Negotiation Skills
Because your worth as a GP isn't just measured in consultations — it's also measured in what you negotiate before you start.
A hand-picked mix of official guidance and real-world resources. Because sometimes the most useful advice is hiding outside the official documents.
Many GP trainees finish their training with excellent clinical skills — but very little experience of the professional conversations that shape their careers. Contract negotiation, salary discussions, and working-pattern agreements are things most trainees encounter for the first time when they are least prepared: at the moment of a job offer.
If You Read Nothing Else, Read This
- Negotiation is a normal, professional activity — not aggressive or rude. Doctors who never negotiate often undersell themselves significantly.
- The best outcome for both sides is a win-win agreement — aim for this, not a "win" at someone else's expense.
- Know your BATNA (your best alternative if talks fail) before you enter any negotiation. It gives you confidence and a walk-away point.
- Know your ZOPA (the range where both sides can agree). Most deals are struck somewhere in this zone.
- In UK GP, the main things to negotiate are: salary, sessions/hours, leave, indemnity cover, CPD time, working patterns, and (later) partnership terms.
- The BMA salaried GP model contract sets minimum terms. You can and should negotiate for more — or at least for clarity.
- Always get agreed terms in writing. Memory fades. Contracts don't.
- Preparation is the single biggest predictor of negotiation success. Research, plan, and practise before the conversation.
The most widely used framework in professional negotiation comes from Roger Fisher and William Ury's Getting to Yes (Harvard Law School). It is taught in business schools worldwide and maps neatly onto the kind of professional conversations GPs face.
Not all negotiations are equal. The type of outcome depends on how both parties approach the conversation:
Imagine you are negotiating salary for a salaried GP post. Here is how these concepts play out:
If your minimum is above their maximum — there is no ZOPA. Walking away is the rational choice, not a failure. If ZOPA exists, aim to close as close to your anchor (your starting figure) as possible.
These are the real negotiations that GPs face. Each one has specific things to ask about, specific traps to avoid, and specific sources of leverage. Don't wait until you are in the conversation to think about these for the first time.
The BMA salaried GP model contract sets a minimum salary range (set annually by the independent Doctors' and Dentists' Review Body — DDRB). GMS practices must offer at least this minimum. PMS practices in England since 2015 should too. APMS practices are not legally bound but the BMA recommends minimum model contract terms for all.
- When will your salary be reviewed, and by how much? (Annual uplift in line with DDRB is the minimum — push for an increment on top of that to recognise your growing experience)
- Is your pay per session or annual? If per session — how many sessions is the post actually offering?
- Are there QoF bonuses or additional payments you could earn?
- Will the practice contribute to your indemnity costs? (This can be thousands of pounds per year — a very important negotiating point)
- Will the practice pay your BMA/RCGP membership? (This is within the spirit of the model contract)
- Is LMC levy covered by the practice? (If not, you may need to pay separately)
- Will you be paid for attendance at practice meetings held outside your normal hours?
- Is there a recognition payment for any specialist interest work or teaching?
A full-time salaried GP works 37.5 hours per week (nine sessions, each 4 hours 10 minutes). But in practice, many GPs negotiate fewer sessions or flexible patterns. The model contract requires a written job plan to be agreed and attached to your contract.
- How many patients per session? What is the consultation length?
- Are telephone or online consultations included, and how many?
- Are there "extras" on the day — duty sessions, prescription signing, test results?
- Are there extended hours or weekend sessions? How often? How are these paid?
- How much admin time is built into each session? (Minimum 1 hour per session is reasonable)
- Are you expected to do home visits? How many, how often?
- Will you cover for absent colleagues, and if so, what is the extra pay arrangement?
- When will the job plan be reviewed?
