Managing a Practice Q&A
This page contains information on managing a general practice.
Members can obtain further advice on any of these questions by contacting Workplace Relations on (03) 9280 8722.
Identify what type of relationship you want with the GP you are about to engage:
- An employee GP
- A contractor that works for the practice
- A GP to which the practice will provide services (perhaps from a service entity)
- A GP who will be a principal in the practice (e.g. associate, partner, shareholder)
Each varies in how much control the principal will have over the work of the GP, the level of overheads required ie paid leave, the risk to the practice, the tax obligations and the attractiveness to the GP.
It is strongly advised that you seek professional advice prior to determining which form of engagement suits your practice.
If after this consideration you have determined that working as a contractor is the appropriate way to go, please contact the Workplace and Advocacy Unit to obtain a template contract. We strongly advise that you seek professional accounting and legal advice prior to settling on the final contract.
I want to employ a person for reception. What are their conditions of employment? Do you have a template contract I can use?Expand
Conditions of employment for a receptionist working in a medical practice are derived from the Health Professionals and Support Services Award 2010 (Award) and the National Employment Standards (NES). Information on minimum entitlements such as hours of work, flexible working arrangements, leave entitlements, rates of pay, termination of employment or redundancy can be obtained from the Fair Work Commission website. However, AMA Victoria has simplified the information into our award subscriber service. Please contact Workplace Relations at AMA Victoria.
In addition it is routine to provide a letter of offer/contract. Click here for your copy of a sample contract template.
Click here to read the Fairwork Information Statement
Where an employer provides a rate of pay that is higher than the minimum rate prescribed in the award, they may come to an agreement with the employee that allows entitlements to be absorbed in to the hourly rate. These agreements are known as Individual Flexibility Agreements (IFAs). Allowable entitlements that may be absorbed are:
- Arrangements for when work is performed
- Overtime rates
- Penalty rates
- Leave loading
IFAs have stringent requirements that must be adhered to. These requirements are outlined in clause 7 of all modern awards.
AMA Victoria has a specially designed Individual Flexibility Agreement Kit to assist employers in creating these types of arrangements and to ensure compliance with the requirements under clause 7 of the modern awards. To obtain a copy of this kit please contact the Workplace and Advocacy Unit at AMA Victoria
A practice nurse is entitled to 5 weeks of annual leave for each year of service with their employer. However, a nurse is entitled to an additional week of annual leave provided they fall within the definition of a ‘shift worker’ as defined by National Employment Standards and the Nurses Award 2010. That is; an employee who is regularly rostered over seven days of the week; and regularly works on weekends. For further information contact Workplace Relations at AMA Victoria.
In order to provide the correct rate of pay, employers must correctly classify their nurses on commencement. Classification is based on the requirements of the job and not unnecessary (for the practice) qualifications an employee brings. Once you have determined the duties of the position and qualifications and put these into a position description you need to compare the requirements of the position with the award classifications. Classification definitions are set out in Schedule B - Classification Definitions of the Nurses Award 2010.
For a list of position description templates, please click on the following links:
- Enrolled Nurse Position Description
- Registered Nurse (in a GP Practice) Position Description
- Senior Nurse Position Description
- Registered Nurse Educator Position Description
You must advise the employee in writing of their classification upon commencement and of any subsequent changes to their classification. This will then determine the minimum rate of pay for their classification. Please click here for the current minimum rates of pay.
Progression for all classifications for which there is more than one pay point will be by annual movement to the next pay point, or in the case of a part - time or casual employee 1786 hours of experience, having regard to the acquisition and use of skill described in the definitions contained in Schedule B and knowledge gained through experience in the practice settings over such a period.
For further information contact Workplace Relations at AMA Victoria.
I have purchased another practice, what conditions of employment am I required to provide for employees of that practice?Expand
A GP who purchases a GP practice (new employer) from another GP (old employer) will have obligations in respect of the employees of the purchased practice where a ‘transfer of business’ has occurred according to the provisions of the Fair Work Act 2009 (FWA).
A ‘transfer of business’ occurs where:
- An employee of the old employer becomes an employee of the new employer (within 3 months);
- The work the employee performs for the new employer is the same (or substantially the same) as the work performed for the old employer; and
- There is a connection between the old employer and the new employer. There is deemed to be a connection where the new employer has the use (or beneficial use) of the assets of the old employer that relate to the business being transferred (whether tangible or intangible).
