Locum GPs conference

Last week, GP/HealthcareRepublic held their first ever conference and, in a decision that reflects the times, focused it entirely on GP locums. And what a day it was. A great location in the heart of Regent’s Park, and sponsored by a sizeable number of locum agencies. NASGP were very much involved, having helped in the design stage, recommended speakers for the day and chairing the conference. As NASGP CEO, I opened with an introduction to the scale of locums in the UK, introduced the NASGP/RCGP’s “GP Locums: The Skills We Need And How To Achieve Them” document, gave the example of locum chambers as a possible solution and talked about how locums could be affected by the White Paper. Mark Levy then gave a run down on how GP locums can do audit, complete with a step-by-step worked example of a simple asthma audit any locum could easily do. Vikki Weeks from the GPC Sessional GPs Sub-committee has been heavily involved with the revalidation pilots, and so was able to give a thorough recap of the outcomes so far. Most importantly, Vikki stressed the need for a “Phase 2” Sessional GP Pilot, explaining that the first pilot confirmed what we’ve suspected all along (i.e. that independent locums will struggle with revalidation as it currently stands) and that we now need to actually see if other tools would enable locums to participate as effectively.

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.

@BMA responds to GMC consultation on #revalidation

Revalidation will pose some very serious difficulties to locum GPs. Fortunately, some of these issues have not been lost lost on the BMA, who have slated the current proposals in their response to the GMC consultation today, according to reports in Pulse and GP.

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.

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

@RCGP reservations about GMC MSF

@Healthcarerep today reports that the RCGP have reservations about the only MSF tool that they have so far approved, that from the GMC. They advise doctors not to use it just now and the article reveals that a tool specifically for sessional doctors is being developed at its test site in Scotland. This is welcome news indeed and may, at least in part, demonstrate that the RCGP are listening to feedback they have received.  You can read more about my reservations about MSF on the NASGP blog.

 John Pike, NASGP blogger

The new @RCGP learning credits system puts locums at a disadvantage

From NASGP blogger John Pike

I was concerned by several aspects of the Learning Credits system described in this article in “GP” today.

My concerns are:

1.       We all have different learning styles that suit us. Personally, I enjoy using a very wide range of media for learning, but there are many who do not find courses helpful and others who do not benefit from internet learning. These preferred learning styles need to be respected.

2.       Personally, I find the limits on the number of annual credits GPs can claim from more basic training too restrictive and inflexible. I would prefer to see a more flexible scheme where appraisers check that the balance of learning is reasonable and appropriate to the doctor’s preferred learning styles.

3.       The article states that “Workplace learning is so important that the RCGP gives no upper limit”. This puts the country’s estimated 15,000 locums and other non-practice based doctors at a very considerable disadvantage compared to practice-based doctors. It is very difficult for locums to demonstrate workplace learning, other than PUNs and DENs. We are not able to make changes to practice systems as a result of learning. All we can hope to achieve is to give examples of patients for whom we acted differently as a result of a learning activity. I entirely agree with Richard (Fieldhouse)’s comment in the article that “locums will only be able to show impact ‘with difficulty’ because of their short-term contact with patients”.

My concerns are not for lack of trying myself. I now spend virtually my whole time on work, meetings, learning, preparing for appraisal and other work-related activities, such as commenting on documents or news items. I am just finalising my appraisal documentation for this year and note that I have spent 262 hours over the year across the following activities: courses, internet learning, mentoring group meetings, meetings of my clinical governance group, meetings of Bristol Association of Sessional Doctors, RCGP Severn Faculty Board meetings, doing an audit, practical sessions at the hospital for the DFSRH qualification, commenting on documents and other activities agreed for my PDP. This may seem excessive but it soon adds up when one tries to meet the requirements as they emerge and to respond to learning needs as one identifies them.

One of the key stated aims of revalidation was to improve quality of patient care. However, I am not alone in finding that the workload for appraisal and revalidation is now increasing so much that considerable extra stress is being generated. The point will come where this extra stress, far from improving quality of care, will actually have an adverse effect on it.

RCGP’s Sessional GP revalidation pilot is set to start soon

You may be aware that the RCGP’s Sessional GP Revalidation Pilot is set to start soon. I attended an interview at the RCGP on 25.9.09 as part of a team that was short listed for conducting this work. During the discussion that took place Professor Mike Pringle clarified a few points, which are not completely new, but which I think are of interest:

1. Revalidation is set to start in 2010/2011 for a few selected volunteers, who will all be practice based GP partners.
2. There is no target start date for revalidation of locum GPs; it is likely to happen some time after the first volunteers have been revalidated and much will obviously depend on the outcome of the pilot.
3. Instead of Multi Source Feedback (MSF) it will be acceptable for locum GPs to request feedback forms from practices, as long as the questions cover all required evidence areas as set out in the RCGP Guide to Revalidation. Simpler forms which for example only have two questions and an empty box for filling in will not be suitable for revalidation (but may be valuable in other contexts).

This pilot and it’s findings are of immense importance to the RCGP and the Department of Health. If the selected team contacts you in the next few weeks for recruitment to this pilot, please do consider taking part. It will be a great opportunity to directly feed back your experiences to the people in charge of revalidation and for finding practical and meaningful ways for locum revalidation.

Prospective audits offer a way forward for peripatetic locum GPs

From NASGP blogger John Pike

There has been some anxiety about clinical audit in revalidation for peripatetic locum GPs. However, NASGP recently agreed with Professor Mike Pringle (RCGP lead on revalidation) that prospective audits are acceptable. Simply decide what you will audit, collect data on patients as you see them and then enter the data onto a spreadsheet or Word document when you find time. When you have 10 or more patients, you can summarise the findings (you can tabulate these automatically if you use spreadsheet software) and then start on the second set of data collection. I recently became aware of a few prospective audits that you can do on the web at: http://www.guideline-audit.com. The site has a separate section for sessional GPs. I signed up for the chest infection and asthma exacerbation audits and entered data on the first 3 chest infection patients today. I asked permission from a partner yesterday to do the audit on patients in that particular practice and to print off my consultation records, which I have since shredded after entering data. I got a bit of a shock when I first saw the 5-part data entry form but, in reality, it did not take long to enter the data for each patient. The time was well worth it, since I was immediately able to view tables comparing my performance with other practices globally and the learning has already begun. I will really enjoy doing this audit.