Leave entitlements are negotiable elements of your contract. The model contract gives minimum entitlements — but more is always possible, especially if salary flexibility is limited.
| Leave Type | What to Discuss | Tip |
|---|---|---|
| Annual Leave | Minimum under model contract; previous NHS service should be recognised. Ask if your prior NHS work counts towards your leave entitlement. | Previous NHS service counts continuously even with gaps up to 12 months |
| Study / CPD Leave | How many days per year? Are mandatory training days counted separately? Is travel/accommodation covered? | Getting CPD funding agreed upfront is worth more than it looks |
| Sick Leave | Full pay and half pay periods. Previous NHS service affects entitlement significantly. | Recognise all your NHS service to maximise this |
| Maternity / Paternity / Shared Parental | Enhanced shared parental leave is now available for salaried GPs in England, Scotland and Wales. Confirm this is included in your contract. | Since 2021/2022 — check BMA guidance for current terms |
| Flexible Working | Right to request flexible working (days, hours, remote admin). New employment legislation strengthens these rights. Ask upfront rather than later. | NHS England actively encourages practices to accommodate flexibility |
Partnership negotiation is a much bigger conversation than a salaried post negotiation. As a partner, you become a business owner — not an employee. The financial, legal, and professional implications are significant. Do not enter a partnership without taking independent advice.
- Parity period — how long before you reach full parity? Some practices have 2–3 year build-ups. This has a large financial impact.
- Buy-in — if the practice owns its premises, buying in can cost hundreds of thousands of pounds. Understand this completely before committing.
- Profit-sharing model — how is profit calculated and distributed?
- Exit arrangements — what happens if you want to leave? What are the notice periods?
- Indemnity as a partner — partners face personal liability. Your indemnity needs will change.
- Workload commitments — partners typically work 10–15 hours more per week than salaried GPs. Is this acceptable to you?
- New to Partnership Payment (N2PP) — NHS England offers a financial incentive of up to £20,000 for new GP partners in England. Ask whether this is available and relevant to your situation.
This section pulls together recurring wisdom from UK GP training forums, sessional GP networks, LMC guidance pages, and practitioner career advice resources. These are the patterns that come up again and again — the things experienced GPs wish someone had told them before they signed their first contract.
All insights below have been checked against BMA, RCGP, and official UK guidance. Nothing here conflicts with official advice or UK employment law.
One of the most repeated themes across UK GP forums is the shock that hits newly qualified GPs when they receive their first job offer. During training, your pay is fixed by national contract and you never have to think about it. The moment you qualify, that safety net disappears completely.
Understanding what changes when you get your CCT helps you prepare for what's ahead.
- Pay set nationally by DDRB trainee scale
- GP registrar supplement fixed at 45%
- Leave and sick pay are standardised
- Job plan defined by training requirements
- Lead Employer handles your contract
- You never have to think about any of this
- No fixed pay scale — open to negotiation
- Pay varies enormously between practices
- Leave entitlement needs explicit agreement
- Job plan must be negotiated and written down
- You are now an employee of a GP practice
- You must think about all of this — now
A common theme in UK GP forums is the confusion — and sometimes shock — around session pay versus annual pay, and what a "session" actually contains. Experienced GPs consistently warn new colleagues: the headline pay per session hides a lot.
A session is officially 4 hours and 10 minutes under the BMA model contract. But what is inside those 4 hours 10 minutes makes all the difference to how sustainable the post actually is. Here is what practitioners say you must clarify:
- 12–15+ patient slots
- Phone calls on top of face-to-face
- Home visits bolted on
- Duty doctor responsibilities
- Prescription signing
- Medical reports and insurance letters
- Admin time carved down to almost nothing
- ~10–12 patients with 10-minute slots
- Approximately 1 hour of admin time built in
- No unplanned extras without prior agreement
- Duty sessions explicitly agreed and scheduled
- Home visits pro-rata and clearly defined
- Prescription admin allocated to admin staff
- Clear finish time that is actually achievable
Across UK sessional GP networks and LMC guidance, there is a consistently recommended list of questions to ask before accepting any salaried post. Many of these go well beyond salary — they are about culture, sustainability, and whether the post will still make sense to you in 12 months. The North East Sessional GPs (NESG) network, Wessex LMCs, and similar regional groups have published versions of this list for years. Here it is, organised clearly.
- What is the routine workload per session? How many patients, phone calls, and tasks?
- How do on-call arrangements work? Are they pro-rata? If the practice has 40 sessions per week and you do 4, you would expect no more than 1:10 on-call on average — is that actually what happens?
- Are clinical notes summarised, and who updates them when new letters arrive — doctors or admin staff?
- How is post (letters, test results) distributed among the GPs?
