The concept of GP locum chambers was first pioneered by the National Association of Sessional GPs (NASGP) in 2002. Chambers are generally small locally-owned and run collectives of self-employed freelance GPs, working together as a team with mutual professional support and a shared group identity to support local practices.
Outside of a chambers, working as a regular freelance 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 to 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 make all the difference to a happy and fruitful career as a GP.
According to a 2016 NASGP poll, 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.
How do locum chambers work?
Locums within chambers remain self-employed and able to contribute to the NHS pension scheme. The practice pays the full session fee direct to the locum, who then pays the chambers a management fee. This fee is anywhere between 3% for NASGP’s LocumDeck chambers and up to 15% of the original session fee for some traditionally-run chambers, depending on its staffing costs and the level of support provided.
It is important to realise that chambers are not agencies. In contrast, agencies are seen as employers and locum work via agencies cannot be pensioned on the NHS scheme. The agency typically retains around 30% of the fee they charge practices, paying the locum around 70%.
Some newer practice-facing online platforms sidestep being defined as agencies, allowing the locum to remain as self-employed, and undercut traditional agencies by typically charging the practice 15% of the locum’s session fee.
Benefits of chambers
In areas where agencies and online platforms are dominant, a chamber could therefore financially benefit both practices and locums. Even if the locum charges a session fee that reflects their chambers' management fee, this is still likely to be cheaper for the practice than using an agency or a practice-facing online platform. Furthermore, the full fee is being fed back into the local health economy by paying the locum and investing into the chambers' running costs.
Locum GP chambers also offer a unique opportunity to retain GPs in the workforce. They are ideal if you are a recently-retired partner wanting to retain elements of teamwork and equally necessary for newly-qualified GPs, allowing them a support structure that was so important during their training years.
Chambers also allow GPs the potential to 'collectivise' and work under the protection of terms and conditions that are designed to protect safe working boundaries. This is key in an environment of rising complexity, workload, risk and litigation.
Ironically, as the need for GP cover rises, there has been a growth of commercial companies seeking to place GPs in practices, but often under terms that are not under the control of the GP locum. Chambers can be an antidote, offering a locally professionally-led umbrella for flexible GPs.
Joining a chambers
If being part of a locum chambers is something that appeals, a good option would be to join an existing one local to you – a quick Google search should find you your nearest. If there isn't a chambers in your area then 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
A branch of a chambers in a new area typically begins when a local locum contacts an existing chambers. This new branch, consisting as it does of local ‘pioneers’, will typically 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.
Initially, the pioneer locum GPs tend to pay little or no management fee to get things off the ground, since ultimately their initial work will lead to more members joining, 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, advice from an accountant and some legal advice on how to structure your fees to avoid falling foul of Competition and Markets Authority rules on price fixing.
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 migrate to using a system already in use. 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.
With the growing success of NASGP’s own LocumDeck - a comprehensive online tool we’ve developed to empower GP locums determine their own professional boundaries, rather than accepting those of a third party agency or platform - we’re now expanding LocumDeck’s capability to help local locums easily and cheaply manage their own chambers.
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 chairman of the National Association of Sessional GPs