Su Stone, a Freelance GP working in chambers and a commissioning GP, shares her thoughts and experiences of working as a Sessional GP in a CCG.
Clinical commissioning groups are the government’s new publicity stunt; a way of corrupting the NHS; backdoor privatisation; the beginning of the end of healthcare as we know it, isn’t it? In short, no, and in my opinion it’s that kind of scaremongering being touted by the vocal minority that is damaging the best opportunity we have of improving services for our patients.
The King’s Fund sums it up nicely: “Commissioning is the planning and purchasing of NHS services to meet the health needs of a local population”. Simple as that - decide what our local population needs, go out and buy it. It’s only privatisation if you buy services from private companies; it’s only the beginning of the end if we all stick our heads in the sand and don’t help it to succeed. It isn’t scary, and it certainly isn’t new - GPs have been commissioning since 1991.
As a newly qualified GP, I was shocked by the apparent lack of common sense in the way local services were organised. GP-led clinical commissioning seems to me to be the perfect solution. Place the opportunity to make decisions firmly in our hands so all those slow, complicated and disjointed services can now be sorted out by sensible intelligent people who care deeply about patients and know what they need – us!
But hang on, not all GPs can do commissioning can they?
You need experience, skills, business acumen, preferably an MBA, right? Wrong. No experience is required at all, just enthusiasm, optimism, and a willingness to get stuck in. The emerging CCGs are already full of experienced managers who need our clinical knowledge and understanding of the local systems. As a GP Clinical Lead, all you need is what being a GP has already taught you. You’ll spend your time planning clinical pathways, looking at clinical guidelines and services from elsewhere in the country, making sense of what you currently have in your local area, where the gaps are, and working out how to fill them. It’s the managers’ job to then take those sensible ideas and bring them to life and understand finances, tariffs, contracts and budgets. What the managers crave is someone who understands what an echocardiogram is, and why GPs want direct access to them. There will be some GPs who take on other roles at the CCG, getting involved in the management side of things and others who prefer to work at a strategic level.
Salaried and locum GPs are excluded from all of this though, aren’t they?
In some areas, I’m afraid we are. Some CCGs have yet to realise that by not engaging sessional GPs they’re excluding up to 40% of their local GP workforce. In my area, we have a locum on the board and the two Clinical Leads who cover most of the projects are both locums, of which I am one, but in other areas of England, locums are actively excluded.
For the past few months, since taking up a post with the RCGP to further the cause of Sessional GPs in commissioning, I’ve been working on a project which establishes just how engaged sessional GPs are with CCGs around the country. The upshot was that, although some of us don’t want to get involved in commissioning, many do. Of that latter group, it’s lack of confidence, lack of encouragement from the CCGs and practices, and lack of opportunity that are our biggest barriers. CCGs told us they wanted to engage more of us, but found us hard to reach, especially locums. However, it’s pretty impossible to break down cultural barriers and build bridges if we aren’t all talking, so the first thing we need is effective channels of communication. The RCGP is working with their partners (including the NASGP and BMA) to try to improve the engagement of all GPs in commissioning, irrespective of their contract status, age or gender, by pushing out the message and also trying to change legislation. In the meantime, us individuals need to be proactive.
So if you feel a tiny spark of motivation to get involved, you should act on it. Working at your local CCG will allow you to improve healthcare for your entire population; you’ll learn more about how the NHS works and develop management and leadership skills. If nothing else, it’ll break up your working week and give you a chance to work in a busy, buzzing office with tea and biscuits galore. Search the internet for who your local CCG is, and fire emails and phone calls at them until you reach someone who’ll chat through with you any local opportunities coming up. Be prepared to be persistent, and perhaps take a role which isn’t exactly what you dreamt of, just so that you can start somewhere. Get in touch with other Clinical Leads and see if they have any advice or opportunities. Make sure you are on the mailing lists for the CCG and are receiving all the newsletters, meeting invites and job opportunities.
Don’t be afraid to give it a go. You never know, you might enjoy it!