- Do doctors have to compile medical reports and insurance letters themselves, or does admin support do this?
- Are there any additional extras expected on the day — blood results, urgent prescriptions, patient queries that land with you outside your booked slots?
- Does the practice use the BMA model salaried contract? (GMS and PMS practices in England are required to — but APMS practices are not)
- Is the post permanent or on a fixed-term contract? If fixed term — why, and can it convert to permanent?
- Is there a probationary period? What happens at the end of it?
- Are salaries reviewed and uplifted annually in line with DDRB and your growing experience?
- Does the practice fund courses and CPD — in money, time, or both?
- Is there a room for developing a special clinical interest, either inside or outside the practice?
- What is the practice attitude to salaried GPs working in excess of contracted hours — is this assumed, or is extra work always compensated?
- Is there any flexibility in surgery start and finish times, or is the timetable completely fixed?
- How are holiday requests managed? What happens during school holidays — is this a free-for-all, or is there a fair system?
- How does the practice accommodate personal commitments — school events, appointments, caring responsibilities?
- Have any GPs in the practice changed from full-time to part-time? How was that handled?
- Is remote working for any admin tasks possible, now or in future?
- What does a typical day actually look like — including the time GPs usually leave the building?
- How many clinical sessions do the partners personally do each week? (This gives you a sense of what they expect of you versus what they do themselves)
- Does the practice have a teaching or training role? Is this valued?
- What is the experience range of the partners — how long have they been qualified?
- What are the practice meetings like? How long, how often, and are salaried GPs expected to attend?
- Do the doctors meet informally — a coffee together, a team lunch? (Small things reveal a lot about culture)
- Have there been successful changes or innovations recently — new systems, new ways of working? Who drove them?
- How is disagreement handled — is there a culture of open discussion, or does the senior partner's view always win?
Experienced GPs consistently flag this as the category of questions most people forget to ask — and the most revealing answers come from here.
- Why is this post vacant? — This is the single most important question. The answer tells you almost everything.
- What has the turnover of doctors been like in the last 3–5 years?
- How many GPs have left, and why did they leave? (A practice that has lost three salaried GPs in two years is telling you something important)
- Is the post new (growing practice) or a replacement (someone left)?
- Have any doctors moved from salaried to partnership here? If so, what did that process look like?
Medical indemnity comes up repeatedly in UK GP forums as the most commonly overlooked element of a new contract — especially among IMGs who may be less familiar with how the UK indemnity landscape works for GPs in primary care.
This is different from hospital medicine, where your Trust covers you. In general practice, the picture is more complex.
A recurring theme in GP career forums is that many newly qualified GPs choose a post primarily on salary and location — and then discover that the culture of the practice makes the job unsustainable. Experienced GPs say the non-financial factors are just as important as the money.
Think of this as your due diligence checklist. These are the things experienced GPs consistently say they wish they had checked.
- Look up the practice's CQC rating — publicly available at cqc.org.uk. A "Requires Improvement" rating in well-led or staffing is worth asking about.
- Check NHS Choices (NHS.uk) — patient comments sometimes reveal things about culture and organisation that you wouldn't learn in an interview.
- Ask a GP you trust — someone who has worked nearby or knows the area may have useful first-hand knowledge about the practice's reputation.
- Ask to shadow for half a day before committing — this is a completely reasonable request that well-run practices welcome. Seeing a real surgery day tells you more than any interview.
UK GP practitioners and career advisors are consistent on one point: the timing of your negotiation matters enormously. This is often called the "leverage window" — the period when your negotiating position is at its strongest.
Your leverage rises and falls at different stages of the job process. Knowing when to push is just as important as knowing what to ask for.
One area of negotiation that UK GP career forums consistently highlight is the value of clinical special interests and additional procedural skills. These are real leverage — not just on your CV, but at the negotiation table.
If you have skills that can bring income or reduce referrals for the practice, you have something concrete to offer — and that shifts the ZOPA in your favour. Some GPs have used this to negotiate a higher per-session rate, additional CPD time to develop the skill further, or protected time within their job plan to run the service.
