We agreed that in order for locums to be fully enfranchised into the structures and processes of their Primary Care Organisation (PCO, such as a PCG, PCT or LHG), the PCO should employ a facilitator [Locum Liaison Officer/LLO] to organise and co-ordinate the non-clinical functions of locums in its area as well as supporting the locums' quality maintenance mechanisms for appraisal and revalidation such as coordinating feedback and collecting audit data. This facilitator would be supported by a fully trained GP mentor to oversee the professional and pastoral needs of those locums, and together form the PCO's Locum Support Team (LST).

The funny thing is is that at our Way Forward meeting were representatives from Bromley PCT who had - we later found out - already set up a very similar scheme in their locality as a means of attracting Freelance GPs into the area. So popular is it that in a recent survey they found that Locum GPs were the most content GPs working in the PCT!

Meanwhile, if you or your PCO are keen to set a LSTs sooner please do get in touch with us so that we can help feed in expertise from other organisations.

SGPST Frequently Asked Questions

"Do the Locum GPs continue to be self-employed, but with more organised support from the SGPLO and mentor?"

Yes - it's a form of "soft management". As you know, GP principals are technically self-employed. Employing all the SGPs would be fraught with problems - a bridge too far perhaps for some Locum GPs and/or PCTs.

"In what sense are the Locum GPs 'fully enfranchised members of the PCT' beyond their existing role of working in the area?"

Because they will formally be involved in clinical governance; be represented at PCT/LMC level; opportunities to actually help develop and lead in primary care development. For example, at the SGPST weekly/monthly management meeting, it transpires that there is a huge variation in the delivery of diabetic care - some good and some bad - across the PCT. So it is suggested by one or two of the SGPST members that they set up a peripatetic diabetic clinic, with the same two trained GPs (Freelance GPs) working regularly in every practice seeing every diabetic in the PCT, feeding back into the clinical governance mechanisms, building up a wealth of data, knowledge, experience and measurable outcomes.

"Are the Locum GPs funded to participate in education/ clinical governance?"

No less so and no more so than any other GP in the PCT.

"Would you expect all local practices to go via the SGPLO to set up any Locum GP cover required?

It would make sense! Some Locum GPs may hate the idea of this, and so they could/should be left to their own devices. But as the system unfolds and those Locum GPs being booked by the SGPLO start to receive greater benefit, I would expect that those initially dissenting Locum GPs may finally give it a go. It would be wrong to force any SGP to something they don't want to - the trick is to develop a service, highlight its benefits for all concerned, and then invite people to join in.

"What about Out of Hours work?"

A lot of Locum GPs can't be bothered - why should they? But, as a member of a SGPST , as they gained greater ownership of their PCT and the PCT/OOH co-op greater ownership of their Locum GPs, I believe that greater synergy would develop and Locum GPs would be far more willing to do OOH than they are now.

"Most of our Locum GPs here work in several PCTs - how do you envisage this working?"

The idea is each SGP would be a member of only one PCT. But two or more PCTs could share meetings, running costs etc. or hold away days together. In terms of booking Locum GPs, SGPLOs from different PCTs could easily "borrow/share" Locum GPs.

Many thanks to Clare Mitchison, Clinical Governance Facilitator for Brighton and Hove City PCT, for posing these questions.