Several years ago the National Association of Sessional GPs (NASGP) came up with the great idea of developing ‘sessional GP support teams'.
Freelance GPs could form a local team administered by a local business manager and guided by a clinical director. Rather than a local population of GP practices being serviced by a group of disparate locums, they could use the services of a co-ordinated team of highly motivated, organised and up-to-date doctors.
The NASGP did not have the money to fund such an initiative, so I approached my PCT. Although it was keen to set up a support team, there was so much red tape involved that nothing came of this.
Meanwhile the first ingredients for setting up a ‘private' support team here in West Sussex and South East Hampshire had appeared. Two good GP friends, who shared the same vision as me, had moved to the area and established an excellent reputation with local practices.
We wanted a way whereby we could pay someone to manage all our bookings, accounting, superannuation, banking and so forth.
The most obvious environment for this was a locums' chambers along the lines of barristers' chambers.
We began by setting down the minimum criteria and standards for being a chambers member. All our members - there are now 16 of us - agree to abide by a set of terms and conditions.
We also give the practices booking our members guidelines on the minimum working conditions they must provide, although these are not always strictly followed.
I share the clinical director role with two other chambers members. As well as regular in-house meetings, we organise meetings with speakers to which other local sessional GPs are invited.
At our in-house meetings we talk about clinical cases, other matters affecting our work, and any positive or negative feedback.
Over the past year we developed a series of feedback pathways between members, local practices and the chambers, including patient questionnaires and significant event audits. This demonstrates the quality of our service to prospective new practices and generates evidence for our appraisal folders.
A full-time business manager working from her home runs the chambers together with all the non-clinical aspects of our work. The bookings are managed using online calendars, with sessions entered into each member's diary.
As we can guarantee a high level of professionalism, all locum bookings are placed via our business manager.
Practice managers are normally happy to take any member offered. If a practice inadvertently faces a week of several different locums, we can often reorganise sessions so that they have the same member with them all week.
Locum pay is negotiable but offering a standardised service is vital to our profile as chambers. Because we account for a relatively small percentage of local freelance GPs, all operating to a specified minimum level of quality and trading through one point of contact, all members work for the same rates of pay. These rates are only given to the practices using our services. Clandestinely fixing our prices with freelance GPs outside the chambers or with other similar groups of locums would quite likely be outside the law, so we have a strict policy not to mention rates to locums outside the group.
Where are we now, three years down the line? It has been a tremendous amount of work getting the chambers to this stage. The three directors have also taken on a large financial risk by investing approximately £100,000 into the business.
I find life as a freelance GP is a lot more fulfilling within the chambers environment.
Because the chambers stands and falls by its professional reputation, we all work hard at making a good impression. We are now talking to other freelance GPs in several areas of the UK with a view to rolling out our chambers model for small groups of locums.
Get in touch if you are interested in starting a chambers in your area.
- Dr Fieldhouse is a sessional GP in West Sussex and clinical director of Pallant Medical Chambers. Contact him at
Setting up a freelance GP chambers
- Contact an existing chambers to see if it can organise the infrastructure for you locally or offer you advice on setting up the chambers yourself.
- If starting from scratch, setting up a chambers is not dissimilar to setting up a GP practice.
- Be prepared to put in a great many hours to ensure that it is up and running.
- Seek advice from a solicitor and accountant.
- Have robust procedures for selecting members to join the chambers with you - starting off with friends may be the best way.
- Your business manager's relationship with local practice managers is key to the chambers' success.
- Local business enterprise centres can give invaluable advice.