Isolation remains key issue for Sessional GPs

Paula Wright, Chairman of North-east Employed and Locum GPs, takes us through the findings of the recent report into Sessional GPs from the Royal Medical Benevolent Fund.

Having spent many years supporting our sessional GP group in a variety of roles as treasurer, website manager and chairperson, I was delighted to have the opportunity to be involved in a research project focusing on support structures for sessional GPs. Our sessional GP group was locally recognised as providing important professional support, including job and educational alerts, and members had quadrupled in numbers since we had commissioned its website. So when the Royal Medical Benevolent Fund (RMBF) commissioned us to carry out this research, the first time these groups have been studied formally, this was a subject close to my heart. The research was a mixed methods study involving a literature review, focus groups and telephone interviews with sessional GPs, and online surveys to deanery educators, sessional GP groups and locum chambers.

Ninety-one percent of sessional GP groups contacted (57/62) responded to our survey, which indicates how keen group leaders were to find out more about other groups. Average group membership was 49, with the largest group having 180 members. The average lifetime of the groups was 55 months, with some existing for as long as 20 years. Membership included a range of sessional GPs: locums, salaried, retainers, GPs on career breaks for example. Groups met in a variety of venues including GP practice, hospital, PCT, and members’ homes.

Seventy percent of groups were run entirely by volunteers, the remainder having some paid administrators or a mixture of these and volunteers. Of those which did receive funding the commonest source was membership fees, though a minority had received funding from either PCTs, the pharmaceutical industry, local deaneries or their LMCs. Sometimes they had local links to deanery tutors, PCTs, LMCs and RCGP local faculties. Groups were perceived to provide key opportunities for networking, and information on educational events and job vacancies. Most provided meetings and a number provided newsletters, websites and locum lists for practices. They were felt to be of particular value to GPs new to the area and newly qualified GPs.

The group changes over time but is friendly and welcoming and works well as a "slow open" group; self-funding, self-governing, we are in total control of ourselves.

The types of meetings that each group held ranged from “committee/professional”, social, educational, to meetings for significant events discussion for appraisal. The issues which most challenged the sustainability of the groups were lack of funding (to pay for an administrator, venues and website), lack of administrative support, difficulty in recruiting volunteers to run the groups and variable attendance at meetings, particularly where the membership was geographically dispersed or very transient. One group raised the concern of being subject to legal action.

This was also the first time that locum chambers have been surveyed. Responses were received from all eight Chambers for whom contact details were available on the NASGP website at the time of survey distribution. Chambers are groups of locums who remain self-employed yet work as a “single undertaking”, setting fees, using shared administrative support (for which a percentage of income is paid), and engaging in joint education and quality review initiatives such as audit and significant event review. Respondents from chambers reported that they valued the opportunities for professional peer interaction to discuss clinical work, support with booking and administration, and collecting evidence for appraisal and revalidation. The downside was that they were reported to require considerable investment of unpaid time for the set up stages. Our research also increased our understanding of the factors which make self-directed learning groups successful.

A key finding from the study was that professional isolation remains a major issue for today’s sessional GPs. They were often left out of mailings from PCTs and deaneries about education, service and guideline developments and job and career opportunities. They missed out on opportunities to speak to their colleagues about cases, significant events and clinical updates, and on opportunities for feedback and to benchmark their practice against peers. A significant factor was exclusion from practice meetings and other non practice-based meetings for a variety of reasons (being locum, or salaried not scheduled to work on the day of the practice meeting, for example). Those most at risk of professional isolation were sessional GPs new to an area, those working as locums, those working for the prison service or an out-of-hours service, and those working fewer hours or working in a rural practice.

Facilitating networking between sessional GP groups and chambers, and also between self-directed learning groups, would all help to pool and build on their collective experience and energy and add momentum to what have become increasingly successful “bottom-up” models of professional support. The NASGP provides a discussion forum for sessional GP leaders but, at the time of writing, there is little activity in this forum. The Sessional GP committee of the GPC is also looking to promote further networking between groups and their leaders.

The RMBF held a stakeholder event in April, attended by representatives of the GMC, RCGP, BMA, deaneries, NASGP and departments of health from the 4 nations to discuss the findings of this research, and the result is the proposal to form a cross-nations working party chaired by the RCGP to take these issues forward.

If you have any thoughts on how we might learn more from each other please get in touch.

Paula Wright

The Project “Support for sessional GPs” was carried out with Gill Morrow and Charlotte Kergon from the School of Medicine and Health, Durham University.

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