AiTs could do with training on how to locum

I had the pleasure of being flown up to Newcastle on Thursday to speak to a group of locums about the joys of working in Locum Support Teams such as locum chambers. While I was there, I spoke to a charming VTS course organiser on how much actual training her AiTs received on how to work independently as a peripatetic locum in a multitude of practices. As expected, she acknowledged that most would be spending months to years working as locums. As expected, her AiTs were receiving no such training.

Working as a locum in multiple practices is different to working regularly in the same place. Unfamiliar surroundings; patients are always new; the patient’s records are nearly alwyas difficult to penetrate (access, quality, vaguaries of IT systems etc); we don’t know about the other GPs, so ‘handover’ needs to be robust – there must be a ‘succession of record’.

As a fresh pair of eyes, we are ideally placed to highlight areas of risk in the practice; working as part of a team, we can be empowered to spread best practice between practices and PCTs. For patients, we can provide a second opinion, a new way of looking their illness.

Considering the overall gigure for the number of locums is 25% of the workforce, the likelihood is that there will be a bulge in numbers at the post-training end of the curve. There needs to be debate, recognition, change and progress.

RCGP is failing to give locum audit for revalidation the seriousness it deserves.

It’s unfair of the RCGP to ask individuals to solve a ‘national’ problem and I’ve just written to them to tell them so.

What strikes me is that locum audit is a chink in the RCGP’s armour and I remain surprised that the RCGP has never done any work to look at this issue.

It also exposes the absence of any investment – any investment – by the college in anything to do with working as a locum GP. Bearing In mind that at any one time 25% of all GPs (25% of all RCGP members?) are currently locum GPs, I’m sure that you’ll agree with us that this may make the college look a little bit slow off the mark. The common, and very strong, consensus from locums is that audit for locum GPs is on the spectrum somewhere between ‘pointless’ and ‘impossible’. If one even begins to scratch the surface of this issue, it starts to raise ugly questions and the RCGP needs to confront this, and move away from its current stance which is no less than burying its head in the sand.

Although laudable asking locums for ‘imaginative’ examples of audit, you and I know this will never happen, and I really think that it is unfair that you’re asking 15,000 individual locums to do this – it’s the college’s responsibility, and it is neglecting locums in their hour of need.

Although I respect the RCGP’s work on generic issues relating to general practice as a whole, it must represent all its proprietary constituents too – it is, after all, the Royal College of General Practitioners, and not General Practice.

Orange Books now out of print – but available on the web…

We’ve always managed to give new NASGP memebrs an up-to-date ‘Orange Book’  - the excellent ‘Handbook of Medical Emergencies in Primary Care’ published by Kingston PCT (it really helped having the ever helpful Oriana Dwight at the other end of the line believing in the cause that disseminating high-quality clinical information to locum GPs was a Very Good Thing).

What it used to look like

But alas, people move on and cost savings by some muppet at the Department of Health means that this essential hardcopy (how many lives has it saved?) is only available for download – useless in a medical emergency. I’ve spent the last hour toing and froing between the Dept of Health Response line on 0300 123 1002 anf The Stationary Office, speaking to all sorts of line managers, being cut off, no end of ‘computer says no’ operatives and the such like. It would have entirely more productive – and more fun – to have been banging my head against my printer for that time.

My latest lead is the National Treatment Agency (for substance misuse – no, me neither) and an answerphone 0207 600 5522. Why do I just know they’ll never call me back?

 

MSF using 360 Clinical may be a useful tool for some locums

 NASGP member Jenny Wilson works as a  regular locum GP in a few practices has just performed some Multisource Feedback from 360° Clinical and has ofeered to share her experience with fellow members:

I decided to try this pilot to see how feasible it would be for a GP locum to do. There were frustrations initially as I could not get it to accept NHS email addresses but that was sorted centrally, I presume they loaded them manually. I found in one practice where I work arranging the patient feedback was easy. I suspect that it would have been much more difficult in the other larger practice with a more deprived and ethnically diverse population. That the feedback went to my appraiser was difficult as she did not know that I was doing this and it is still 5 months until my appraisal. She sent me the paper copy which I felt that I am quite capable of coping with myself.

As to the results, from the patients I admit that I had flicked through them before sending them off. This could have led to me extracting poor ones but as there were not any I didn’t worry. The only score which disappointed me slightly was that patients seem to perceive I do not ask their permission to examine them adequately. I need to think about how I address this. I also wonder why comments were not asked for when they are from colleagues.

As I looked through the colleague results they were all very positive and I was happy and unsurprised. There were some very special comments. The surprise came when I looked at my results compared to others in my speciality and the national average where I fell below, particularly on the clinical side and with keeping up to date. As a locum and part time GP I do well over 50 credits worth of education a year. I do not see how I could improve upon this.

In conclusion, I felt quite positive about the process. The only change that I will try to make is in asking patients permission to examine in a more definite way. I am already doing this. As to whether this process is suitable for locums, for those locums like me who work in a limited number of practices on a regular basis and have strong relationships with those practices then the answer is definitely yes. For locums who work in lots of different practices short term then it would be much more difficult, but due to the nature of the patients survey by no means impossible. 

