New #RCGP Sessional GP Survey

The Department of Health has recognised the vital role of Sessional GPs in general practice, and is funding a large RCGP project to get more locum and salaried GPs into GP-led clinical commissioning and wants YOUR views on how more of us can get involved.

The advantages of us getting a lot more of us involved are so blindingly obvious that we’re not going to mention them here, and would prefer YOU to tell the RCGP and DH exactly what your feelings are through these 2 short surveys.

• As a Sessional GP, you can give your views here.
• And if you’re a SGP and already involved in a CCG, we’d love you to complete this quick survey too.

And if you have any other comments to make, feel free to leave them on this blog!

RCGP to lead freelance locum GP working group

Earlier this month the Royal Medical Benevolent Fund (RMBF) hosted a national conference attended by many professional organisations and representatives of the Chief Medical Officer from all four UK countries and, of course, yours truly.

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.

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.

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

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.

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.

iMap raises key areas for developing competence framework for locum GPs

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

‘GP’ looking for sessional GP bloggers

With increasing numbers of Sessional GP bloggers out there, why not try and turn one of your articles into cash? GP Newspaper and the RCGP are offering 3 GPs up to £150 for an article on life as a GP – anything from 300 to 800 words. And if one of the 3 winning articles relates to life as a salaried  or locum GP, we’ll give the author/s a year’s free NASGP membership worth over £70. If all three winning entries are about Sessional GPs, i’ll do something silly like run a marathon or something.