- Fitting coils (IUDs/IUS) and subdermal implants
- Joint injections and minor surgery
- Spirometry and respiratory assessment
- Skin surgery and dermatology procedures
- Women's health and menopause
- Substance misuse and addiction medicine
- "I have a certificate in X — this could allow you to bring that service in-house."
- Propose a higher session rate that reflects the additional income generated.
- Ask for protected time to develop the service further — framed as benefit to both sides.
- Link it to a review date: "Could we revisit my salary in 6 months once the service is running?"
International Medical Graduates make up a significant and growing proportion of the UK GP workforce. There are some specific challenges around negotiation that come up repeatedly in the forums they use — and this section addresses them directly and respectfully.
You bring exactly the same professional qualifications, responsibilities, and workload as any other UK GP. You are entitled to exactly the same protections, the same minimum contract terms, and the same right to negotiate. Your background, nationality, or route into UK medicine does not reduce your professional worth — and should never be used as a reason to offer you less than the standard minimum. If you feel you are being treated differently, contact the BMA immediately.
Based on recurring themes across UK GP training forums and career guidance resources, here is what experienced GPs most commonly wish they had negotiated — or asked about — before starting their first post.
Based on recurring themes in UK GP forum discussions, LMC guidance, and career advisory resources. Illustrative, not a formal survey.
Good negotiation is not a single conversation. It is a structured process. Here is how to approach it.
These phrases are calibrated for UK professional culture — assertive but collegial, never aggressive.
These are the patterns that crop up again and again when newly qualified doctors approach their first professional negotiation.
The PREP Framework — Prepare for Any Negotiation
Run through this before any significant professional negotiation:
- I have checked the current BMA/DDRB salary guidance for this role
- I know my ideal outcome, minimum acceptable outcome, and BATNA
- I have a list of everything I want to discuss (not just salary)
- I have thought about what the other party needs and what flexibility they might have
- I have prepared a professional, positive opening statement
- I know which objective criteria I will use (BMA guidance, model contract terms)
- I am ready to trade, not just concede
- I know that silence after making a request is fine — I will not fill it by backtracking
- I will confirm any agreement in writing afterwards
- I have the BMA member helpline number or LMC contact in case I need advice
| Feature | Win-Lose (Competitive) | Win-Win (Integrative) |
|---|---|---|
| Goal | Get as much as possible at others' expense | Find the best outcome for everyone |
| Tone | Adversarial, positional | Collaborative, interest-based |
| Focus | Stated positions ("I want X") | Underlying interests ("why I need X") |
| Outcome | One side often resentful; relationship damaged | Both sides satisfied; relationship preserved |
| Best used when… | A one-off transaction with no future relationship | Ongoing professional relationship (GP career) |
| In GP life | Almost never the right approach | Almost always the right approach |
Negotiation skills are a core component of the RCGP's Organisation, Management and Leadership (OML) capability. Many GP trainees arrive at their CCT with excellent clinical skills but almost no professional-skills toolkit. Salary negotiations, contract discussions, and working-pattern conversations are things most trainees face for the first time without preparation — and often come off worse as a result.
Teaching this early in training is genuinely career-changing. Even one tutorial on professional negotiation can prevent years of underselling.
- Assuming that asking for more is impolite or aggressive (particularly common among IMGs)
- Thinking that salary is the only thing worth negotiating
- Not understanding what the BMA model contract actually provides as a minimum
- Accepting verbal agreements without written confirmation
- Never having thought about BATNA — what they will do if a job offer falls through
- Conflating "negotiating with patients" (clinical communication) with "professional negotiation" (this topic)
A newly qualified GP is offered a salaried post at a practice. The salary offered is at the bottom of the DDRB range. The job description mentions extended hours on Thursday evenings. Indemnity is the GP's own responsibility. There is no mention of a written job plan.
Discussion prompts: What are the key things they should negotiate before accepting? What is their BATNA? How should they open the conversation professionally? What should they confirm in writing?
A salaried GP has been in post for six months. Over time, they have been asked to cover additional duty sessions and take on a growing list of patients. Their actual hours are now significantly more than their contracted sessions.
Discussion prompts: What should they have done before starting? What mechanisms exist to address this (exception reports, job plan review)? How do they raise it professionally with the practice manager or senior partner?
