While the number of salaried GPs and locums in the UK has boomed in the last decade, research shows that many still feel isolated. Sessional GPs face a lack of information about systems and support, missed opportunities for peer interaction and professional difficulties through lack of feedback and unintended ignorance of protocols – all of which keep them at arm's length from commissioning.
Salaried GPs and locums are poorly represented on the new boards of CCGs – because of a lack of engagement between the boards and the sessional sector – but GP commissioners must review this if they are truly going to represent all the GPs at their member practices and get the best out of them. All GPs will need to modify their referral and prescribing decisions in line with new pathways, and to keep within budget, so inclusion of sessional GPs is critical. If sessional GPs refused to comply with certain commissioning decisions, for instance, the effect would be disastrous.
The CCG governing body also needs to reflect the workforce demographics. The evidence is that by sharing leadership and distributing responsibility, better decisions are made and those with the best skills or knowledge for the job are utilised. Given current trends and the large numbers of partners planning to retire in the next five years, sessional GPs are likely to remain central to the model of primary care.
Here are six ways GP commissioners can engage better with salaried GPs and locums.
1 Take advantage of spare capacity in the sessional sector
Many factors contribute to the increased workload GPs are experiencing in their surgeries. GPs in the UK face 300 million consultations every year1 and consultations are longer and more complex than ever, as the prevalence of long-term conditions rises. Every GP experiences pressure, but it disproportionately falls on GP partners, given their responsibility to run a practice and engage with commissioning.
However, the sessional sector has a huge capacity for backfill – in a recent BMA survey, three-quarters of salaried GPs reported they were only working part-time, and locum GPs' work is flexible by nature.2
Some salaried GPs or locums may be motivated by project work or a leadership role as part of their career development and could provide input in their own time, without any impact on the practice and its appointments. In some cases it is more cost-effective for a partner to employ a sessional doctor for commissioning work than to take time out of their practice themselves.
2 Enable sessional GPs to vote on commissioning decisions
The GPC states: ‘All GPs – partner and sessional – should be eligible to stand and vote in CCG elections. The constitution of the CCG should explicitly state this and outline electoral processes inclusive of all GPs in the CCG area. In particular, all GPs regardless of contractual status should have the opportunity to stand for all elected positions – at board level or below – and vote in elections.'3
Excluding salaried GPs and locums from voting for members of the CCG governing body may disengage as many as half of GPs locally.
Sessional GPs may be less well known locally than partners, and therefore less likely to have peer support and success in elections, so some CCGs have therefore co-opted them onto the governing body to represent their colleagues.
3 Use small tasks to identify talent
Giving sessional GPs a small piece of project work will test their skills and commitment and allow them to develop the same sort of skills as partners. Work could include helping on a project such as tackling obesity, redesigning a clinical pathway such as COPD or an audit on prescribing.
Most large companies have a formal process for talent management in a deliberate attempt to attract, develop and retain people who can meet current and future organisational needs.
Sessional GPs with enthusiasm and talent for commissioning can be spotted at practice level and encouraged to contribute in similar ways to partners. There are plenty of tools available to measure performance and potential.
There is a self-assessment tool available as part of the Leadership Framework, made available by the NHS Leadership Academy, which sessional GPs could undertake by themselves to find out whether they're ready for a leadership position.
Commissioners might want to set the questionnaire for sessional GPs who identify themselves for leadership roles, and use the personal development plan templates in the Leadership Framework to set them up for senior roles.4
However, it's important to remember that sessional doesn't mean inexperienced or lacking in expertise. Many GPs have left or avoided partnerships to pursue their own careers, meaning that some may already have the expertise and leadership experience you're looking for.
Identifying talent in these GPs should be as simple as reading through their CVs and seeking references. The NHS Leadership Academy is developing a process of talent management through an online leadership needs assessment available this summer.
4 Invite salaried GPs to practice meetings
The demands on general practice are unprecedented, with increases in consultation rates and length, and more case management for long-term conditions. This means managing a large team well is vitally important to make use of everyone's talent and potential.
Inviting salaried GPs to practice business meetings will help them develop the skills to become leaders in primary care and commissioning in future, and they may offer new and useful insights.
CCGs should use technology to enable participation where part-time sessional GPs struggle to attend meetings – for example, by setting up a conference call to get a sessional GP's view. Practices could use video conferencing through WebEx or Skype (the latter is free), or a conference calling system such as Spiderphone.
On a very basic level, it also helps to take notes at every meeting and make them available by email or by posting them online, perhaps by using Google Documents.
5 Work with locum chambers on commissioning cover and project work
A GP chambers is a group of GP locums working together to provide medical services to GP practices and CCGs. In return for a membership fee, the chambers manages all non-clinical aspects of being a locum GP – such as all aspects of booking work – as well as providing professional development and educational support, the latter also open to salaried GPs.
Locum chambers offer quality of service, know the local practices well, are able to share good practice and are more cost-effective than locum agencies.
In some areas, locum GP chambers also contribute members to their local CCG governing body and help undertake project work. Locum GPs from chambers are being used effectively by CCGs on their emerging governing bodies, as they often know a variety of local surgeries well and can share good practice.
6 Encourage sessional GPs to set up a self-directed learning group
CCGs might want to consider setting up a self-directed learning group for salaried GPs and locums, to ensure they are kept up to date with best practice and the latest evidence. Sessional GPs in some areas meet regularly to address their professional development needs, including the skills they need for commissioning.
These groups can help generate evidence of continuous professional development for members' appraisals and revalidation, but also provide a local knowledge base, networking opportunities and flexible learning opportunities.
Groups make the workforce better skilled and more adaptable to the needs of the local CCG, so it is in sessional GPs' and commissioners' mutual interests to set them up and maintain them. Commissioners might want to consider liaising with group leaders to provide training sessions or mentoring partnerships.
Dr Penny Newman is a salaried GP in Ipswich, and a member of the NHS Midlands and East commissioning development team
Dr Ed Garratt is chief operating officer of West Suffolk CCG
The authors would like to thank Dr Richard Fieldhouse, chief executive of the National Association of Sessional GPs and a GP in Chichester, for his help with this article.
References
1 Orton P, Orton C and Gray D. Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1,876 patient reports in UK general practice. BMJ Open 2012:2:1
2 BMA. Results of the sessional GPs representation research programme. 2010. tinyurl.com/bn6onnc
3 BMA. CCG constitutions white paper. 2012. tinyurl.com/6qvntmh
4 NHS Leadership Academy. Leadership Framework. 2011. tinyurl.com/8yklsh7
