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At the heart of general practice since 1960

Why I set up a chambers for locums

Taking the innovative step of setting up a locum chambers two years ago was a big gamble that has paid off and transformed his freelance career ­ Dr Richard Fieldhouse explains

Apart from a six-month stint trying to be a GP principal, I've been a freelance GP for the last 12 years. My early experiences were dismal ­ isolated, disenfranchised and disorganised. So I set up a local locum group with a friend, which worked fantastically ­ a bunch of like-minded GPs to work and play with.

I then set up the National Association of Sessional GPs1 with a whole bunch of new friends. And that's worked a treat too as one of the premier organisations to redefine the way sessional GPs now work.

It is my opinion that one of NASGP's greatest creations is the Sessional GP Support Team (SGPST) concept, which we conceived in 2003. For a SGPST you will need a 'locale' (PCT, city, etc), one or several like-minded and very hard-working GPs, a business manager (£30,000/year) and several freelance GPs who trust you!

The business manager handles all the non-clinical aspects of the freelance GPs' day-to-day work ­ booking, billing, educational content, meetings, complaints, audit etc ­ and is overseen by the leaders.

I approached my PCT with the idea and they loved it. I then presented it to our local practice managers and they loved it too. Unfortunately, when I presented it to a small group of freelance GPs, a rather vocal group were set against it ­ I'd never seen them before and have never seen them since. So the PCT didn't fund it.

A year later I went through the same cycle ­ the PCT wanted a structure to appraise sessional GPs and thought the SGPST model would be excellent. But they couldn't fund it. When you believe in something but can't get people to see your way, you either give up or carry on anyway. So I thought 'sod the lot of them' and did it myself.

Fortunately, my newly discovered belligerence coincided with making two very good new friends ­ both freelance GPs ­ and a phone call from a neighbouring PCT wanting my help to cover a load of sessions for them. My friends and I had already discussed setting up our own SGPST based on a barristers' chambers, so we met the PCT and used the cash to kick-start our chambers.

The three of us then started to approach a few select colleagues ­ locums we knew with impeccable professionalism, a good reputation and who trusted in this new idea.

Our aim was to provide the best possible service to practices and patients while making the life of the locum more pleasant and fulfilling. We created a set of terms and conditions to balance the relationship with practices ­ what they needed to provide, what checks would be made, what an individual should or should not be expected to do, start and finish times.

We also developed policies relating to what service our members provided ­ READ coding, name badges, door plates and perhaps our most successful idea ­ the 'GP profile'. This is a laminated card with a photograph and some text about the GP that the receptionists hand out to patients before they see them ­ the patients really seem to appreciate it.

The next task was to find a business manager to handle inquiries and bookings from practices. This meant yet another person had to take a leap of faith to trust in our idea.

How long would they have a job? What would it involve? What skills would they need? We didn't have the answers as we were exploring the whole idea ourselves anyway, and the business manager would be helping.

Lift-off

Once we'd provided our manager with a PC and a mobile phone, she was soon handling all the inquiries from practices and booking our work. All we had to do was to turn up to our allotted practices at the times she gave us, and then see our money appear in our bank accounts sometime during the next month.

We had receive a completed set of superannuation forms together with the amount we'd need to send our PCTs, and an invoice from the chambers for handling all the bookings, etc.

Another great asset of our SGPST was our 'brand' ­ I guess, our 'corporate identity'. We've developed a high exposure approach, using a logo and trying to get our name into as many practices as possible. We all carry business cards and use stationery specific to our chambers that helps us in our clinical care but also gives us greater exposure to practice managers and other doctors, continually promoting our high-quality service.

But this, of course, is the biggest potential disadvantage. Because of this high profile, we as members ­ 11 of us in all ­ are intimately professionally related to each other.

A mistake by one of us ­ possibly clinical, a problem with attitude or simply turning up late ­ could deter that practice from booking more doctors from our chambers. Any complaints have to be handled immediately and sensitively for all concerned, and the relationship between the practice managers and our own business manager is crucial.

To help foster our team environment, we schedule regular meetings where members can discuss issues, talk about clinical cases and share experiences of other practices.

For the three of who set up the chambers, it's been a very busy two years. We've met, on average, at least once a week. Systems and procedures have been developed from scratch and tested. Problems have been dealt with, managed sensitively and robust procedures have been set up to minimise their recurrence.

Although for us it was a lot of hard work, developing a SGPST can be extremely rewarding. But don't take it on lightly ­ a simple mistake at any stage could irreparably damage the team's reputation overnight.

Running the SGPST, one plays a significant part in being responsible for the livelihood of others. You'll need help from a good accountant, a solicitor and a business adviser, none of which come cheap.

Richard Fieldhouse is CEO of NASGP and works in West Sussex and south-east Hampshire

Proceeds from this article will go to Help The Aged to support Dr Fieldhouse's London Marathon run ­ he finished in 4hrs 23mins

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