In most instances where a practice is sold by one GP and bought by another GP, there will be a ‘transfer of business’.
Employees of the old employer who become employees of the new employer (within 3 months) as a result of a transfer of business are defined as ‘transferring employees’.
Generally, for transferring employees, service with the old owner counts as service with the new owner. However, the FWA allows a purchaser of a business (the new employer) to decline to accept continuity of service for the purpose of annual leave and redundancy, but not personal leave. This means that the new employer can choose whether or not to recognise the annual leave and redundancy pay entitlements accrued by the employee under the old employer. Long service leave entitlements must be recognised by the new employer.
If the new employer elects not to recognise the previous service of the transferring employees, the old employer must pay out the accrued entitlements owed to the employee.
There is an exception where the transfer of business occurs between ‘associated entities’ as defined by section 50AAA of the Corporations Act. The old employer and new employer will be associated entities if the old employer has a controlling interest in the new employer (or vice versa). A new employer that is an associated entity of the old employer must recognise continuity of service of the transferring employees.
In most cases, where there is no prior connection between the old employer and the new employer, they will not be associated entities.
The FWA also provides for current enterprise agreement conditions to transfer across to the new employer. Generally, this is a matter requiring close attention to ensure that the new employer does not take on any unexpected additional pay obligations or end up with unduly complicated payroll arrangements from having different groups of workers on different deals.
We recommend that the sale of the business documents reflect the liability conferred on the new employer and the old employer in respect of for employee entitlements.
Buying or selling a practice requires specialised knowledge as there may be exceptions to the general rules outlined above. As a result, we recommend you contact AMA Victoria for tailored advice suited to your particular circumstances.
The doctor is retiring and the practice is closing down. What should I do with my medical records?Expand
Medical records must be kept (in full) for 7 years from the date of the last appointment or until a patient who is a minor reaches the age of 25.
Medical practitioners should consult the statutory guidelines issued by the Health Services Commissioner which set out the requirements regarding closure of a practice and retirement. A link to this document is provided here1.
If you are retiring, you must notify your patients that your practice will be closed down, and take the following steps no later than 21 days prior to closure:
1. Publish a notice in the newspaper circulating in the locality of your practice (for example, the Leader newspaper) stating:
- That the practice is being closed down; and
- The manner in which you propose to deal with the medical records of your patients;
2. Place a written notice stating that the practice will be closing down in clear view in your practice, for not less than 2 months prior to the closure; and
3. Provide information in writing that the practice will be closing down to each patient regarded by you as ‘currently receiving a program of care, a course of treatment or whose condition is scheduled to be monitored or reviewed by the provider’, to the extent that such notification is practicable in the circumstances. Determining which of your patients fall with this category is a matter of judgement to be determined by you in the circumstances, taking into account the expectations of the patient and the seriousness of the condition.
Some medical practitioners prefer patients to collect their medical records from the practice prior to closure to take to their new doctor.
Alternatively, you may choose to transfer all your records to another practitioner (provided that the practitioner agrees to accept the records). Where this occurs, patients must be notified but consent is not required.
If you choose to do either of the above, we recommend you keep a detailed record of when and by whom the record was collected or to whom it was transferred. The risk is that it may be difficult for you to locate records that may be required in the future for medical defence purposes.
Alternatively, you may prefer to store your medical records in a secure storage facility and provide an address to which patients can write to request a copy of their medical record. Any requests for records will be treated as a request under the Health Records Act 2001 and must be complied with as soon as possible.
You should ensure that AHPRA and AMA Victoria have your current contact details so that any requests for records received by either of these organisations can be referred to you.
In the event of the death, it is the medical practitioner’s legal representative that becomes responsible for the obligations under the Health Records Act 2001. Medical practitioners should consider and plan what they want to happen to the health information they hold as they would with any other property.
Medical records must be kept (in full) for 7 years from the date of the last appointment or until a patient who is a minor reaches the age of 25.
Medical practitioners may have obligations under other laws or to their medical indemnity Insurers to retain records longer than the specified periods.
When medical records are destroyed, you must make a written note of the name of the individual to whom the health information relates, the period covered by the record and the date it was destroyed.
Care should always be taken before destroying any records, and should be carried out by an authorised confidential shredding service. AMA Victoria can provide you with the contact details for this service.
