My registrar signs an employment agreement with the practice and a contractor agreement with the hospital, but isn’t engaging a registrar as a contractor illegal?
No. It is not ‘illegal’ to engage a registrar as a contractor. This is a poor choice of words and something that is factually incorrect. The reason the NTCER requires registrars to be engaged in an employment arrangement is because registrars do not fit the definition of a contractor for payroll tax, income tax and superannuation. Therefore if a practice engages a registrar as a contractor and does not pay payroll tax, income tax and superannuation, the practice may find themselves in breach of legislation and may pay a penalty as a result. However, in most on-call circumstances the on-call component of the registrar’s work is covered by the employment contract in place with the training practice. Thereafter, the income related to on-call, after hours work is generally paid to the practice by the hospital and released with appropriate payment of taxes and superannuation to the registrar. If your practice is paying appropriate tax, insurances and super on all income related to the registrar, inclusive of their on-call work, then your legal obligations in this regard are satisfied.
My registrar will be uninsured as a result of the contractor agreement in place for on-call work.
No. Your registrar will be covered by their workers compensation insurance, medical defence insurance and public liability insurances of both the practice and the hospital they are performing on-call work for. The scope of practice does not change for the registrar whether they are performing after hours or in hours consults. They will still be confined to the scope for which their supervisor is qualified or for which they have appropriate qualifications such as advanced qualifications in anaesthetics for example. There is no problem of being uninsured where an appropriate employment agreement and contractor agreement are in place. This has been checked with multiple Medical Defence Organisations and consistently confirmed. For peace of mind we encourage all registrars to check that they are adequately covered by their MDO insurer for after hours on-call work.
If the registrar’s supervisor does not have anaesthetic qualifications, but the registrar does then the registrar cannot perform anaesthetist functions as their scope of practice is limited to that of their supervising GP.
No. If a registrar has an appropriate advanced qualification in a specific discipline, that qualification appropriately extends their scope of practice beyond that of their GP supervisor should the supervisor not have the same qualification. As such the registrar will be covered by all of the appropriate insurances. For peace of mind we encourage all registrars to check that they are adequately covered by their MDO insurer for their specific scope of practice.
Once the registrar is officially on call all of the legal and insurance risk becomes the responsibility of the hospital.
No. the GP registrar must have adequate supervision and normally this supervision will be provided by the same supervisor(s) as during in practice consults. While the supervision tends to be more remote/ via phone, the supervision support must still be in place and available to the registrar throughout the duration of their on-call work. As such, while the hospital’s liability insurances will come into play if something goes wrong during an on call shift, the registrar’s supervision needs, and the role of the supervisor may well come into relevance. At this time a supervisors own insurances and those of the practice will likely be required – jointly and severally.