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Tips for managing locum cover

​When associates need to take time away from the practice, it is important to work together to find the right solution.

Alan Pitcaithley BDA Practice Management Consultant

Sometimes associates may need to take time off in addition to holidays and CPD. This happens for a range of reasons such as undertaking training, or parental leave. Sometimes absences are unexpected in the case of illness or self-isolation.

It benefits both the associate and the practice owner to work together in planning for these scenarios. Clear communications can help avoid difficulties for both parties.

Self-employment and associate agreements

Most dentists in general practice carry out their work as associates, under the terms of an Associate Agreement. Most agreements have a clause setting out that after a period of absence, associates are required to engage a locum. If the absence is over four weeks, the local health authority must also be informed.

Under associate agreements the practice owner is paid a licence fee to allow the associate to work at the practice. The licence fee is typically calculated as a percentage of the associate's earnings, with deductions for items such as lab bills and pension contributions.

Our current Model Associate Agreement allows associates as much time off as they need, which is a key benefit of being self-employed. However, with income based on work provided, associates do not usually take extended periods of leave. To help cover periods of absence our agreement includes a minimum licence fee. This ensures that the associate will pay the practice owner a fixed minimum amount each month. This payment provides a safety net, ensuring income for the practice owner and a cap to the amount the associate needs to pay.

Finding and engaging a locum

In most cases, the associate is responsible for recruitment and deciding who the locum will be. Checks must also be carried out to ensure that the locum is suitable. There may be times when a practice owner objects to an associate's choice of locum. This is very rare, and the practice owner would need to have good reason. It is important that all locums are engaged correctly, the relevant authorities need to be notified and the necessary paperwork needs to have been submitted to relevant authorities.

Practice owners and associates can work together to find a suitable locum, but sometimes it may be more suitable for the practice owner to take the lead.

Practice owners and associates can work together to find a suitable locum, but sometimes it may be more suitable for the practice owner to take the lead in finding a locum. This is especially true if the absence is due to sickness. However, in these circumstances, the associate is still technically responsible for engaging and contracting with the locum.

If the practice owner agrees to take over the responsibility, they and the associate will need to discuss and put in writing what happens if a suitable locum cannot be found. Or, if the locum cannot fulfil the same number of sessions that the associate typically works.

A locum can be a dentist who joins the health board/Health and Social Care Board dental list as a Contractor/Principal, or they may be taken on as an employed dentist (an assistant) under a contract of employment. As a Contractor/Principal we view locums as self-employed workers. This status provides additional rights, such as holiday pay.

Our Model Locum-Associate Agreement can be used to agree written terms between the locum and associate. Associates are accountable for paying locums, but for practical reasons, practice owners are responsible for the administration of payments to the locum and associate.

When a locum isn't an option

If a locum cannot be engaged, sometimes remaining dentists in the practice will agree to provide cover. Taking on extra sessions will need to be carefully considered, along with the apportioning of Continuing Care and Capitation Payments. This option could also have an impact on any health service Covid top up payments being received.

Having no locum is not an ideal solution financially.

Having no locum is not an ideal solution financially. If the associate's patients can only be seen in an emergency, or by other dentist's not seeing their own patients, then the practice owner will likely be left in a significantly worse financial position.

Sometimes practice owners will be prepared to accept not having a locum, accepting loss of income. In these circumstances, the associate usually agrees to pay the practice owner a set amount, this could include receiving Continuing Care and Capitation Payments in full as the associate is no longer providing care to patients or receiving some or all the associate's health service allowances. Depending on the circumstances, this can be difficult if the associate is relying on allowances to cover bills.

We can support you

We can support you as you discuss, engage and work together to find the best solution when associates need time away from the practice. Whether engaging with a locum, or looking for a different solution, it is important to follow what is set out in the Associate Agreement. If a locum cannot be found, this also needs to be carefully considered and set out in writing.

We have prepared advice and templates to help members. Our advisors are also available to Extra and Expert members for one-to-one advice by calling 020 7935 0875 or emailing: [email protected].