GP Locums as Clinical Commissioning Champions (CCC): Professional isolation or a chance to shine as leaders? (Part 1)

Whether you like it or not, it’s inevitable that the new NHS landscape at the end of the 2012/13 will look and feel very different in that the new landscape would have transformed into one locally focused clinical commissioning system, with the development of CCGs, assisted by commissioning support units and overseen by the NHS Commissioning Board.

With the recent publication of ‘The Operating Framework for NHS 2012/13’ -

- it is clear that there is still a stronger emphasis and need exist for good systematic engagement with staff, patients and the public is essential for any new service delivery and change is taken forward with the active involvement of local people.

The NHS staff and patients provide essential insights into the quality of services. The framework went on to urge that the organisations should listen closely and act on any information from staff about where services need to improve and the way in which care is delivered to the patients you are caring for.

As sessional GPs, particular as locums working with other staffs and teams in many different practices, you would’ve experienced some diversity in the way in which the care is delivered to these patients. I am sure you agree sometimes the cause of some of these failures lies within the way the practice is organised than the lack of resources that become unmanageable by local practices. And according to our new NHS reform this is what commissioning is setting about to change; it has the potential to radically change the way we help manage patient care.

So how difficult or easy it has been so far for you as GP locums in engaging yourself with the newly formed Clinical Commissioning Groups (CCG) and how can GP Locums get involved in leading and shaping this new commissioning landscape?

In the recent months there were strong themes emerged (and we are still hearing some disturbing news   from some publications) from various media channels and all linked to describing the ‘whole affair’ of ‘disenfranchising’ a chronic condition (Pulse) or ‘impostor syndrome’ (GP Online) suffered by many locum GPs- professional isolation and fragmentation.

A recent survey (May 11) carried out by National Association of Sessional GPs (NASGP) asked sessional GPs if they’re being involved with commissioning seems to confirm that emerging consortia are not involving locums in GP commissioning.

Survey revealed that over two-thirds of the 223 sessional GPs surveyed say they have received no communication from PCTs or consortia inviting them to get involved in GP commissioning.

This lack of communication has been the main theme which hindered any involvement of locum GPs within CCGs at all levels, from simply having heard nothing from their CCGs at local levels to being actively blocked out of consortia voting or have been told that partners will be taking on active role or the risk and therefore will end up running the show.

There has also been recent disruptive or negative media coverage (Pulse, November 11) where Southwark Clinical Commissioning Committee revealed plans to impose a ‘referral ban’ on locums in a bid to drive down ‘significant over activity’ in hospital referral rates.

The report shows that the CCG hopes to ‘launch the ban’, which will see GP partners asked to police locum referrals, at locality monthly meetings. Although this peer review of referrals could seem like a positive step, but sessional GP leaders warned that singling out locums would come across patronising and sends mixed messages that GP partners are somehow above sessional doctors. Through the lack of meeting attendances with other PCT/CCG or GP Principles, the locums may not appreciate the pressures put on practices to keep within patient health care budgets while driving down prescribing and referral costs. Without this clear education or guidance, even though locums are clinically competent in making correct clinical judgments, they may not be familiar with the local referral pathways and may not fully utilise less costly community services.

At this crucial stage in the whole engagement of GPs with the new reforms, it is paramount for locum GPs to be pro-active to use their initiatives to engage with their local CCGs to become the designated Clinical Commissioning Champions (CCG). With the low uptake of locums and their involvement in commissioning still questioned, there are glimpses of more opportunities for locums opening up as CCGs become more established. Dr Liliana Risi, a locum GP, who is also a clinical lead for cancer and end-of-life care in Tower Hamlets reported last week (24^th November) in GP Online that:

there are currently over 61% of GPs in Tower Hamlets are sessional GPs, while somewhere between a third and a half of GPs in London are now sessional too, yet there are still blind spots in terms of dissemination of information and the all-important development of leadership.

The network of practice structure exists within Tower Hamlets, whereby practices were already organised into eight networks and each network is represented on the CCG. Two of the 10 members on the CCG are sessional GPs. This allows information to be cascaded through separately for any locum GPs, hence keep them fully informed of any decisions or maintain a systematic communication of CCG activities.

End of Part 1