Happy Christmas Two Loo!

We've asked for ours to arrive in avocado green

All here at the NASGP would like to wish all our members past and present a very Merry Christmas and a Happy New Year. As is now tradition, we’ve dispensed with Christmas cards and instead purchased something a little more practical from one of our favourite overseas aid charities as a gift from our members. So this year we couldn’t resist these two delightful latrines which will help communities in Bangladesh and Africa.

It really has been an exciting year here at NASGP and we’re very much looking forward to next year (decade!) and working to raise the profile of salaried GPs and locums even more!

50th edition of The Sessional GP published today.

With our 50th edition we launch our consultation on the core competencies of locum GPs; Judith has been in touch with her poetic side; Liz is predicting what we’ll be getting for Christmas; Sara has a scary story for New Year’s eve; Naomi has a more practical application for the musicians amongst us; Richard’s done a brief summary from the blog; plus our usual round-up of Sessional GP Groups.

Paper copies are now being printed and will be packaged and posted by the NASGP elves over the weekend.

New consultation document on the Core Competencies of Locum GPs

This document addresses the problems of training, support and governance of non-practice-based GPs. It focuses on locums but is also relevant to GPs in Out Of Hours organisations (OOH).

Locum doctors keep the show on the road. They provide a crucial flexibility in the workforce. At any one time around 25% of GPs are working as locums. These 15,000 doctors consult with around 36 million patients every year. Many GPs spend time working as a locum, especially at the beginning of their careers, and for some it is a long-term career choice. Yet GP training does little to prepare doctors for locum work. Trainers are practice-based and any experience they have of as locums is unlikely to be recent. Vocational training schemes give it little attention. The RCGP curriculum does not mention locums. The profession’s governance systems are geared to practice-based GPs.

One locum’s experience illustrates the challenges. In three months he worked in 40 rooms and in 20 practices varying from the well-equipped to the chaotic and even dangerous, in seven primary care organizations (PCO) areas. Six clinical software systems were used differently in every practice. He struggled with 20 different models of printer. He referred patients to six different district general hospitals as well as dozens of other secondary care facilities, using six different referral pathway systems, and saw around 2,600 patients, almost all for the first and only time. In three months most partners will not have stepped out of their own consulting room.

Good locums need to be flexible and adaptable, able to get rapidly to grips with each working environment, quick to evaluate and decide how to manage their patients, able to interpret poor patient notes and write good ones, and assiduous about hand-over at the end of each session. Since they work without the cushion of a practice structure they must be resourceful, organised and independent, but able to slot quickly into any team. They need good negotiating and business skills. Since they can only work as well as their working environment permits, they must be able to bear the risks contingent on enforced underperformance. They are particularly vulnerable to complaints, especially as many are newly qualified. Yet they are not being trained for the job or assessed by criteria which test these skills.

NASGP recognises the problems that locum and OOH work presents to those who do it, those who employ them, and those who educate and revalidate them. We offer an analysis of the needs and obligations of all parties, with the aim of benefiting the GPs, practices, the profession and most of all the patients. Locums are a substantial, vital and highly skilled, yet poorly served sector of the GP workforce. NASGP asks the profession’s leaders to acknowledge the crucial contribution of the locum in patient care by providing training and support that recognises their special role. Please become part of this consultaion by reading our full document.

MPS publishes 32-page booklet for Sessional GPs

We’re proud to have been working with the MPS over the summer to help them produce this huge (certainly in Sessional GP terms, anyway) publication focusing on issues faced specifically by salaried and locum GPs. If you’re an MPS member you’ll be receiving an electronic copy very soon, or meanwhile everyone else can read it on-line here (there’s a link on the right to access the pdf document). And if there’s a good response the MPS are hoping to bring out another publication in around 6 months time so please email Sara at sara.williams@mps.org.uk.

