GP-led commissioning is a real opportunity to cut inefficiency within the NHS.
But while GP principals have the opportunity to get involved in clinical commissioning groups' (CCGs') work, sessional GPs - both salaried and locums - are finding this difficult.
Bearing in mind that many GPs are not partners - in London, for example, between a third and a half are sessional - this is excluding a lot of clinicians. Over time, as more new GPs qualify and if partnership opportunities become scarcer than now, this exclusion problem will worsen.
Reports of non-principals being excluded from the new CCGs have emerged. One salaried GP who applied to his PCT asking to be involved was turned down. In other areas, sessional GPs' applications to join CCG boards have been denied.
Dozens of locum groups all over England have been getting nowhere with their local CCGs.
Reap the advantages
CCGs would reap many advantages from involving salaried and locum GPs:
- They are often at an early stage in their career so tend to be fresh, hardworking and motivated.
- They are more used to adjusting to unfamiliar IT systems (including while working in out-of-hours and urgent care settings).
- They have good a network of colleagues from their training days. Having recently come out of hospital settings, they are more familiar with the primary/secondary care interface than many senior GPs.
- Younger GPs will actually work within the new system and will not be retiring within the next few years.
- Consultancy firms recruited to support CCGs complain about the very limited time they are allowed to spend with GP principals gaining their clinical perspective. Sessional GPs work more flexibly and can give a greater time commitment.
- Experienced locums working across different areas have a broad knowledge of different referral pathways and care systems.
- They may also generate fewer conflicts of interest.
Considering this last advantage: although in theory being involved in commissioning should not directly affect practice income, there is a chance that it will. For example, a GP partner could propose a new care pathway for all patients in the community with condition X that is said to reduce their hospital admissions.
Naturally this new pathway would require new infrastructure and thus the GP's practice might expect the partner's expertise to be harnessed and funded both for setting up the new pathway and for providing patient care at an appropriate stage along the way.
Whether or not the pathway is then successful, the partner (and practice) may benefit from receiving the set-up funding.
Sessional GPs do not directly benefit from increased practice income (indeed some sessional GPs believe that GP principals are more interested in increasing their profits than in the future of the profession).
Therefore by involving them you are getting clinician input without the same potential for conflicts of interest.
Of course, recompense is important: it makes sense that clinicians giving up hours of clinical work for commissioning will expect some payment. Recompense is also necessary if we want good quality and time-consuming work to be produced. So why not make payments to reimburse this activity completely transparent?
If GPs were openly paid for their time to provide the clinician's perspective to CCG management staff who would actually implement new schemes, I believe that sessional GPs, if allowed to do this work, would have an incentive to speak out about commissioner/provider clashes. If they spot potentially damaging conflicts of interest being overlooked they could call attention to them. That way, involving sessional GPs would put a safety check in place.
- Dr Arasu is a GP in London