Case study 10 - Pallant Medical Chambers

This page is for responsible officers and employers. The case study is about about how Pallant Chambers are preparing for revalidation.

Introduction

Pallant Medical Chambers is a group of GPs working together to provide freelance medical services to GP practices and Clinical Commissioning Groups in Sussex, Hampshire, Surrey, Avon and Essex and extending across the UK.

The Medical Chambers manage all non-clinical aspects of being a locum GP, such as booking work, professional development and clinical governance, allowing locum GPs to concentrate on their clinical role. For the GP practices that they serve, they are a single port of call for all locum services. All members work exclusively through the chambers.

Challenges

By their very nature, locum GPs face various challenges when preparing for revalidation: they normally practice in many different placements for varying amounts of time, some placements can be as short as half a day and locum GPs may not necessarily go back to the same surgery more than once. In addition, because of the limited amount of time locum GPs often spend in a surgery they may have limited opportunities to interact with other members of staff, as their time is mainly spent with patients. This can make it difficult to collect colleague and patient feedback.

Founder and Director of Pallant Medical Chambers, Dr Richard Fieldhouse explains further challenges: “When locums go to a GP surgery, quite often they remain anonymous in a number of ways. Firstly, they are not always given individual user names for the computers, most of the time they log on to the system using a generic locum identity. As a consequence their practice cannot be tracked and there is also a risk of the records of their practice being mixed up with other locums who use the same log-in.

“Secondly, locum GPs will normally be using someone else’s office, when they operate, with someone else’s name or perhaps no name on the door. Sometimes, even the receptionist doesn’t know the name of the locum doctor in the practice. This can be very worrying to the patient as they don’t know who they will be seeing and it makes it very difficult when the GP needs to get feedback from the patient.”

In addition, the fact that locums are not connected with one surgery can mean that it is challenging to complete other professional development activity, such as training in new clinical developments or e-learning. All of which can make it difficult for locum GPs to develop the portfolio of supporting information required for appraisal and in turn revalidation.

As Dr Fieldhouse explains: “We are aware that freelance GPs can become isolated and miss out on the clinical support and feedback of their peers; avoiding this was the real motivation for setting up the chambers.”

Action

Pallant Medical Chambers provide simple, practical solutions to the problems that locum GPs face in terms of dealing with these issues around anonymity. They advise doctors to ensure that their placements provide them with log-ons under their own name, so they can track their own practice. They also provide name plates for the consulting room door, name badges for the locum GP to wear and a plastic laminated card with a profile and picture of the locum GP, which is given to the patient by the receptionist. Whilst these measures may seem very simple, they help to build the patient’s confidence in the locum GP. Dr Fieldhouse explains: “The patient might be alarmed that they are not seeing their regular GP, but with our system, by the time they get into the consulting room, they know who they are seeing, what their background is and understand that they are just as capable of dealing with their problems as their normal GP. This helps to build the relationship between patient and doctor and will ultimately help when they need to get feedback from the patients as they will remember which GP they have seen.”

Pallant Medical Chambers have a Revalidation Toolkit, which is available online to all of their members. The system sends reminders to GPs about their appraisal date and lists the GP’s previous placements so that they know where to collect feedback from.

“We have a members' only area called our 'cupboard', complete with a bespoke toolkit designed for our locums. We have developed over 20 different types of feedback forms to help the locum GP get the feedback they need. All they need to do is print them off and hand them out,” explains Dr Fieldhouse.

The different feedback forms help GPs get the information they need from a variety of sources. For example, one form looks at the referrals the locum GP has made. The GP can send this form directly to the secondary healthcare professional to which they referred the patient, with their referral. On the form, the secondary healthcare professional is encouraged to give them feedback on the quality of the referral, which the locum GP can then include in their supporting information for appraisal. There is also a feedback form which Pallant send to the surgery with their invoices, to encourage the surgeries to give feedback at the end of the doctor’s placement at the practice rather than at a later date.

The Chambers also help their GPs with the professional development necessary for their appraisals and revalidation. Alison Barnes is a freelance GP who joined Pallant Medical Chambers a year ago. She has found the training and professional development very useful when preparing for her annual appraisal.

“Pallant has internal chambers meetings on alternate months at one of the GP’s houses, where we share clinical experiences, discuss significant events and provide mutual support. These are written up by our Chair and can be used in our supporting information for appraisals as evidence of continuing professional development. In addition, Pallant organises regular teaching meetings for its members from hospital specialists, so we can keep up-to-date with the latest developments. They also organised the compulsory annual resuscitation and child protection training on one evening, at a hotel, which I would have found hard to source if I had been practicing on my own.”

Alison also takes advantage of the Pallant Chambers blog, which distils newly released NICE and SIGN guidance for its members. Reading the blog contributes to the e-learning that Alison needs for her portfolio.

Results and benefits

“Our commitment to professional development amongst our GPs means that all 70 of our members are ready for revalidation and have regular appraisals,” says Dr Fieldhouse. “We try to make it as simple and easy as possible for them as it’s a necessary part of practicing medicine, which helps reassure patients and happens in many other professions.”

Alison Barnes recently had her first appraisal since she started at Pallant, “I felt very prepared for my annual appraisal and I feel totally ready for revalidation because of the services and support that Pallant Chambers provides. There’s no point reinventing the wheel, and that’s why Pallant are so helpful – we can all share our learnings and techniques to ensure that it doesn’t become overwhelming.”

Key findings

• Help locums to avoid isolation and anonymity – GP practices can adopt simple measures to make it easier for locums to gather supporting information and feedback from patients for their appraisal and revalidation. They include providing locums with their own access to a practice’s IT systems, and name plates on consulting room doors and name badges to help patients know and remember who they’re seeing.
• Group together – One of the ways that doctors who practise as locums can access professional support is by grouping themselves together to form networks that can share in educational opportunities.
• Always seek feedback – doctors who practise as locums need to get into the routine of regularly asking for feedback about their placements as they go. This will help to avoid the challenge of obtaining feedback after a lot of time has passed.