Dr Richard Fieldhouse, Chair of the National Association of Session GPs and Clinical Director of Pallant Medical Chambers, argues the case for a new model for locum GPs.

Q: What first led you to decide to set up Chambers for locum GPs?

A: The idea was the product of an eight hour workshop, which I ran at the RCGP in 2001. I’d assembled 35 leaders of locum groups from around the UK, trying to find a solution to the professional isolation experienced by locums. I eventually managed to start a chambers in 2003 with two like-minded colleagues.

Q: What have been the main advantages for those locums who have joined chambers?

A: Firstly, support. Our managers arrange our monthly meetings, summer parties, run our discussion forums and help us set up our instant messaging so that we can all closely interact and support each other.

We also pay our chambers managers to do everything apart from actually seeing the patients. An illustration of this is that we currently have several colleagues with significant health issues – one was even recruited on this basis – and our team ethos helps all these members thrive.

Outside chambers, all other locums work independently and are effectively in competition with each other. A conventional independent locum can go weeks or months without any professional interaction. There is a lot of paperwork that goes with locuming – booking, confirming, advertising, banking, pensioning, bookkeeping, appraisal, organising education, correlating feedback.  This all takes a significant amount of time out of being a GP, and in itself adds to the feeling of isolation.

Q: Do you find chambers appeal to any particular types of locum?

A: Pallant Medical Chambers appeals to any GP who sees the importance of sharing and supporting and working in a team (and appreciates the lack of paperwork).  Once these locums join us they won’t leave! Even if going abroad or relocating, they still want to be a Pallanteer. Conversely, it doesn’t appeal to GPs who want to just see patients and not communicate with other GPs. Unfortunately for these GPs, they will find revalidation extremely difficult.

Q: Have there been any disadvantages?

A: For the directors and chambers leads, it is a lot of very hard work.  It’s taken a huge investment, firstly to create and then develop all the systems and processes that create this holistic support environment. It also takes sustained human effort to make these systems work for our members on a day-to-day basis. At one end of the spectrum we’re managing a complex service for each GP surgery, and at the other we’re providing a caring, supportive infrastructure for medical professionals.  Although these two concepts are very different, we believe it is vital that professional goals and aspirations are linked with the mundane task of bringing in income, so that our GPs can focus on their professional needs.

Q: How have GP Practices in your area responded to chambers being set up?

A: Extremely positively. It costs them no more than an independent locum and is far easier to arrange, as our chambers managers look after all the locums’ available working slots. We keep all our positive feedback and it goes on for pages and pages! However the hard evidence is that we are taking about 30-40% more bookings each year.

Q: What do locums pay to become members?

A: Nothing to become a member.  We charge each member a percentage of their income as a management fee. They do however commit to work on average at least 2 sessions a week, contribute to their chambers and attend the meetings.

Q: And what do they receive in return?

A: Membership of a supportive, peer-led organisation that looks after their every professional need and allows them to thrive as GPs.

Q: Can any locum join your chambers or is there some form of application and selection process? If so, what does this involve?

A: Any locum can apply and, just like a conventional practice, the chambers lead (a designated GP from each chambers) interviews new candidates to assess suitability to join their team. If accepted, references are vetted and members of the existing chambers are given the choice to accept.

Q: How would you say chambers differ from a traditional locum agency?

A: We’re not an agency – totally the opposite. In agencies, the managers employ their GPs.  In our chambers, the GPs employ their managers. So, chambers members can still get NHS superannuation. Chambers members work only through the chambers (rather than via up to 10 different agencies) so it’s much simpler all round. Chambers members fund the service, not the practices, so the locums themselves have control in how the chambers are run.

Q: Revalidation could be a big issue for locums. Can chambers help here?

A: We already are! A significant part of our work is providing the evidence each GP needs for revalidation. Because of our holistic approach to support, we can integrate Multisource Feedback into all aspects of the locums’ work, right from turning up to their surgery, through patient care, working in teams and audit to handling complaints. We know when all our members’ annual appraisals are, and make sure they’re given the evidence they need in time for their appraisal interview.

Q: How do you ensure the quality of medical care provided by locums in your chambers?

A: At initial assessment, through feedback from practices and peer interaction at chambers meetings. We fully respect the capability of GPs to take control and responsibility for their quality and professionalism, just so long as they have a supportive and conducive environment for this. We believe that our model of a locum chambers is the ideal environment for this, and by providing the architecture for this our members are fully empowered to do this.

Q: In a chambers context, does the legal liability remain with the individual locum, or does the chambers take on any responsibility or provide any support, for instance in the event of a complaint?

A: With the locum; we’re part of the MPS practice scheme, so not only do our members all benefit from reduced rates, but also our managers are protected too.

Q: Is there a risk that chambers could become like GP Practices, with the locum Directors doing the sort of things GP Partners would?

A: That’s exactly what we do, although I’d argue that GP partners do far too many tasks that they’re over-skilled for. GP partners should recognise that patient care is a precious skill that many of us find quite natural after many years of learning and experience. However, because it is natural, we tend to undervalue it. For some reason, GP Partners like to throw themselves at IT, financial planning, management, human resources… all the things they have no training for, and therefore the things that are more unnatural and stressful, and just the sort of thing non-GPs should be doing. At Pallant, one of our mottos is “99% of what we do is being a GP”. Our members thrive on patient care, and that is all they have to do!

Image credit: by Tom Ventura from Denver, CO, USA (Flickr) [CC BY 2.0], via Wikimedia Commons