Personal Medical Services” Demand-led Service secure long-term contract taxation advantage

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Independent Contract GMS or PMS Core Services Item-of-Service payments Target payments Drug/Dispensing payment Reimbursement

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Partnership Partnership Agreement (contract) Teamworking Trust

mutual support buddying covering duties sharing workload

Rotas

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Partnership

Strengths/Weaknesses

Roles Chemistry Numbers/divisions Bonding/cohesion Flexibility/tolerance

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Holiday Rota

Bank Holiday 10 year planJames Street Family Practice

Winter Half-Term Easter Mayday Spring Summer Half-Term First Choice of August Autumn Half-Term Christmas New Year(off) Good Friday Weekend Monday (off) Summer Holidays (off) Day Boxing Day (weekend) (weekend)

Past1996 LP AM * LP x ST * ST AM ST IC1997 AM * IC LP AM LP/AM ST x IC LP LP LP IC ST AM1998 LP IC LP IC ST AM AM x LP ST AM ST AM LP1999 ST AM ST AM LP IC LP x ST AM JM LP JM/LP AM2000 AM LP JM LP AM ST ST x JM* LP ST AM * JM

Future2001 LP ST AM ST LP JM AM JM HH ST LP JM LP ST AM2002 JM HH LP HH ST AM ST AM JM HH AM ST AM HH JM2003 AM JM ST JM HH LP HH ST AM LP HH LP HH AM ST2004 ST AM HH AM JM ST LP HH LP JM ST JM ST LP HH2005 HH LP JM LP AM HH JM LP ST AM LP HH LP JM AM

* No Co-op shifts

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Structure

R ec ep tion & A d m in is tra tion D is p en sary P rac tice N u rses C lean in g

P rac tice M an ag er

P artn ers

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Roles Practice Manager Practice Nurse Dispenser Receptionist Secretary Data Clerk

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Attached Staff District Nurses Health Visitors Palliative Care

Nurse Midwife Podiatrist

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Other close contacts Podiatrist Mental

Health/Drug Abuse

Gynaecologist Chiropractor Homeopath Audiologist

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GP Registrar Roles & Responsibilities Supernumerary Protected training time Self-directed learning

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Premises

Health Centres Cost-Rent

Scheme PFI/LIFT Equity Partners Use of space Long-term return

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NHS Primary Care Structure Department of Health (DoH) NHS Executive (NHSE) Regional Health Authority (RHA)

(Trent) Local Health Authority (LHA)

(Lincolnshire) Primary Care Group (Trust) (East

Lindsey)

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East Lindsey PCG Determines local health needs Deploys resources to meet needs Holds Prescribing/Staff budgets Clinical Governance

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Taxation Schedule D

self-employed expenses “wholly

and exclusively …” Schedule E

PAYE tax code given expenses “wholly

and necessarily”

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Professional Expenses