The NASGP is excited to learn of a bid led by a GP locum to develop “bottom up” solutions, harnessing the experience of locums to support vulnerable practices.
Dr John Sanfey, a chambers GP locum in London, is in the process of bidding for part of a £10m programme to support vulnerable practices, and is inviting expressions of interest from locums, sessional GPs or even partners who might want to diversify their portfolio and become involved in planning and developing sustainable system changes in practices and their networks.
John highlights the scenario that many locums will be familiar with in struggling practices: "Sometimes vulnerable practices are caught in a recruitment vicious cycle, whereby reliance on expensive agencies tempts them to use the locums to see as many patients as possible, which leads to reduced quality, further worsening the recruitment problem.” But rather than being the cause of the problem, John sees locums as a key part of the solution, “I believe most of these locums are capable of effective quality improvement work, if only they can be helped to form teams with access to good technical know-how by managers and IT specialists."
John is dubious about the effectiveness of top-down, remote support of vulnerable practices, and has a positive belief in the value of change being led by clinicians from the ground up. So John’s idea is of ‘parachute teams’ made up of clinicians working at the sharp edge of practice, empowered by allowing them funded time, space and resources to organise themselves. The RCGP support this approach, which builds on the their experience with the special measures pilot.
So how would it work? An early task with each practice will be to formulate a bespoke development plan. "Vulnerable practices typically have poor communication, information sharing, clinical handover and safety netting.", says John. "The project would provide funding to address this core deficiency by paying for time for all the clinicians to meet for 30 minutes daily to discuss issues arising from the clinical sessions, and also for the time to introduce system changes in practices. Team members will rotate through a number of practices including some that have excellent systems from which to learn and share good practice. There will be funding for experienced managers, nurses and IT specialists to help develop systems arising from these discussions ."
Often as locums, with the benefit of our experience working in many settings, we are in the paradoxical situation of having great clarity in identifying problems around us, but limited ability to bring about change in systems that could benefit patient safety and improve the working lives of ourselves and our colleagues. John is really onto something in seeking to tap into this clinician experience.[Tweet "...the only true solution to the problems of primary care must come from the empowerment of those of us at the sharp edge."]
John has no doubt that this will be challenging work but adds “I believe the only true solution to the problems of primary care must come from the empowerment of those of us at the sharp edge. This project ticks the box of being an attempt to mobilise from the bottom-up and to help ourselves and our practice-based colleagues. It is exciting that the often overlooked locum workforce should lead the profession out of the doldrums. Most of all, I am excited by it because I have no doubt that it can work.”
John can be contacted at firstname.lastname@example.org