The Crimes Act 1958 (Vic) creates a criminal offence for the destruction or concealment of documents where a person knows those documents are reasonably likely to be required in any ongoing or potential future legal proceedings, and particularly where there is an intention to prevent those documents from being used in legal proceedings.
It is recommended that all practices implement a document retention and destruction policy that complies with the obligations under the Health Records Act 2001. Please contact AMA Victoria for assistance with drafting, implementing and complying with the policy.
I have been asked to provide a medical report by a solicitor for one of my patients. How much should I charge for the report? Is it different if WorkSafe or TAC requests the report?Expand
Please make sure that you have the consent of the patient to do the report. A doctor is free to set his/her fees independently – whatever the doctor thinks is fair and reasonable having regard to the particular circumstances of the case. As far as practicable, the report fee should reflect the effort, skills and resources associated with the provision of that report. It is advisable to notify the requestor of the report fee upfront to avoid any misunderstanding and confusion. WorkSafe/TAC have a ceiling on their report fees. The doctor can either charge the WorkSafe/TAC set fees or bill patients privately. Patients should be warned that the reimbursement from WorkSafe/TAC might not cover the doctor’s report fee.
I have received a formal complaint from a staff member claiming they have been a victim to bullying from another member of staff. What do I need to do?Expand
Instances of Bullying in the workplace can have a significant affect on your practice. Complaints should be taken seriously and dealt with as a priority.
If a staff member complains of bullying you should:
- Investigate to ensure whether the behaviour is “bullying”. This can be most easily done if you have a practice policy on Bullying and Harassment which defines unacceptable behaviours. In anther question in this section we have provided a broad descriptor of bullying behaviours. The investigation may be as simple as asking those involved, what behaviours occurred, when and by whom. Your response should be proportionate to the alleged behaviour. For example if the complaint is that another staff member put the employees life in danger by their behaviour the matter may best be dealt with by referral directly to the police
- If on balance you think that bullying behaviour has taken place advise the bully:
- that he/she is to stop the behaviour
- what is acceptable behaviours in the workplace
- whether the discussion is a counselling, warning or final warning and
- what will happen if it reoccurs
- Advise the employee who complained that the matter has been investigated, a decision made as to the behaviours and that action has been taken to minimise the risk of a reoccurrence. This without disclosing confidential information. The person should be told to immediately report if they experience similar behaviours in future and offer them support if they feel they need it.
- Ensure you have a policy in place that deals with the issue and that every employee and principal is made aware of the policy. The policy should as a minimum contain:
- the nature of bullying and harassment
- the sanctions that attach to it
- the course to be following if the staff member believes they are being bullied,
- Ensure you have a policy in place that deals with the issue and that every employee and principal is made aware of the policy.
- If on balance you do not think that bullying behaviour has taken place, advise the person who complained that the matter has been investigated and a decision made that it is not considered that bullying took place (and why). You should advise them of your policies on bullying and harassment and ask them to immediately report if they experience bullying behaviours in future.
I have an employee who has been on sick leave for an extended period. What are my legal obligations to him/her?Expand
It is often difficult to determine when an employee’s absence from work or their continued inability to perform their full-time pre-injury duties reaches the point where dismissal is justified.
There are obligations imposed on employers by the Fair Work Act 2009 (Cth), the Equal Opportunity Act 2010 (Vic) and the Disability Discrimination Act 1992 (Cth), the Occupational Health and Safety Act 2004 (Vic). These obligations will vary depending on whether or not the cause of the injury/illness was work related.
If the incapacity is work related, worker’s compensation legislation requires an employer to keep open suitable employment for the employee for a period of 12 months.
Where the incapacity is not work related, no ‘protected period’ applies. However, it is unlawful for an employer to terminate an employee due to a ‘temporary absence’ – that is, an absence which is less than 3 months (either consecutively or a series of absences totalling 3 months over a 12 month period). The worker will also be ‘temporarily absent’ if the worker is absent on paid sick leave (even if the duration of the paid sick leave is longer than 3 months).
Outside of the protected period, there is no minimum or ideal period after which an employer can consider dismissing an employee for incapacity. It will depend on the facts of the case. The employer can direct the employee to attend a medical examination to determine whether or not the employee is fit to perform their duties and to assess the long-term prognosis of the employee’s capacity. An employer should also make his or her own assessment of the employee’s present and future capacity to perform the role.
