Shadow GP consortia so far mostly ignoring Sessional GPs

This month’s survey asking sessional GPs if they’re being involved with commissioning seems to confirm that emerging consortia are not involving sessionals in GP commissioning.

Over two-thirds of the 223 sessional GPs surveyed say they have received no communication from PCTs or consortia inviting them to get involved in GP commissioning.

At a time when the profession is split over its support for reform, it makes no sense for consortia to exclude this huge pool of enthusiastic, experienced GPs. Although not all Sessional GPs will want to be involved in the reforms, each consortium is likely to contain practices within it that are reluctant to help commission. Therefore consortia should make sure that they get everyone who wants to get involved, is involved.

Salaried and Locum GPs needed to champion GP Commissioning

The RCGP has set up a new Centre for Commissioning, and is looking for a range of GPs from First5, Salaried, Chambers, Locums and Partners to apply to become Clinical Commissioning Champions. These Clinical Commissioning Champions (CCCs) will use their first-hand knowledge of working in the frontline of primary care to inform the production of educational resources and support tools. These champions will then be responsible for delivering training and education to GPs and those involved in commissioning, so a great opportunity for Sessional GPs, especially those working across a range of practices, to bring their knowledge and experience to the forefront of commissioning.

These posts will initially be for up to 10 days a year and GPs will be reimbursed for £393 per day. To find out more and  to apply to become a Clinical Commissioning Champion visit the RCGP website here.

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The only independent representative organisation for locum and salaried GPs

 

Thanks for looking at the NASGP Blog. With over 100 postings and links to both the NASGP website and a host of other websites relevant to Salaried GPs and GP Locums, this is by far the largest resource for Sessional GPs anywhere on the internet. If you like what you see, we’d love you to join, and you can do this very simply for only £8, and remain a member for as long as you like.

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.

Survey into locum pay

GP Medeconomics are again undertaking a survey of GP locum pay, and the closing date is the 13th June 2010. We’ll no doubt be providing in-depth and incisive comment on the results when they’re published ;o)

Ubani wake up call to enfranchise GP locums fully into NHS

The inquest into the very sad death of Mr David Gray after being injected by a lethal dose of diamorphine by a GP locum has now begun. It’s widely envisaged that the 10 day inquest will focus on the fact that the locum, Dr Daniel Ubani, was not used to working in the UK, having only travelled from Germany the day before, had been trained outside the EU, and English was not his first language.

But there are elements to this case that will resonate with many UK trained and resident locums. With anything up to 15,000 GPs working as locums in the UK at any one time, working often in excess of 30 different surgeries a year, in several different PCTs using any one of around 9 different IT systems, often isolated from other GPs and poor or absent methods of locum induction, Britain’s locum GPs should congratulate themselves for this not happening more often.

Although fortunately such tragedies as this are highly unusual, it’s safe to say that underperformance – or perhaps better described as enforced underperformance – is an all too common situation faced by GP locums. Even our profession’s own Royal College’s consultation document recognises that locum GPs will find periodic revalidation more difficult than a conventional GP. This isn’t for want of trying – GP locums are on the whole a very enthusiastic group of highly qualified professionals. It’s root, however, is institutionalisation. The number of GP locums has soared, yet absolutely no investment has been made to support locums whilst in practice (there are some locum support organisations, but practically all are run voluntarily), to develop systems that would fully enfranchise such GPs into the systems and processes of the NHS (for example, GP locums are still excluded from receiving essential prescribing information otherwise easily accessable by any other GP) or to teach GPs in training how to work in so many different practices.

GP locums are desperate to be released from the shackles of NHS institutionalisation, and have spent years campaigning for our main representative bodies to ensure we’re able to practise in a safe and effective way, yet the response to this has been painfully slow. The Age of GPs working in positions of enforced underperformance needs to be assigned to the history books, and measures that emancipate locums to work as safely and effectively need the profession’s most urgent attention. To this end, the NASGP has nailed its flag to the mast in terms of its Core Competencies consultation,  and now waits for the profession to see sense and adopt changes to create a level playing for all GPs – and their patients – in NHS primary care.

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.