The proportion of salaried GPs has increased by 940% in the last decade, with no concurrent increase in the number of partnerships, and salaried and locum GPs make up between 40 and 60% of the total GP workforce depending on geography.
However, proportionally there is only a minority of sessional GPs on the new Boards of Clinical Commissioning Groups (CCGs). CCGs must review this if they are truly going to represent their member practices and get the best out of the talent available to them.
Here are ten more reasons why sessional GPs should have greater involvement in commissioning.
1. Every GP counts
All GPs will need to change their referral and prescribing decisions in line with new pathways and to keep within budget – inclusion and communication with all GPs is therefore critical. If sessional GPs are not represented on the new governing bodies, it is possible that up to two thirds of the GP workforce may become disengaged and not comply with commissioning decisions. The CCG governing body therefore needs to reflect the workforce demography.
2. Sessional GPs are future leaders
Given the rapid increase in numbers of sessional GPs, sessional GPs need development as they will be the leaders of the future. This is at both practice and CCG level. The future of primary care may be in their hands.
3. GP partners face huge work pressure
Many factors contribute to the increased work load GPs are experiencing in their surgeries. For example, a 40% increase in the number of consultations per patient from 1995 to 2008, an increase in the length and complexity of consultations and more case management for complex patients with long term conditions. This pressure is experienced by everyone, but more so by GP partners given their responsibilities running the practice.
In a recent BMA survey, three quarters of salaried GPs worked part-time, and locum GPs work flexibly. If motivated by project work or a leadership role as part of their career development, salaried and locum GPs may be able to provide input in their own time, without any impact on the practice and appointments.
4. Locum chambers are cost-effective on backfill
To be released for CCG meetings many GP commissioners are finding it hard to find a locum. Chambers or groups of sessional GPs with administrative and educational support are able to better co-ordinate cover at less cost than locum agencies . Locum GPs from chambers are being used effectively by CCGs on their emerging governing bodies as they know local surgeries well and can share good practice.
5. Distributed leadership uses the best and brightest
New clinical commissioning groups will be able to use all those with talent and enthusiasm in their member practices to help solve the complex problems, for example, designing pathways for gynaecology or cardiology, or making services for complex families less fragmented.
By sharing or distributing leadership and responsibility the evidence is that better decisions are made, more people are involved and the decisions owned, and those with the best skills or knowledge for the job are utilised.
Sessional GPs make up a very large proportion of the workforce and may have a specialist interest or skills in their portfolio roles. Having diversity on the governing body means better performance.
6. ‘Sessional’ doesn’t mean newly-qualified
Clinical commissioning not only requires time and skills, but the right attitudes, behaviours, enthusiasm and commitment. While it is assumed that most sessional GPs are newly qualified, a recent BMA survey revealed that the majority are women aged 36-40, many are male GPs nearing retirement and a number have portfolio careers and therefore a wider range of skills. Each GP should be judged on their own merit and competency not by the type of contract they hold.
7. It reduces the risk of conflict of interest
As sessional GPs are not directly responsible for a practice income, there are fewer potential conflicts of interest. This might make decision-making clearer and safer in the long run, compared with GP partners.
8. Sessional GPs have the same training as partners
A good GP is a good GP. The skills needed for clinical commissioning are different to those needed for running a practice, for example, service redesign, change management, strategic development and needs assessment for a large population. As clinical commissioning is new, most GPs are learning how to develop these skills, and starting at the same level. Sessional GPs have the same clinical training as GP partners – it is important not to develop a two-tiered profession.
9. It follows a leadership trend
A number of CCG leaders are becoming salaried to cope with the workload and demands of clinical commissioning. Having a CCG chair who is salaried, while failing to encourage other salaried and locum GPs to apply and contribute to commissioning, doesn’t make sense.
10. Sessional GPs value engagement
Research indicates sessional GPs feel isolated and disenfranchised. Increasing access to senior roles will enable all GPs to realise their potential and increase personal satisfaction in a leadership role through career progression – including sessional GPs.
Dr Penny Newman is a GP in Ipswich, and a member of the NHS Midlands and East commissioning development team; Dr Ed Garratt is chief operating officer of NHS West Suffolk CCG.