This autumn saw the second GP/NASGP Locum GP conference in London, with a range of talks including the opportunities and threats of the NHS White Paper; how to market yourself as a locum by our very own Judith Harvey; locums in leadership roles within clinical commissioning groups; staying tax efficient; issues relating to appraisal and revalidation; representation from the BMA and Medical Practitioners Union; improving care and avoiding complaints, and finally a talk on how to be more involved with CCGs from Ross Clark of Hempsons Solicitors.
Several strong themes emerged from these talks throughout the day, all linked of course by that chronic condition suffered by so many locum GPs – professional isolation. The main thread appeared to be how this isolation and fragmentation has hindered the inclusion of locum GPs in Clinical Commissioning Groups at all levels, from simply having heard nothing from their CCGs at a local level to being actively excluded from any form of participation. There are examples of local locums being involved, but these appear to be strictly limited to locums from chambers, and even then only in small numbers. Yet several speakers expressed their dismay that, despite all the advantages that locum GPs can bring to a CCG (namely, the freedom and flexibility to do the job, a wide experience of many local practices, their own unique professional skills, credibility and neutrality and that free-spirited, brave and fearless quality that’s so needed to actually be a locum GP), so many of us have to date been excluded, with CCGs ‘missing a trick’ by not engaging with locum GPs. And when you add in all the reasons why a GP principal might not be such a good choice (already having existing strong commitments to their partnership, their experience often being very specific to just their own local practice, and of course the potential for financial conflict of interest in their own area), locums being widely excluded starts to take on a rather unpleasant feel.
On a very positive note, Liliana Risi, a locum GP and NASGP member from Tower Hamlets, gave a wonderfully inspirational talk on her experiences of exactly what can be achieved as a locum GP in a CCG. Not only did we hear firsthand about the hurdles involved, but more importantly how these could be overcome. Liliana, who is the CCG’s cancer lead, spoke of how over 60% of all GPs in Tower Hamlets are Sessional GPs, yet there are still blind spots in terms of the dissemination of information and the all-important development of leadership.
Judith Harvey gave a forthright presentation on working as a locum GP – issues relating to training (or lack of), whether one is actually cut out for locum work, whether our administration systems are up to scratch (a huge training need), managing one’s reputation and the all-important how to market oneself as a locum.
On to revalidation and appraisal, Vikki Weeks from the GPC gave us a thorough review of exactly where we are in terms of locum GPs participating in these formative and summative processes. Although on the one hand a lot of this was already familiar, the travesty of the situation is that it has been so similar for so long, yet for all locum doctors working within primary care these systems and processes should actually have changed the most. A revalidation pilot is beginning in London to test revalidation on locum GPs, yet with little or no change to the isolation of locums – highlighted by the sheer difficulty in recruiting locums into the pilot! – we may well simply re-confirm what we’ve known all along.
Debates on the representation of Sessional GPs can sometimes be a bit charged, but one thing that is clear is that both the representatives from the GPC’s Sessional GP Subcommittee and the NASGP are determined to work towards fully integrating all Sessional GPs into the structures and processes of the NHS. NASGP are also pleased to announce a new closer working relationship with MPU-Unite, shortly providing a new joint membership scheme.
Tax and Pensions! At any other conference this might have been the chance to catch up on some sleep, but we were treated to a riveting run-through of tax and pension implications for locums. A lot of it not exactly rocket-science but, bearing in mind that running the financial aspects of your locum GP business doesn’t even get a look-in during GP training, it certainly provided a great deal of new information to those present. But to summarise, the advice I’m sure all present would agree on, is get an accountant!
As anticipated, MPS’s Steph Bown’s presentation on GP locums and risk management gave rise to some salient and sobering figures and prompted some interesting questions. As well as issues with prescribing – often a minefield for locums – there were questions with regard to the increasing use of nurses taking on clinical roles outside their competence, and how this relates to the locums who are nominally supervising them. Two big take-home messages, though, were that effective communication can significantly reduce litigation, and that locum GPs must steadfastly refuse to accept logging onto a practice’s IT system using a shared generic username and password.
In all, it was a great day with lots of good questions and debate, and a very sobering take-home message that locum GPs, and all those that represent us, still have some way to go to emancipate themselves from professional isolation.