What’s the buzz about teamworking?

In the run-up to revalidation, “locum teams” has joined a family of oxymorons such as “open secret” and "found missing”. But are locums really working in well-organised groups, or is it a myth? Dr Richard Fieldhouse, founder of the National Association of Sessional GPs (NASGP), investigates

All great solutions descend from a problem. You cannot invent something if there is not a need for it in the first place. The creation and development of our locum chambers not only prove this, but the huge change that it’s bringing to locum GPs illustrates the sort of problems faced by locums.

More than “just a locum”

My colleagues and I started working as a team because locuming independently wasn’t effective. We ran a local voluntary locum group. This was a reliable way of meeting fellow locums and getting all our practice woes off our chests, but it was hit and miss – attendance was patchy and there was little or no commitment from some members to work more closely. So we put a small business plan together and made a commitment to create a team of like-minded locums to transcend all the misconceptions of being “just a locum”.

The Holy Grail of locuming

To do this, we needed to achieve the ultimate goal of good locuming, which tied in all aspects of clinical governance, booking work and professionalism.

Our basic idea was to appoint some clinical directors to oversee the running of smaller discrete chambers, each with no more than 12 members and each with a chamber leader. The clinical directors would employ staff to take on all the non-clinical aspects of running each member’s day-to-day non-clinical business, such as booking, invoicing, banking, certification, appraisal, information and marketing, etc. This proved successful.

Now, all new members are interviewed by a clinical director and a chambers lead. If it goes well, and their references are excellent, then they are accepted into one of the chambers, subject to all other members agreeing and a six-month probation period. So teamworking has proved a real benefit for locums, but it is also beneficial for the reasons which I will now discuss.

More consistency

All members – and practices – have to sign up to the chambers terms and conditions. These conditions are not designed to act as small print to tie members in, but they are a liberating guide to how we can work most effectively in a way that benefits all the members, the practices we work for, and their patients. For example, all members are asked to use the name badges and door plates provided for them.

Apart from the obvious benefit of staff and patients being able to see our names, the removal of professional anonymity brings with it a sense of emancipation that focuses our minds as professional GPs in our own right, and gives us an enhanced sense of control over our working environment.

You get more feedback…

How am I doing? What’s the rest of my team up to? What do others think of us? What is it that makes our locum team work? Asking questions is a great way of gaining feedback. Cementing our chambers together is a network of feedback systems and processes aimed at allowing individuals, separate chambers and practices to monitor all our professional interactions. For conventional independent locums, such monitoring would be hard to achieve and, as loosely-affiliated individuals within a conventional locum group, it would be a complicated spider’s web.

But as a coherent and highly-organised team, with access to financial and physical resources, our managers and directors facilitate the collection of pertinent information from practice staff, patients, consultants and other team members.

…And have access to more learning

Together with a rolling programme of formal clinical meetings to discuss and plan outcomes from all these sources, not only do we learn more about our personal clinical practice, but we are fully empowered to actually do something to improve it too.

You can spread “best practice”

Periodically, each chamber chooses a practice that it would like to pass on advice to – whether this is regarding the repeat prescribing procedures (or lack of), the heavy-handed allocation of visits (we have strict guidelines on this) or the way diabetic care is managed.

Equally, we like to let excellent practices know what we think of them too. Working in so many different practices and being exposed to many different systems and processes, there are no professionals better placed than a team of locums to really point out exactly where a practice’s strengths and weaknesses lie.

After collecting feedback from members of our team, one of our clinical directors then collates the feedback into a useful format and presents this, with considered advice, to the practice manager.

We have more control over our working environment

Our enhanced reputation as a highly-organised group of professional locums means that many practices prefer to work with our members. They prefer not to risk using a GP they don’t know as well, and our chamber managers make the booking process much simpler and safer.

This also puts us in a good position to lay down the law with a practice that feels it doesn’t have to treat locums with any seriousness. Our managers can insist upon the minimum conditions as defined by our team. For example, a practice that did not have a confidential username or password would mean that locums who had previously worked there would not have been properly protected. We would tackle this with a swift call from our managers, to make sure that it didn’t happen again.

It is more fun

Although it can be lonely working as a partner, independent locuming can be extremely isolating. But as a team, with its collective financial and organisational resources, and the necessity for obligatory attendance at meetings, isolation is not an option. Members get to know each other well, both socially and professionally, and our team has spawned many firm friendships.

Lavish summer parties, and team-building skittles evenings and quiz nights, are blended in with our formal internal chambers meetings and slightly less formal educational evenings, where all other local sessional GPs are invited too.

It raises standards

Our hard work to improve the working environment for our members has a knock-on effect for local locums who are not members of one of our teams. As well as organising local educational events for other locums – this requires taking on the role of “informal local GP tutor for sessional GPs” – practices are effectively trained to take better care of other independent locums.

It improves workforce planning and recruitment

Geographical areas with groups of locums who work in similar managed teams tend to be more “chaotic”, in terms of how locums are assigned and managed to different practices. In these areas, as it is left much more to chance, practices use alternative methods to cope with a shortfall in GP manpower, using internal cover, a nurse, cancelling appointments or just making do without.

Booking a locum can sometimes be so much hassle that it’s simply not worth it. But we’re finding that practices seem to be using us more and more, and looking upon using a locum as a positive experience rather than a neutral, or even negative, one.

Looking forward

The ethos of the chambers is to improve our working lives; there’s no commercial “tie-in” like a locum agency. In fact, when new members join, we gauge their career aspirations and endeavour to place them in practices that are looking to recruit a new partner or salaried GP. Working as a GP can be a risky business and we need to be extremely aware of how important it is to practise in a safe environment.

A safe environment is one that we have control over. Working as a team creates the domain of possibility for locums to thrive as professional GPs in their own right, which is not only good for us, but for our practices and our patients.