Poetry a key to unlocking emotional involvement with our patients

From NASGP Blogger Judith Harvey

Hilton Koppe is a genial Australian GP whose talent for engaging an audience can be judged by the fact that he can cajole Aussie orthopods to write poetry. His thesis is that we spend our lives writing down patients’ stories, but are not encouraged to reflect on them or allowed to admit our emotional involvement. He argues that we need a way of making sense of the dramas which we witness, and creative writing offers us that opportunity.

At this year’s WONCA conference in Basel Dr Koppe persuaded a multinational audience of GPs to choose their most memorable heartsink patient and to write down adjectives beginning with B to describe them. Aussies apparently are good at this: ‘b****y crazy’, ‘b****y maddening’, ‘b****y pain in the a**e’. We were then given a simple verse structure – no rhymes required – and ten minutes to write about our chosen patient. Several participants responded to the invitation to read out their work. Most wrote in English, for many their second or third language. One participant explained that he thought that AU against Dr Koppe’s name in the WONCA timetable meant ‘Austrian’ and had he realised that the workshop was being run by an Australian he, a Kiwi, would have joined the session on teenage health in Slovenia. Still, he read out his poem. A GP from Basel explained that she had written in her mother tongue, but was confident we would understand. We did. Few languages can express frustration as satisfyingly as Schweitzer Deutsch.

We then moved on to consider some event in the past that rankled still. Easy. My first surgical firm as a medical student. Had I not given up so much to go to medical school, I might well have quit training at that point, so negative was the model presented to me of the profession I was struggling to join. Dr Koppe asked us to write in prose without stopping to think, just letting the words flow. I was amazed at the bitterness which poured from my pen. We then had to write from the point of view of the other side. For me, that meant the surgery tutor who declined to teach because it was ‘spoon-feeding’. The exercise was enlightening. And therapeutic.

There is a growing interest in narrative – story-telling – in medicine. And this is happening at a time when we are losing the richness of the historical record. Old patient notes are fascinating social documents, as anyone who has gone back through thick Lloyd George envelopes knows. When they are shredded so is much of our history. Doctors don’t write like that nowadays. Not just because patients now have the right to read what we write. What renders 21st century records so sterile is the medico-legal sword of Damocles. So the kernel of the patient’s story is lost in a thicket of possibly significant negatives. Gone are the days when a doctor conjured up a patient by writing ‘there she sits at the bar looking like Marilyn Monroe but twice as vulnerable’.

GPs are witnesses to events which challenge people’s lives. Perhaps as we leach emotional colour from the medical records we have more need to find outlets for our feelings about the stories in which we play this strange role. Try poetry.

My poem, the first I’ve ever written, was about my heartsink patient, ‘Annie’:

Who’s shaking whom?

Get it together, Annie,
Get a grip.
Get a life.
Get away.
Get a pair of boots and start walking.
Do all this before I get my gun.

Dr Koppe is running a two-day creative writing retreat for doctors in Australia in March 2010. He would also like to present a workshop in the UK if doctors here are interested. And if you’ve written your own poem, please share it with us my clicking on ‘leave a comment’ above.

GP locums to receive H1N1 vaccinations from their employing practices

There’s only one sensible way for locums to get their H1N1 jab, and that’s as soon as possible in one of their upcoming sessions at their next GP surgery. The BMA’s forthcoming advice on this will be quite clear:

Locums should seek vaccination at the practice at which they are registered in the first instance. However, if it is more practical for their vaccination to be administered at the practice at which they are working, they should ensure that the practice with which they are registered are informed that this vaccination has taken place.

The General Practitioners Committee of the BMA has been working on this in order that we can get our vaccines done and just get on with treating our patients. Experience is showing that practices are being really supportive and open-minded about this, and always remember that when it comes showing appreciation a packet of Hobnobs for the staff always goes down well.

