In the third of our series of articles on CCGs and local locum GP chambers, we explore how CCGs can work with the local chambers once it has been established, and how the partnership between the two can benefit local practices, patients and the wider healthcare system.
Once a chambers has been established locally, CCGs can partner with them to put together a programme to offer training and other services to local practices. This programme can include:
Practice Improvement. The chambers can collect regular feedback on each practice from its GP locums and sensitively provide constructive feedback to help practices improve their working relationship with its clinicians. It can also play an active role in identifying local best practice and spreading it to other areas (e.g. appointment systems, DNA policies and procedures etc.)
Backfill to create GP time for CCG business. GPs often cannot attend CCG meetings because no locums are available. Local locum GP chambers can work in partnership with the CCG and use their local workforce intelligence to ensure these meetings are organised at a date and time when backfill can be arranged.
Practice Manager Training. The Chambers can put on workshops for practice managers on how to make the best use of locum GPs, including elements such as getting their feedback on your practice, how to make sure locums want to keep working at your practice, avoiding risk and complaints, and spreading best practice.
GP Locum Training. The chambers can provide training for locums to include elements such as high quality referrals, improved prescribing, supporting continuity by writing better notes, being involved in clinical governance, increasing effectiveness as a locum by giving better feedback, engaging with the practice, risk management and clinical handover.
Workforce Planning. Commissioners and the chambers working together proactively can ensure an effective use of the local GP locum workforce to help manage and avoid workforce issues, including holidays, sickness, winter, out of hours and weekends.
Service Provision. As with other GPs, many GP locums have specialist skills e.g. women’s health, dermatology etc. As locum GPs these skills are often under-utilised, but within the chambers model, these skills can easily be deployed across the CCG when and where they’re needed.
Direct locum Involvement in CCGs. CCGs and local locum GP chambers can work together to better involve the dedicated pool of flexible locum GPs so that they are more involved with commissioning, especially building on their experience in working in lots of different practices across the patch.
Some local GP locum chambers may be prepared to go a step further, and consider a scheme for the chambers to support local General Practice. In such a scheme the CCG would contribute the administration costs of the running of the chambers (rather than this being paid directly by the locum GPs themselves). In return the locums would offer to meet specific needs the CCG has. The table below provides an illustration of some of the potential elements of this scheme.
| GP locums open up their availability five months in advance | Often, GP locums will only make themselves available one month in advance. Incentivising them to open their availability to 5 months would enable better and longer term planning by local practices. |
| Practice-blacklist amnesty | A locum agrees a trial of returning to work in a practice they have otherwise chosen not to work in. Appropriate safeguards are agreed in advance, and feedback is given after the assignment to identify issues and solutions. |
| At busy times (Christmas, Easter etc), enter into a ‘holding pattern’ | Typically, well organised practices book well in advance, and struggling practices book when they are ‘desperate’. The ‘holding pattern’ would entail a commitment by the GP locum to work, but the location is only announced when local practices have been assessed on a needs basis by the commissioner. |
| Minimum commitment | Locums agree to a minimum level of service e.g. four sessions per week. |
| Time ringfence | A commitment is made by the locum to give first choice to the sponsoring CCG up until a set time period, after which the locum can make themselves available elsewhere. |
| Backfill | If a practice is in crisis, local experienced partners can be deployed to the failing practice, whilst the chambers deploys a group of chambers locums in the donor practice to reduce loss of continuity. |
| Attendance at clinical governance meeting | Already a requirement of many chambers, regular attendance at internal clinical governance meetings to discuss significant events, complaints and feedback about practices. |
Whilst such a scheme is not currently in existence, the Chairman of the National Association of Sessional GPs (NASGP) Dr Richard Fieldhouse believes the potential of such a scheme to be huge. He says, “As a system we consistently fail to make the most of the opportunity that locum GPs provide. The Chambers model enables effective partnerships to be developed between commissioners and locum GPs, and a scheme like this is the logical next step”.
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