Using self-directed learning groups
Steve Crone, chief executive of the Royal Medical Benevolent Fund, explores how self-directed learning groups can combat sessional GP isolation
NASGP estimates that 42% of GPs currently work on a sessional basis
With more and more doctors qualifying as GPs, and fewer partnerships being made available, sessional GPs are growing in numbers, each year brings more locums and salaried appointments.
The NASGP estimates that 42% of GPs currently work on a sessional basis (25% locums and 17% salaried). Sessional GPs are becoming the frontline of primary care – with potential implications for patients, sessional GPs and primary care services in general.
Isolation
Because locums don’t have the same employment protection as their colleagues with salaried contracts, locums can be particularly vulnerable if accident or illness strikes
The research, which the Royal Medical Benevolent Fund (RMBF) commissioned from Durham University, showed that professional isolation is a recurring problem for many sessional GPs, and that while some Deaneries, PCTs and GP practices have a good track record of supporting sessional GPs across the UK, this is often patchy.
The RMBF provides financial support and specialist money advice for doctors and their dependants in times of need and so has first-hand experience of the sort of problems that sessional GPs face. The applications for help that the RMBF receives show that, because locums don’t have the same employment protection as their colleagues with salaried contracts, locums can be particularly vulnerable if accident or illness strikes.
This is why, in addition to commissioning research into the needs of sessional GPs, the RMBF also undertook research exploring the value of self-directed learning groups (SDLGs) as a way of helping to reduce professional isolation by providing local networks of peer support and continuing professional development.
Running self-directed learning groups
SDLGs are groups of GPs who regularly meet to address their professional development needs, typically for educational purposes and peer support. The educational content of these meetings is chosen by the group members (self-directed). The venues range from members’ houses to local restaurants, and meetings usually take place on weekday evenings.
Group members are primarily sessional GPs, but members can include GP principals and registrars
Group members are primarily sessional GPs, but members can include GP principals and registrars. Typical meetings involve discussion around clinical topics, examination of patient cases or significant events, an external speaker or general chat around support issues.
Establishment, administration and maintenance of SDLGs is done by the groups themselves (often by one person/group leader). Although pockets of funding are made available to help with catering costs, administration and paying speakers, the majority of groups appear to be self-funding. Historically, these groups have been set up by the sessional GPs themselves, in response to perceived local needs.
Sometimes the NASGP or proactive deaneries and PCTs have acted as a catalyst. There is no central support (administrative or financial) for SDLGs available on a national basis, although there is varying support from individual deaneries across the UK. The NASGP website provides a useful central resource for information.
RMBF research
The project consisted of preliminary research into existing SDLGs and interviews with key stakeholders to explore the issues around value, logistics, delivery and sustainability. This was followed by the organisation of sub-regional ‘hub’ meetings for sessional GPs, with meetings being held in different parts of England, to facilitate the establishment of local SDLGs.
The RMBF ‘hub’ meetings attracted an average of 33 sessional GPs and of the delegates, some were already members of local SDLGs; some were interested in joining existing SDLGs or setting up new ones (depending on availability); others were simply interested in the opportunity to network with other sessional GPs and/or hear a specific speaker.
Key findings
Here is a list of the key findings of the study.
Some sessional GPs feel trapped financially, as their insurance costs could rise significantly if they worked more than two sessions a week
- Professional isolation is a major issue. Sessional GPs reported feeling ‘left out of the loop’ with regard to QOF updates, drug updates and CPD opportunities.
- Sessional GPs who are new to an area, or work as locums, work for an out-of-hours service, work fewer hours or work in rural practice face additional risk.
- Many UK organisations provide support to sessional GPs in a variety of forms, from tailored events and CPD support to funding for SDLG meetings, but this is not consistent across the UK and there seems to be little cohesion between these organisations. Some Deaneries, PCTs and GP practices have a good track record of involving and supporting sessional GPs; and appraisal and revalidation are proving a useful stimulus here – but again this is consistent across the UK.
- Some sessional GPs feel trapped financially, as their insurance costs could rise significantly if they worked more than two sessions a week. Therefore paying subscriptions to organisations, paying for courses and missing sessions to attend CPD events seemed out of reach, or unreasonable to them.
- Sessional GPs face practical challenges, including funding for meetings, catering, venues and speakers; the need for a proactive individual or individuals to take a lead and commit time to organising meetings; childcare and work commitments; the sometimes ‘underground’ nature of SDLGs (meaning the existence of individual SDLGs may not be widely known); and the lack of opportunity to network with sessional GPs to find or start groups.
- Benefits reported in the research by both sessional GPs and organisations working with them, included reduced professional isolation, improving learning and idea sharing and CPD, enhanced confidence, better opportunities for networking and personal support (in relation to employment as well as clinical issues) and improved assistance with appraisal and ultimately revalidation.
Overall the findings suggest that, despite progress in a number of areas in recent years, several issues still exist, such as:
- a lack of national cohesion from support organisations
- problems in identifying sessional GPs in any one area
- fewer/no records of local SDLGs or an easy way for sessional GPs to find groups
- non consistent funding and arrangements for ‘hub’ meetings for sessional GPs around the UK.
Potential solutions
There are a range of measures that could enhance support for sessional GPs, including:
There is a genuine need among a neglected group within the medical workforce
- taking simple, practical measures, eg, providing a box for sessional GPs to tick when registering on a performers list, to opt into receiving CPD information from deaneries and other relevant organisations, rather than allowing data protection to block access to useful information.
- each stakeholder organisation designating a lead Council member or equivalent to take on a watching brief and consider, when the organisation is introducing new policies and procedures, what the impact is likely to be for sessional GPs. This is likely to be particularly important for the new GP consortia.
- supporting doctors with skills training and guidance on the management of groups, such as running meetings, dealing with conflict and setting up a group.
- creating national resources to assist with record-keeping for appraisal and revalidation, such as templates for recording minutes of meetings, reflective learning, etc.
- establishing and maintaining regional registers of SDLGs, populated by local groups, working in partnership with the deanery and/or GP consortia. This could be facilitated by a national website with a login area for visitors to submit group details.
- continuing initiatives to periodically ‘pump prime’ the development and revitalisation of SDLGs in each region – for instance through an initial set of ‘hub’ and ‘spoke’ meetings; arranging an online ‘meeting place’ for sessional GPs; and through a resource bank and/or training for current and potential SDLG leaders/facilitators.
The bigger picture
This study suggests that there is a genuine need among a neglected group within the medical workforce. As sessional GPs are an important group within primary care, the RMBF hopes that these findings will encourage discussion about the needs of sessional GPs and encourage national policies and professional structures which will support sessional GPs in their careers.
The findings also suggest that SDLGs have value, are easy to establish and maintain, and provide a sustainable model on which to build career development. With wider professional support for SDLGs more sessional GPs could take advantage of these benefits, which would be better for patients, and the profession, as well as the sessional GPs themselves.
The RMBF would like to thank the Sessional GP Advisory Panel and all the colleagues who contributed to this project.