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GPs buried under trusts' workload dump

Other health professionals aren't doctors ­ we must keep control

Deanery funding cuts are a major threat

to the retention of sessional GPs in the

workforce, says GP tutor Dr Paula Wright

Whenever I start

to doubt the value of my work in supporting sessional GPs

I have only got

to spend a few moments talking

to one who has recently resigned from partnership. They are often astonished if not indignant regarding their drop in status, especially regarding access to education.

Sessional GPs, previously known as non-principals, include locums and all types of employed GPs. The difficulties they experience in accessing education has been known at least since the publication of a report based on a survey by the standing committee on postgraduate medical education 11 years ago. One of the recommendations of this major project was to devise local databases of non-principals so that this group of doctors could be targeted to receive information about education.

Supplementary lists were brought in during 2002 under the umbrella of trying to 'regulate' this group of doctors (particularly locums) about whom there have been concerns that nomadic habits may lead to performance problems going unnoticed and unresolved. It quickly became clear supplementary lists would not deliver any 'quality assurance' in respect of this part of the workforce.

Checking references for locums joining PCT supplementary lists is one 'quality assurance' mechanism, but we know the majority of significant adverse events have more to do with systems failures ­ in particular lack of skills or training and poor communication. Despite these valuable lists sessional GPs continue to be excluded from PCT or deanery mailings about education, clinical governance issues or service developments. Yet PCTs and practices seemed quite happy to use this educationally deprived pool of locums to deliver care.

Inclusive ­ not just 'supplementary'

In its recent report on extending appraisal to non-principals, the Sheffield centre for health and related research recommended that PCTs bring non-principals into the 'communication loop' in the sense of making sure they had equal access to important information about education, training, service developments, clinical governance systems etc. The centre also recommended that deaneries develop 'inclusion' strategies for non-principals.

As educational events become more PCT centred, locums are often still made to feel unwelcome unless they are long-term locums. But the reality of the locum market is that many practices have preferred to hire extra help on a casual and short-term basis ­ to cater for holidays and special interest activities ­ rather than commit to the financial responsibility of employing GPs.

They are highly dependent on the fact that locums are prepared to work in this flexible way, yet the very same locums are penalised for not being geographically committed to a PCT area, as if this were a reflection of inability to integrate and commit.

There is good evidence that supplementary lists are often inaccurate because those managing them have not considered the frequency with which GPs now change practices, status and area. They have also not considered data protection issues that would have permitted sharing of contact details with PCTs and educationalists.

Educational provision and deaneries

Formal educational needs assessment carried out in my deanery, designed specifically to be relevant to both principals and non-principals, has brought into sharp focus the very different barriers the two groups face. Locums struggle to access information about where the education is happening, and then face the direct costs of giving up paid work in order to attend. Employed GPs, most of whom are part-time, find childcare issues most problematic, and there is little awareness of the part-time workers' regulations (2000).

This group also struggles to get timely information about educational events (even from other doctors in their practice). In contrast, principals primarily complain that they are unable to be released from clinical commitments and find existing events not relevant to their needs.

My educational needs survey showed very little difference in the learning priorities of principals versus non-principals, but they did differ in their preferences as regards a peer group for learning. Both employed and locum non-principals preferred learning with other non-principals whereas principals clearly preferred learning within a geographically defined group.

Learning is about exploring and taking risks so it is not surprising that there might be differences in the preferred environment for learning of these two groups.

Is this costly duplication? Perhaps, but then neighbouring PCTs put on large-scale multidisciplinary educational events with almost identical agendas ­ where economies of scale could also be made.

So what can be done in practice ?

PCTs and lists

PCTs need to be better than ever at managing their most precious asset ­ their workforce. Locums on career breaks (having a family) or near retirement are often hovering on the edge regarding their level of commitment to GPs. Their retention can be a direct benefit of looking after their education and appraisal needs. In order to do this PCTs need to be better at managing their performers lists.


Practices need to start valuing their salaried and locum GPs. Better integration into practice educational opportunities and time for continuing professional development (as required under the new salaried model contract) are essential and need to be formalised by proper job planning as is being developed by consultants.

Sesssional GPs

In these times of rapid change non-principals need to be wary of isolation. They need to join a local non-principal or sessional GP group that networks actively with local LMCs, PCTs and deaneries. E-mail is also a key mechanism for avoiding isolation: you can sign up for all forms of important newsletters (from the Chief Medical Officer, Department of Health, public health alerts, NICE newsletter, journals, etc) and it also provides a cheap means for PCTs to include you in the loop.


These need to systematically assess how inclusive of sessional GPs they are being as regards educational needs assessment and provision. GP tutors have a key role in ensuring support in their education so they are not disadvantaged when it comes to undergoing appraisal and revalidation.

Helping these doctors access 'mainstream' PCT-based education, while offering some sessional GP-only events for meeting specific needs of this group, are two important tasks.

Funding cuts to deaneries are a major threat to the retention of sessional GPs in the workforce. It is imperative that PCTs learn to manage and support their sessional GPs.

Paula Wright is a freelance GP and GP tutor for non-principals, Northern Deanery

Useful websites

National Association of Sessional GPs

North-East Employed and

Locum GP group for examples of how educational events can be cascaded through a website to all sessional GPs who register

For online electronic modules on clinical topics see:


BMJ Learning

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