As a regular locums in a modest number of practices, Jenny’s findings are indeed encouraging and I entirely agree with her concerns though for those of us working in multiple practices, as according to our recent survey over half of all locums work in more than 5 practices a year, and even this is likely to be under-reporting – analysis of a sample of locums, 50%  under-report their number of sessions by a factor of 2.

 

MDU advises practices on how to reduce risk to locums

Great to see the Medical Defence Union coming up with simple, pragmatic advice published in GP newspaper yesterday, to our practice-based colleagues on how to avoid risk when employing locums. Cuts both ways, and gives us all a break!

GP locums need to develop audit projects

That’s the message from the RCGP. NASGP member Stephanie Franz has just returned from meeting Mike Pringle, the college’s lead on revalidation. Steph was very impressed with Mike’s commitment to ensure GP locums are included in the plans, and recognises the situation we’re in. Our survey returned 178 responses from members, and you can view Steph’s summary of these comments here. Mike’s message to the NASGP is to get locums involved with developing ‘imaginative and workable’ audit projects that can be used as examples.

All very well, and we need to accept the challenge. But of course we also need to accept that to be in any way realistic this is going to require substantial funding for development and implementation and so NASGP will now need to work with the RCGP to see how our Royal College is going to implement it’s first EVER work for it’s thousands of locum GP members.

NASGP 47 newsletter June – July 2009

The latest edition of the NASGP Newsletter is now on line.

• John Pike FRCGP is losing sleep over the RCGP’s plans for locum revalidation.
• Richard ponders on the impotence of PCTs.
• Judith has warts.
• Liz has been dying to tell us about inheritance tax.
• Sara scares us with another ‘there but for the Grace of God go I’ story…

Plus our usual round-up of Sessional GP groups and much more.

What precisely should practice managers be doing to get the most out of their locums?

We’re always moaning about how this practice does this badly and that practice that. Driving for an hour to get between surgeries and not so much as a glass of water to keep you going. Not logged in to Windows. No stationery. Can’t get in the door because you don’t have an access code.

But practice managers aren’t evil – in fact they’re lovely. Very busy – yes. Overworked and under pressure – yes. So you’re not necessarily their No. 1 priority. Their’s is a conspiracy of simple ignorance rather than contempt, and who better to put that right than the locums working in these practices.

So what good ideas have you got? What good experiences have you had? What can we here at NASGP feed back to these practice managers?

The end of the AiT training is leaving it rather late to learn about locuming.

Have been speaking today to 80 or so GP Associates in Training (AiTs) – or ‘registrars’ as they used to be called – for the South East Thames Faculty of the RCGP on the invitation of James Heathcote. It was on the subject of how to get a job, so talks from the LMC, BMA as well as the RCGP. And I had the real pleasure of meeting Professor Deborah Saltman who gave a very buzzing talk on GP academia. What was striking to me was, despite effectively being on job creation schemes for at least a year, how they seemed to know rather little of the job market. When they are about to face some huge lifestyle choices, AiT training – much as it was when I trained – still seems to be in the Dark Ages, with training being very focused on finding a good ol’ fashioned partnership. And the minefield of salaried GP contracts was given some attention, but nevertheless will still require significant further independent research from each delegate. Anyway, I hope I got across my points about GP locuming being a fantastic career choice. But it leaves me wondering now how we can put pressure on those responsible for GP training to make careers advice les focused on partnerships and include instead practical advice and pragmatic help on working as a salaried GP and particularly GP locuming.

Thinly spread locums a challenge to bread and butter revalidation evidence.

According to our recent membership survey after 256 replies, 55% (n=118) of locums work in more than 5 practices a year, and 25% in more than 10. The most popular number of sessions worked in an average week was 5 to 6 sessions (31%, n=67) so, in a typical scenario, this averages out at 46 sessions spread out over 46 weeks. For the 25% working in more than 10 practices a year, that means the same number of surgeries in twice as many practices. 

When I asked myself how many practices I’d worked in last year I guessed around 15, although a proper look at my invoices showed I’d actually worked in 34 and I suspect that others too will have underestimated to a similar degree. So what, we may ask? As John Pike points out in our main article, revalidation in its current guise will expect every locum to provide two audits and two formal multisource feedbacks over the 5 year cycle. Unfortunately, there is not yet any evidence to show that GPs working in more than one practice a year can provide audit or MSF, let alone whether it’s useful or not.

If our best guestimate of there being 15,000 practicing locum GPs in the UK is any where near true, we’re talking here of around 8,000 GPs having to struggle to provide evidence for revalidation. That clearly is not only going to create a huge problem for a significant number of jobbing GPs, but also risks undermining the efforts of the RCGP whose task it is to ensure that it represents all GPs when clearly its ‘GP MOT’ revalidation will discriminate against many non-practice based GPs.