Two years ago I took the plunge, resigned as a principal of 11 years and became a locum, although I continued as an appraiser and trainer.
At the time, an appraisee told me about the National Association of Sessional GPs (NASGP), so I joined.
Over my six years as an appraiser, circumstances have led to me appraising more than an average number of locums and sessional doctors. Since joining the NASGP I have become much more aware of the potential problems that itinerant doctors could face in revalidation.
I have been fortunate in that, although I call myself a locum, I have settled into working fairly regular hours in just two practices, such that most staff assume that I am salaried.
I have followed with interest the work of the NASGP in negotiating revalidation for locums and sessional doctors. When our local GP tutor emailed about taking part in a pilot 360-degree appraisal, I jumped at the possibility.
Multi-source or 360-degree feedback is feedback from a variety of sources on the GP's performance. In the pilot, this was organised for me: elec-tronically for colleagues and on paper for patients.
For colleagues I had to supply email addresses, 15 in total to include doctors, nurses, administrators and, because I am a trainer, students. The questions are subject to copyright but include areas such as time management, diagnostic skills and helpfulness.
I was sent paper questionnaires to distribute to at least 20, if possible consecutive, patients. The patient questions were about listening skills, respecting the patient's point of view, and shared decision making.
I decided to try this pilot to see how feasible it would be for a GP locum to do. There were frustrations initially as I could not get the system to accept NHS email addresses but that was sorted centrally, I presume they loaded them manually.
I found that in one practice I work in, arranging the patient feedback was easy.
I suspect that it would have been much more difficult in the other larger practice with a more deprived and ethnically diverse population.
The fact that the feedback went to my appraiser was difficult because she did not know that I was doing this and at the time it was still five months until my appraisal.
As to the results, I admit that I had flicked through the patient surveys before sending them off. This could have led to me extracting poor ones, but as there were not any poor responses I did not worry.
Only one score disappointed me slightly. Some of my patients perceive that I do not ask their permission to examine them adequately. I need to think about how to address this.
As I looked through the colleague results they were all very positive and I was happy and unsurprised. There were some very special comments.
The surprise came when I looked at my results compared with others in my speciality and the national average. I fell below the national average, particularly on the clinical side and with keeping up to date.
As a locum and part-time GP I do well over 50 credits of education a year. I do not see how I could improve upon this.
In conclusion, I felt quite positive about the process. The only change that I will try to make is to ask patients permission to examine in a more definite way. I have already started doing this.
As to whether this process is suitable for locums, for those locums like me who work in a limited number of practices on a regular basis and have strong relationships with those practices then the answer is definitely yes.
For locums who work in lots of different practices on a short-term basis, then it would be more difficult.
However, due to the nature of the patient survey it would by no means be impossible.
- Dr Wilson is a locum GP, and a GP appraiser and trainer in Bedford