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Shutting out salaried GPs and locums could wreck commissioning

Sessional GPs have a huge amount to contribute to consortia, says Dr Richard Fieldhouse

GPs have a highly puritan work-ethic with a dogged determination to get things done, no matter how much fuss we make about those in power telling us we have to work harder. I suspect the Government is well aware of this and takes advantage of it at every opportunity.

During times of change however, some of us develop a siege mentality which only plays into the hands of our detractors by contributing to the self-fulfilling prophecy of failure. Which rather puts us on a knife edge – are we going to grab GP commissioning by the proverbial horns, or are we going to retreat to our safe little turrets and just hope it'll all blow over?

How as a profession are we going to make a success of this and ensure we keep our NHS, rather than failing and losing out to the private sector?

The key here is working together, and avoiding at all costs the corporate siege mentality. And that means sessional GPs have got to play an integral role in every aspect of GP commissioning – as, indeed, must any health professional who is involved with the management of the transition between primary care and secondary care, or any other type of care.

In some areas, we've already seen salaried GPs and locums excluded from the new consortia that are being formed. One salaried GP who actively applied to his PCT asking to get involved was turned down – elsewhere, applications to join consortia boards have been denied. Dozens of locum groups all over the country have been getting nowhere and have been ignored.

It would be crazy to ignore the opinions, experience and huge collective wisdom of the more than 15% of GPs who are salaried, work largely outside the constraints of partnership and focus almost entirely on direct patient care. Or the more than 15,000 GP locums – 25% of the GP workforce – who work across dozens of very different practices and PCTs and know all the subtle vagaries of local healthcare provision.

Many salaried GPs are at a relatively early stage in their careers. They tend to be fresh, have a good existing network of colleagues from their training and often have an excellent insight into the potential services offered by local hospitals, particularly since they so recently worked there. These GPs are also tomorrow's partners and will be next week's commissioning leads.

Established locums, working across many different areas, have a broad knowledge of many different referral pathways and care systems. Their knowledge and experience won't have the same depth as a practice-based GP, but it will be much wider – the two combined perfectly complement each other. Some sessional GPs are ex-partners

in sight of retirement, with many years of experience behind them and inherited wisdom from decades of change. Many will have been leaders in their time and have recently benefited from working in many new practices after having worked for so long in their own. They will have memories of GP fundholding, too.

Finally, locum GPs are not constrained by any contractual or partnership agreements with any practice, and so are better able to focus their attention on local healthcare in a non-partisan way.

GP-led commissioning provides us with a unique opportunity to provide a holistic package of care to our local community – and the only way of doing that effectively will be if all those involved in patient care have a say. Yes, in many ways it seems as if general practice is under attack by the Government, and a natural reaction is to dig in our heels and protect what little territory we have left. But this will not provide us with a solution. We have to work together in order to make this work – and if we don't, we all know what the alternative is.

Dr Richard Fieldhouse is chief executive of the National Association of Sessional GPs and a GP in Chichester, West Sussex

Dr Richard Fieldhouse Sessional GPs 'actively' excluded from consortia formation


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