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.

GP locums exposed to NHS pension cost-cutting

We’ve received yet another email from a frustrated member:

I have just had my supperannuation cheque returned from [X] PCT as it is just over the 10 weeks, even though as pointed out to them i only got the paper work and cheque from the practice 1 week ago and the forms were dated so.

We wrote to the BMA 2 weeks ago (no reply yet) with this list of PCTs (as a result of our member survey) where locums have experienced problems submitting their payments where these PCTs have cited either the 10 week rule (locum form A) – or the 7 day rule (locum form B):

• Berkshire West
• West Sussex
• East Sussex
• Bury (Lancashire)
• Surrey
• Nottingham County
• Hampshire
• Oxfordshire & Buckinghamshire
• Kingston
• Wandsworth
• Croydon
• Sutton & Merton

We don’t necessarily blame the PCTs – they’re arguably just ‘doing their job’ and we’d never expect them to look at this issue particularly creatively.

Either, legislation needs to be changed in order to give realistic periods of time for locums to be paid by practices. Or, PCTs must allow locums to pay their (average) contributions by direct debit and have just one annual deadline to submit paperwork (a system that works so smoothly in other sectors such as medical protection and Inland Revenue etc).

PCT bureaucracy threatens GP locum superannuation

We have a new survey for our members. As if it’s not already complicated enough, paying your superannuation contributions might be getting harder. We’ve been getting some reports from members recently that their local PCT has been told from up high to strictly apply the 10 week LocumA form rule: 

“You cannot apply to your PCT/LHB for Scheme membership for any GMS / PMS / APMS period of locum GP work that ended more than 10 weeks before the date they receive the application.”

and the 7 day LocumB form rule:

“You must complete and send a monthly form GP Locum B to your host PCT / LHB within 7 days of the end of the calendar month. For example, you should complete a July 2009 form to show all the NHS locum pay you receive from GP Practices between 1st and 31st July 2009, regardless of when the work was done, and send it to your host PCT / LHB”

Why is this such a problem? Firstly, some employing practices (with PCTs being the worst culprits) can take weeks and weeks to pay their locums and complete Form A, thus locums receive their cheques after the Locum A 10-week rule. If one then sends the Form A in late, often with other Form A’s that are within their date, the entire cheque/payment is returned and thus further jeapordising the rest of that month’s contribution.

Secondly, our Form B’s and corresponding cheque have to arrive at the PCT by the 7th of every month. PCTs bless ‘em can ONLY accept a cheque. This means that we can’t go on holiday from the 1st to the 7th on any given month. Or be ill, or be away on a course or visit granny or live in a country that celebrates religious/national festivals that last more than a day and don’t fall midweek.

The NHS superannuation people have as usual been very supportive, but unfortunately it’s the Department of Health who are in charge of the rules. As it’s the BMA who are responsible for negotiating with the Dept of Health, we’ve asked them for their advice. So far, apparently, this has not been flagged up as a problem by any BMA members, so therefore we’re conducting a short survey to find out just how widespread the problem is. Once we’ve got some more information we’ll present this to the BMA who would then like to “work closely with the NASGP” to help resolve this issue. We’d be most grateful if you could spend a minute completing the survey, and the more replies we get the more we’ll be able to do to resolve this issue.