Locums - Appraisal and revalidation help

Revalidation need be no more of a challenge to locums than it is for other GPs, says Dr Linda Miller.

Dr Linda Miller: 'Locums have a unique perspective on practice systems and the pros and cons of the different ways they organise things' (Photograph: D Solomons)

Being a locum GP with a portfolio career is a positive choice for many. With planning, revalidation and annual appraisal need be no more of a challenge for locums than for other GPs.

The Revalidation Support Team pilot scheme in London that started last month and continues until December 2011 seeks to ensure the process is fair for locums (see box).

  • The aim of the Revalidation Support Team pilot in London is to ensure that proposals for an NHS publication, the Medical Appraisal Guide, will be fair to locums.
  • Revalidation will entail collecting evidence of good practice in all of the GMC domains and the pilot is testing use of a straightforward document to collate this evidence.
  • The pilot is running until 1 December 2011 and is an opportunity for locums in London to do a 'practice run' appraisal and offer feedback about the process. There is a financial incentive for locums and their appraisers to take part.

Contact sonali.roy@londondeanery.ac.uk or 020 7866 3202 for further details of the pilot scheme

Meanwhile, here are some pointers for revalidation and appraisal that locums anywhere in the UK can use.

Learning needs
Locums can record interesting cases and the learning they prompt in learning logs as easily as partners or salaried doctors.

Learning needs can be met in a variety of ways, including e-learning, postgraduate meetings, cased-based discussion with specialists or GPSIs, and reading up on patients' unmet needs and doctors' educational needs (PUNS and DENS).

With the move towards integrated care pathways, consultants are keen to participate in multidisciplinary learning.

Significant event audits
Significant event audits (SEAs) can be about positive events or those that could have been handled better.

Using 'structured reflective templates' can help to identify specific changes in practice that will improve care.

If only negative events or serious untoward incidents (SUIs) are included in appraisal documentation, the learning from positive events and minor negative events may be lost.

For example, sharing a positive SEA about prompt incidental detection of pre-eclampsia might remind all clinicians to check pregnant women's BP opportunistically, regardless of their presenting complaint.

Sharing SEA organisational learning with a practice is difficult for a peripatetic locum who is not invited to meetings. Sharing learning with a sessional GP group can be more valuable because peers understand locum-specific challenges, such as a receptionist biasing patients against 'the locum', poorly equipped consulting rooms, or the lack of a locum pack giving local referral pathways. Such matters can lead to complaints or negative significant events.

Leadership/quality of care
Locums have a unique, external perspective on practice systems and the pros and cons of different ways in which practices organise appointments, repeat prescribing, paperwork, referrals, protocols and so on.

The poor attitude of too many practices towards locums means that you need great tact and diplomacy to point out areas for improvement or of unsafe practice. But appraisal and revalidation can be a reason for locums to share good practice with GP principal colleagues.

With patient feedback surveys - patient enablement questionnaires, for example - locums should choose questionnaires that ask specifically about 'the doctor you saw today'.

The most meaningful locum audits are those triggered by a patient presentation or a challenge arising from an organisational matter.

Some sessional GP groups organise audits that are carried out jointly by locum members. The advantage is that locums can compare their work, for example, personal prescribing or referral habits, at a variety of locations.

This could be more meaningful than a locum doing a QOF audit at a practice where they only work occasionally.

Practices can assist locums' revalidation by inviting them to meetings, passing on compliments and positive significant events, and offering assistance with multisource feedback.

  • Dr Miller is a portfolio GP in London with an interest in medical education and continuing professional development

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