If an employee refuses to attend a medical examination, the employer may (after due process) dismiss the employee for failure to follow a lawful direction.
Prior to considering dismissal, the employer should ensure that any reasonable adjustments to accommodate the long-term ill/injured employee have been made, insofar as they do not impose unjustifiable hardship on the employer. Dismissal will be lawful only if the employee is unable to perform the inherent requirements of the job after reasonable adjustments have been made. What classifies as a ‘reasonable adjustment’ varies depending on the circumstances and the size and resources of the employer.
An employer should always discuss the situation with the employee and give them the opportunity to comment on any adjustments or modifications, prior to any decisions regarding dismissal being made.
Managing ill/injured staff is a complex issue and we recommend that you contact AMA Victoria Workplace Relations to assist with this process.
WorkSafe (and TAC) are required under legislation to reimburse the claimant (patient) the cost of reasonable medical and like expenses. WorkSafe uses the Medicare Benefits Schedule (MBS) as a basis for determining what services it will reimburse. However given it is required to pay reasonable medical expenses, the payments they make to claimants are higher than MBS. View the WorkSafe and TAC payments on their websites.
By convention many doctors direct bill WorkSafe after a claim is accepted. This is not a requirement.
WorkSafe sets the level at which it will rebate people who claim for medical expenses but it cannot determine what fee doctors will charge. It is up to each doctor to determine his or her own fees. If your fees are above the level of reimbursement that WorkSafe will make, you need to do three things:
- Inform your patient prior to providing the service that your fees will not be entirely covered by the WorkSafe rebate and that there will be some out of pocket payment. Download a pro-forma letter here.
- Charge the patient directly for your care at the time of provision of the service.
- Advise that they seek payment from either their employer or WorkSafe Insurer
In the absence of a termination policy or employment contract provision, it is suggested that the practice take a cautious but firm approach to dealing with the performance management of an underperforming employee.
Above all else, employers must ensure that a fair and equitable process is followed. When managing an under-performing employee, an employer must give the employee a reason why he or she is at risk of being dismissed and that reason must be based on the employee’s conduct or capacity. The employer should ask why the employee is not meeting expected performance/conduct levels and based on the employee’s response, either accept the reason, or provide a formal warning. If a warning is issued, employers then need to provide a reasonable time for which the employee is expected to improve their performance/conduct and offer additional support and/or training in order to ensure the employee meets the expected levels required by the employer. It should be reiterated to the employee that if there is not an improvement, that there is a risk that they may be dismissed from their position at the practice.
It is advisable to provide this warning in writing as it can be used to form an evidence base should a claim for an unfair dismissal remedy be made. Small business employers should also complete a copy of the Small Business Fair Dismissal Code Checklist. This can also be used as evidence to demonstrate your compliance with the code.
If following this there is still no visible or marked improvement, an employer will need to organise another meeting to understand why the employee is not meeting expected levels despite receiving a warning. With a meeting concerning dismissal, an employee is entitled to have a support person present, but that person must not act in legal capacity. When explaining to the employee that there has been no improvement and asking why the employee has not met expected levels of performance, if the employee’s response is unacceptable, the employer may dismiss the employee.
This process may be shortened if the practice believes on reasonable grounds that the employee was involved in serious misconduct such as theft, fraud, violence and serious breaches of OH&S procedures, in which case the employee may be summarily (instantly) dismissed following an investigation of the conduct/behaviour.
Management of under-performance is never a clear cut and advice is very much provided on a case by case basis based on the many variables that may come in to play. It is advisable that if you are to embark on a performance management process where dismissal may be eminent, that you call Workplace Relations so a plan can be put in place in order to assist your needs.
The Fair Work Commission has announced a 3.5% increase to minimum wages following its 2018 Annual Wage Review. The increase will apply from the first full pay period starting on or after 1 July 2018.
This is an increase to the minimum wages contained in the Health Professional and Support Services Award and the Nurses Award.
If you run a private practice, you will need to ensure you are paying staff above the new minimum rates.
Practices are not required to increase rates of pay, unless they fall below the minimum award rates.
Award Subscriber Service
Subscribers to the AMAV Award Service will receive the full table of rates, penalties and allowances as well as other updates to the Awards.
Practices wishing to subscribe or renew their Award service should contact Aspa Papas on 9280 8722 or via email at email@example.com
Members can access the following condensed version of the rates: