Case Study 11 - Northern Ireland affiliate scheme for GP locums

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Introduction

The Northern Ireland (NI) Affiliate Scheme was developed in conjunction with the Northern Ireland Medical and Dental Training Agency (NIMDTA), the Health and Social Care Board and the BMA’s GP Committee in Northern Ireland.

Over 1,500 GPs practise at around 365 GP practices in Northern Ireland. Since it was established in early summer 2012, approximately half of the GP practices in Northern Ireland have joined the Affiliate Scheme.

Challenges

For the last six years NIMDTA has been in charge of the appraisal process for GPs in Northern Ireland. Every year they work together with the Health and Social Care Board to ensure that all of the doctors on the Performers List, that is those General Practitioners who are registered to practise in Northern Ireland, have an annual appraisal.

Over a third of the doctors on the Performers List are sessional GPs, including locums who, by the very nature of their practice, can work in many different locations and can spend a very short amount of time in each place. This makes it challenging for them to prepare the supporting information needed for appraisals and, in turn, revalidation. Activities like clinical audits, collecting colleague and patient feedback, keeping up-to-date with training and being part of the information cascade, can be challenging when you do not have a permanent place of practice.

Dr Claire Loughrey, Director of GP Postgraduate Education at NIMDTA explains: ‘When the Deanery took over the appraisal process, we received feedback that sessional and locum GPs were finding it difficult to get the supporting information needed for their appraisals and were concerned that they would struggle with revalidation when it was introduced. We were aware of the potential isolation and challenges that locums can face, so we needed a solution to address these issues and ensure that all of our doctors were supported in preparing for their appraisals and revalidation.’

Action

Working together NIMDTA, the Health and Social Care Board and the BMA GP Committee devised a scheme that would align sessional doctors with practices who would help the doctors to take part in training and collate supporting information needed for their appraisal.

The scheme allows sessional GPs to informally affiliate with one practice. Normally this would be the practice where they were a trainee and/or a practice where they regularly work. The practices will then add their affiliated GPs to their information cascade emails, include them in any training that they are organising, allow them to carry out clinical audits and support them in getting patient and colleague feedback. The scheme ensures that sessional GPs are supported in the same way as a permanent member of the practice would be.

To recruit practices, the Health and Social Care Board wrote to all practices in Northern Ireland asking them whether they would be willing to take on sessional GPs and become part of the NI Affiliate Scheme. The response was good, with nearly half of all GP practices in Northern Ireland volunteering.

The names of the practices taking part are now posted on the NIMDTA website, so that sessional GPs can see which practices offer the scheme.

‘We had a lot of interest in the scheme from GP practices,’ says Dr Tom Black, Chair of the BMA’s General Practice Committee in Northern Ireland and part of the team that developed the scheme. ‘It’s good clinical governance on their part - it’s in their interest for their sessional GPs to have the most up to date information and training.’

Dr Loughrey adds: ‘It means that the practices have another member of staff, who can carry out clinical audits or if necessary, significant event audits, and other quality improvement activity. The practice benefits from this work and the GP can use it towards their appraisal. The scheme has the backing of the Department of Health’s Confidence in Care Group and the Health and Social Care Board, which also encouraged GP practices to sign up.’

Currently, the Affiliate Scheme is promoted to sessional GPs through the NIMDTA website. Appraisers will also promote the scheme to sessional GPs during their one-to-one appraisal session and Dr Loughrey believes that there will be a large influx of sessional GPs affiliating with practices following the appraisal season this year (which runs from October to December).

‘The success of the scheme is in its flexibility,’ explains Dr Black. ‘We don’t dictate the exact support that GP practices must provide or the conditions under which the GPs can affiliate with different practices – so it is up to the GP and practice taking part. In addition, the informality allows for people moving around throughout their career. The fact that the affiliation is informal means that if you relocate to another part of the country, there is not a lot of paperwork. There’s no need for excessive bureaucracy, cost or to make more work for ourselves. The flexibility and informality of the scheme are key.’

Additional support for locums in Northern Ireland is also available on the NIMDTA website, which has guidance on how to collect patient and colleague feedback as well as template feedback forms.

Results and benefits

Dr Loughrey is confident about the future of the NI Affiliate Scheme: ‘The scheme is in its infancy and from what we’ve seen so far, I think it will grow and grow. We’re ready for revalidation in Northern Ireland and this scheme helps to support large numbers of sessional doctors through the process of appraisal and revalidation,’ says Dr Loughrey.

While they have a list of the practices who have signed up to the scheme, there is not currently a list of sessional GPs who are taking part. To measure the reach of the scheme, when registering for appraisals, sessional GPs will be asked if they are affiliated to a practice and this information recorded.

Dr Black believes that the reach of the scheme could be much further than anticipated: ‘Because of its flexibility and informality, I think that some sessional GPs are approaching the practices directly, and the practices will affiliate them, without involving us or adding themselves to the list. It’s a scheme that has benefits for both parties and makes sense.’

Key findings

• Flexibility encourages participation – ensuring any such scheme is informal and flexible, enables it to be easily adapted to the needs of an individual GP, ensuring it remains relevant and usable.
• Utilise systems that are already in place – For many practices, including a sessional GP on to their email system will not be a big burden.
• Champion best practice – The fact that the practices are listed on the website as being involved with the scheme holds them up as best practice examples. This helps to attract more practices to the scheme.