There will be a tiny number of intransigent and short-sighted practices, so we’ve prepared some rebuffs for you:

• “We can vaccinate you, but it’ll cost you £5”
  • Politely refuse to pay, stating that the BMA has issued strict guidance on this that locums are not to be charged, and locums are considered as part of the practices own occupational health policy. If this doesn’t throw them off then suggest they contact their LMC first!
• “It’s against good practice to vaccinate locums”
  • No its not, and the BMA has obtained specific advice from the medical defense organisations stating that GPs are ‘covered’ to vaccinate their employees with this vaccine.
  • The BMA has advised to make sure your own GP is notified of you having had the vaccination, in line with the policy that if you treat family/friends always make sure their GP is given a record of what you’ve done.
• “You’ll have to go to your own GP because we’re so busy/haven’t got enough for our own staff etc”
  • GP locums are front-line staff and sending them to their own GP just moves the problem elsewhere. And deploying this logic means that the practice will have to vaccinate its own “GP locum-patient” so still have not solved any problems, only created them.

Time to define and refine OOH skills for GPs

We’ve absolutely no idea what the stats are on this, but it doesn’t take a rocket scientist to work out that a significant number of GPs working Out of Hours are Freelance GPs. Exactly how many isn’t the issue (but it would help to know), it’s the quality of care they’re able to provide within the context of the support thay’re able to receive to practice as GPs in as risk-free way as possible.

To help us understand more about this, the NASGP has set up a working group of 3 Out of Hours Freelance GPs to construct a ‘core competencies’ document to first deconstruct, then define, the skills required to work as an OOH GP. On the basis of this we then hope to be able to look at any necesssary training and development needs for OOH GPs.

And we’d love your help! We’re looking for any OOH GPs to help us with this so if you’re interested then please leave your comments on this Blog, or email us at info@nasgp.org.uk, and we’ll get back to you.

Revalidation: it’s all about how many different practices you work in

Five years ago the National Association of Non-Principals, as we were then, changed our name to the National Association of Sessional GPs. The reason being that although an extremely accurate title, the term ‘non-principal’ defined us by a negative association – by what we were not, rather than what we were. Which is why the term Sessional GP works so well in that respect.

But the term Sessional GP isn’t without it’s critics, and me for one. Everywhere I go I hear or see the term misused. When we adopted the phrase, it having first been suggested by Dr Andrew Dearden at one of our national NASGP conferences, it was then a catch-all term for any GP working as a salaried or locum or retainer GP. But it still seems to be being used to define just one or the other, often interchangeably or without reference to any other. So, one document about just locums refers to locums continually as ‘Sessional GPs but without actually saying that salaried GPs are Sessional GPs too.

The biggest danger, however, lies in its actuall application where actually it’s just not helpful. The specific case here is in terms of Revalidation, where Sessional GPs are often cited as being a problem. But that’s a huge oversimplification, and the issue here is not whether they’re employed (salaried) or self-employed (locum), but whether they’re actually practice-based or not practice-based. Indeed, one often comes across locums who seem to have been working 5 sessions regularly in the same one practice for the last 5 years (obviosly without the knowledge of the Inland Revenue!).When it comes to Revalidation, by far the most important factor we need to get our collective heads around is the complexity of collecting useful evidence if you work in more than just a few practices.

Although i’m not for a second suggesting we turn our selves into the National Association of Non-Practice Based GPs and some Practice Based GPs On A Salary (NANPBGPPBGPOAS), we should be more careful before we start to dictate missives about one or other contractual group of GPs when actually the contract has liitle at all to do with it.

October newsletter

NASGP Newsletter Oct/Nov 2009

In our 49th edition, Ron Singer from the MPU tells us all about Sessional GP representation from their perspective; Judith tells it from the side of recovering from illness; Liz reckons we could all learn a lot more about pensioning our work; Sara navigates us through the chaperone minefield; Richard’s done a roundup from the blog; plus our usual round-up of Sessional GP Groups.

How has the nature, complexity and length of your consultations changed?

Here’s an opportunnity for you to have your say @Pulse-today. The survey only takes a couple of minutes to complete.

John Pike, NASGP blogger