Revalidation – where next for Sessional GPs?

The final report on “Revalidation processes for Sessional GPs – A feasibility study to pilot current proposals” is now available to read here. The study set out to explore the potential problems locum, salaried and remote GPs might have with the proposed supporting information required for appraisal as part of the revalidation process. GPs who experienced the most difficulty tended to be peripatetic locums and out of hours GPs with no permanent practice base.

The findings will come as no surprise to these GPs and will make worrying reading for those tasked with implementing a revalidation process that is fair to all doctors. Concerns raised in the report included:

• lack of support by practices and locum isolation.
• There were significant problems with the key revalidation requirements of Clinical Audit, Significant Event Audits.
• Patient Satisfaction Surveys and Multi-Source Feedback.

Possible solutions suggested included peer groups for reflective discussions, locum Chambers, greater support from Deaneries, LMCs, practices, OOH organisations and PCOs, alternatives to audit and other requirements, mentoring schemes, and locum prescribing numbers.

The RCGP has already gone some way to find alternative evidence that it would be acceptable for Sessional GPs to collate, and Version 4 of the Guide to Revalidation of GPs describes “equivalent portfolios” that GPs in Special Groups can present. However, substantial problems persist, and it remains to be seen how much support for locums will actually materialise. Past experience would suggest that there is a steep uphill path.
The BMA, in its evidence to the GMC consultation, had a number of criticisms of the current proposals, and opposition has come from several other quarters.

According to “Pulse” today, the “Department of Health is planning to substantially scale back revalidation in light of concerns over cost and anger among GP leaders about the level of bureaucracy to be heaped on practices”, and the article suggests areas where cuts may be made. With so many concerns about the cost, process, and fairness of the current proposals, it is surely time for the GMC to go back to the drawing board.

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

Feedback for locums could work if more practices completed them

Version 2 of the @RCGP guide to revalidation states that locums will be able to use feedback forms from practices as an alternative to MSF. Furthermore, RCGP lead on revalidation, Professor Mike Pringle has said that locally-designed forms will be acceptable provided they ask specifically about all of the domains in the GMC’s “Good Medical Practice”. In July, in preparation for appraisal/revalidation, I asked 17 practices at which I work regularly to complete feedback forms for me. 9 replied and the responses was very favourable; no doubt this will be adequate when the time comes round. However, it bothers me that nearly half (8) of the practices cared so little about my appraisal/revalidation that they could not be bothered to complete a simple questionnaire that takes only 1-2 minutes to complete.
Do any of you have experience of using feedback forms? If so, NASGP would love to hear from you at info@nasgp.org.uk, on the discussion forum or please leave your comments on the blog..

John Pike, NASGP blogger

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.

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?