A GP wants to reduce to 6 sessions per week and change one of their clinic days to accommodate a caring commitment. Their practice has two partners and a small patient list. They are concerned the partners will be resistant.
Discussion prompts: What are their rights? How do they frame the request positively? What solutions could they propose that address the practice's concerns while meeting their own needs?
A GP is offered a partnership at the practice where they work as a salaried GP. The parity period offered is 3 years. There is a buy-in requirement for premises. The partnership agreement has not yet been shared.
Discussion prompts: What should they ask for and review before deciding? What independent advice should they seek? What are the key risks they need to understand?
- "Have you ever been in a professional negotiation that went badly? What happened, and what would you do differently?"
- "What does your BATNA look like right now — if your current or planned job doesn't work out, what is your Plan B?"
- "What in your current (or planned) contract do you feel least confident about? Have you read the BMA model contract?"
- "Do you feel comfortable discussing salary with a prospective employer? If not, what specifically feels uncomfortable about it?"
- "If a colleague was offered a GP post at the bottom of the DDRB range with no written job plan — what advice would you give them?"
Absolutely not. The BMA actively encourages salaried GPs to understand and negotiate their contracts. Practices expect this conversation. It is a sign of professional maturity, not aggression. The key is to be respectful, well-prepared, and collaborative in tone — not to avoid the conversation altogether.
Before you accept — this is your moment of maximum leverage. Once you have formally accepted, your ability to renegotiate drops significantly. Raise all important points at the offer stage. For internal negotiations (e.g., changing hours when already in post), you have some leverage around your value to the practice — but it is harder. Timing matters enormously.
Shift the conversation to other elements of the package. Ask about CPD funding, indemnity contributions, BMA/RCGP membership, leave, session structure, or a training budget. If salary truly cannot move, these alternatives can collectively represent significant value. Also ask when the salary will next be reviewed — and get that agreed in writing.
BMA membership gives you access to the contract checking service, the salaried GP handbook, salary guidance, and individual employment advice. These resources are directly relevant to your ability to negotiate well. For a newly qualified GP facing contract negotiations, BMA membership is widely regarded as one of the best professional investments you can make. Note: BMA membership is separate from the LMC levy — different things.
The Doctors' and Dentists' Review Body (DDRB) is an independent body that makes annual recommendations on NHS pay for doctors, including salaried GPs. Its recommended salary range for salaried GPs sets the national minimum standard. GMS and PMS practices (in England) must offer at least this minimum. The DDRB range is updated each year — always check the current figures via the BMA before negotiating salary.
Yes, fully. The BMA model contract and DDRB salary guidance apply equally regardless of background. If anything, IMGs sometimes need to be more proactive in understanding their rights, as they may be less familiar with the UK professional landscape. There is a specific international GP recruitment scheme (IGPR) with its own model contract — if you joined through that route, check the specific terms. Your LMC and the BMA can help clarify your position.
If a genuine ZOPA doesn't exist — if what they can offer genuinely doesn't meet your minimum acceptable terms — it is professional and rational to walk away. Having a strong BATNA means you are never trapped into accepting something unsatisfactory. If you are already in post and a dispute arises that cannot be resolved locally, your LMC and BMA are your first ports of call for individual support and advice.
🏁 Final Take-Home Points
- Negotiation is professional and expected in GP — not rude, not aggressive. Doctors who never negotiate consistently undersell themselves.
- The goal is always win-win: an outcome both parties are genuinely satisfied with. Take your ego off the table.
- Know your BATNA before any negotiation — your confidence comes from having a solid Plan B.
- The BMA model contract and DDRB guidance are your objective criteria. Use them as anchors, not just background knowledge.
- Salary is just one part of the package. Indemnity, CPD, sessions, leave, hours, and training budgets all matter — sometimes more.
- Always agree a written job plan before starting any post. Vague verbal promises about workload are one of the biggest sources of GP burnout.
- Confirm every agreed change in writing. A short email summary protects both you and the practice.
- Your strongest negotiating position is at the point of job offer. Once you have accepted, your leverage drops.
- Use your LMC and the BMA — both offer free support for contract and employment issues. Most GPs underuse them.
- Preparation accounts for 80% of negotiation success. Research, plan, and practise before the conversation.