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Sessional GPs amount to between
4,500 and 7,500 doctors working in the NHS. Approximately 65% of these GPs work
as self-employed GPs (Freelance GPs) and are by their very nature peripatetic and
therefore not practice based. Sessional GPs have over 20,000,000 patient
encounters every year.
All doctors working in general practice must
participate in clinical governance, and Freelance GPs are no exception. Similarly,
the quality and assurance systems of revalidation and appraisal are imminent.
No national database currently exists to identify all these
Freelance GPs. But the
key areas of clinical audit and group learning are almost impossible to apply
to peripatetic GPs.
Many Freelance GPs are members of
Sessional GP groups -
there are currently over 70 such groups in existence with membership varying
from around 10 members to over 150 per group. Most exist primarily to provide
mutual professional support, some run a regular program of educational
activities and others distribute a regular list of available
Freelance GPs to local
practices.
The Freelance GPs in Sessional GP groups often outsize their local
practices in terms of medical manpower and in this respect could be seen as
forming an informal partnership of Freelance GPs working within the NHS in
their area. In other respects these groups of Freelance GPs may even account for a
larger proportion of prescribing, referrals and patient care than other more
conventional local GP practices. Yet these groups fall outside the traditional
ways of providing primary care. No groups have to date been able to provide any
data on the quality of care they give or any other means of
audit.
Although there are many aspects of clinical governance and
revalidation that Freelance GPs will be able to take part in, other areas such as
audit, working in teams and managing complaints will fall outside their current
scope. Similarly the necessary infrastructure for providing continuing medical
education (CME) is inconsistent at best and absent at worse.
These
Freelance GPs teams could be able to overcome these obstacles and allow their "partners" to
take part in such audit, CME, primary care development whilst affording the
Freelance GPs involved entitlement to superannuation and overall improved
morale.
Our proposal is to develop a framework for allowing such
Freelance GPs
to continue providing General Medical Services for local practices in a Primary
Care Group or Primary Care Trust within the NHS, providing flexibility in their
place and times of work and independently of one traditional
practice.
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Foreword