Working as a GP locum can be a thoroughly isolating affair. You have to work out how to go about booking sessions, deal with issues related to working in struggling practices and manage last-minute session cancellations on your own. You also may not have colleagues readily available to offload about a vexatious complaint you’ve had or work through case reviews for your next appraisal.
So working as part of a locum team, with support on-tap for any issues relating locuming, and meeting regularly with colleagues who all share a similar professional identity can lead to a greater sense of belonging. This is where being part of a chambers can help.
Over 90% of members of GP chambers agree that the main reason they’re still a GP at all is because of the chambers. In fact, over half of members say they’re living where they live because of the support the chambers gives them.
In Pallant Medical Chambers, the iteration of the National Association of Sessional GPs’ (NASGP) original chambers model that myself and two GP locum friends set up in 2004, members refer to themselves as ‘Pallanteers’, with lasting friendships made.
What is a locum chambers?
So what is a locum chambers? It is perhaps more useful to look at what a chambers isn’t.
It’s easy to leap to the conclusion that a locum chambers is an employment agency. Unlike locum agencies, which tend to employ their locums under a PAYE contract, locums within chambers remain self-employed.
And, rather than pay the full amount for the session to the locum, agencies typically retain around 30% of the session fee and pay the locum around 70%. In chambers, the full session fee is paid direct to the locum, who then pays the chambers a management fee, which is anywhere between 5% and 15% of the original session fee.
Locum GP chambers offer a unique opportunity for practices to recruit and retain GPs in the workforce. They are ideal if you are a recently-retired partner wanting to reatin a sense of teamwork, and equally necessary for newly-qualified GPs, allowing them a support structure that was so important during their training years.
Without chambers, and in an environment with increasing complexity and ever-changing systems, working independently as a GP locum can soon lead to professional isolation that can have an adverse effect on the individual, and ultimately reduce their ability to contribute to the local healthcare economy.
Joining a chambers
At the moment, locum chambers cover two large areas in England. Pallant Medical Chambers has chambers from Bristol, through Wessex, Sussex, Surrey and Kent and into London, with a new one just getting of the ground in Birmingham. Meanwhile, Yorkshire Medical Chambers has chambers throughout Yorkshire, with one now in Cumbria and another in Manchester.
If being part of a locum chambers is something that appeals, your best option would be to join an existing one if you live in one of these areas. But if not, there are two choices: either to ask an existing chambers network to help set one up in your area, or set one up yourself.
Setting up a new chambers with support
New branches of chambers typically begin when a local locum contacts an existing chambers, with or without endorsement from a local CCG or federation (although having that endorsement does help).
Then, with the support of the existing chambers, that new chambers locum effectively begins marketing himself as a chambers locum and very soon other local locums get to hear about it, often from practice managers.
This very first group of local locum pioneers will receive a huge amount of support from the sponsoring chambers to become established and there tends to be a lot of excitement in getting it off the ground. After around three to four months, the work will have paid off and the chambers will now become a locally well-respected team and often the first port of call for work.
Counter to intuition, the locum GPs themselves tend to pay little or no management fee to get things of the ground since ultimately their pioneering work will lead onto more members, who then go on to pay the regular chambers management fee. Recently, CCGs and GP federations have taken a real interest in chambers as a means of recruiting and retaining GPs and are exploring ways of paying each chambers' locum management fee for them.
Doing it yourself
If there are no chambers in your area, the other option is to venture down the very exciting route of setting up your own chambers, although this is not for everyone.
If you’re in it for the really long game, and don’t mind growing very slowly, then all you need is a spreadsheet, some locum friends, and advice from an accountant.
Just like an existing chambers all it will cost is the chambers management fee that you and your friends charge yourselves and as this money grows, so will your options and possibilities.
You will soon see the need for developing your own IT system, or look into leasing one of the IT systems already developed for chambers locums. You will also eventually need to think about training and employing someone to help you manage the bookings, liaise with practices, help sort out complaints, handle queries etc.
Setting up a chambers from scratch will eat into your time like nothing else and is as likely to drain your energy as it is to energise you, so keep close, sensible counsel, find a mentor and set yourselves targets in advance that, if you haven’t met, you can gracefully withdraw with no harm done.
- Dr Fieldhouse is chief executive of the National Association of Sessional GPs and clinical director of Pallant Medical Chambers
Photo: JH Lancy