October 22, 2009
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.
August 25, 2009
NASGP member Christine Haseler has just had her iMap orals and not only raises concerns that could have an impact of revalidation, but also suggests some key areas for research and development into working as Sessional GPs
Although I am not sure of the outcome yet of my membership by Assessment of Performance for the RCGP (iMap), the process did seem fair but there is a definite lack of understanding of the environment within which locums work.
For example, in the section on referral letters, one of the questions was “how would I ensure that the practice had followed up on an action that came back in a referral letter”, that I only obtained because I specifically went back to the practice to seek it out.
As salaried, locums and out of hours GPs are here to stay, there needs to be a whole competency framework around these positions agreed with the RCGP although I am concerned that the RCGP may not have representatives in significant numbers from these areas of practice, if at all. The competencies of these GPs are very different from the competencies of a good partner, and to try to judge them by these standards means they will fall short, and also not be tested on important areas of their practice, such as handing over cases, dealing with patients in a one off consultation, notes appropriate to the one-off consultation, negotiating a safe working environment, seeking feedback and working as part of a team in the locum, salaried or out of hours doctor environment.
Dr Christine Haseler
July 13, 2009
Death in Service benefit can apply to GP locums
There seems to be a leedle bit of confusion over the perceived lack of ‘death in service’ benefits for GP locums. The BMA has recently flagged this up as an issue apparently because on the flu pandemic – something that leaves us here at NASGP a little confused, but I’m sure there’s a good reason somewhere.
Hopefully, we can clarify the situation for you thanks to our friends at the NHSBSA.
Freelance GP locums doget death cover from the NHSPS, even though they may not be tied to a particular PCT/LHB. If [a locum] were contracted to work at a GP Practice as a freelance GP Locum from Monday to Friday however died on the Wednesday you (or rather your family) would get the full death in service benefits; i.e. the same as a GP Provider would. This includes a death gratuity which would be based on twice your average uprated (dynamised) GP Locum pensionable income. A widow’s pension and child allowance may also be payable.
If, however you died on the Saturday (i.e. between jobs) you would fall under ‘the death within 12 months of last pensionable job’ rule. You (or rather your family) would get slightly different death in service benefits. This includes a death gratuity which would be based on three times the value of your accrued annual pension. A widow’s pension and child allowance may also be payable.
Like pretty much any freelancer, we’re not covered by a corporate injury scheme (in our case, the NHS Injury Benefits Scheme which can also pay out a death in service benefit). So, for that, the BMA’s interim advice does apply.
June 19, 2009
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.
June 19, 2009
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!
June 17, 2009
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.
June 6, 2009
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?
June 4, 2009
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.
December 7, 2008
I’m becoming increasingly disheartened that Plan B for revalidation will simply be, for those who haven’t got enough support to get through the ‘conventional’ route, to sit the MRCGP. And considering that it’s the RCGP delivering revalidation, it’s a somewhat disingenuous situation whereby we’re potentially ending up lining the pockets of those who’ve left us in the lurch. I’ve written to the RCGP pointing this out, and have already had an acknowledgment that they will meet.
November 20, 2008
I’ve just returned from the bi-monthly meeting of the RCGP’s Revalidation Stakeholder Group, so I thought I’d give you a brief update. Please bear in mind that a lot of what goes on in these meetings is still “under development” so I’m talking mostly in general terms.
When I’ve got my revalidation hat on, I talk mostly in terms of locums as, generally, salaried GPs will be covered by practice based systems:
- Audit – probably looking like every GP – locums of course included – will have to do a clinical audit cycle twice every 5 years. In my opinion, locums who are spread among many practices and/or who are isolated from other locums could find this really tough. What I’d really appreciate here is your help – please, I’d love to hear from any of your locum members who’ve done some audit on their locum practise so that I can further develop the Audit For Locums section on the NASGP website at http://www.nasgp.org.uk/cpd/auditaudit so that we’ve all got a central resource for ideas over the coming months and years.
- MSF – I thought this was something to do with DIY before I realised it stands for Multi-Source Feedback or 360 feedback. Again – a couple of times possibly (I did say it was all still vague, didn’t I?) over the course of the 5 year revalidation cycle. As locums, we’re going to have to apply to colleagues –either other GP locums or GPs in practices where we’re “well known” – to formally provide us with feedback on our clinical ability and professional behaviour from up to 5 clinicians and/or other non-clinical staff. Again, any experiences from you in doing this as a locum would be really helpful.
- I did get a tadge irritated today as yet again I felt we (all 15,000 of us!!) were being overlooked on the issue of complaints – not so much how locums are involved in the process, more the fact we’re often entirely overlooked and simply aren’t told about them – just not booked again! The solution, I fear, warrants a tidal shift in the attitude of many practices (which is why we so need the NASGP).