Dear NELG Member,
Most GP locums work entirely freelance and manage themselves as a "sole trader" negotiating and agreeing their terms of work and fees with each practice.
There is however an increasingly popular way of engaging in locum work which allows locums to work, as part of a GP partnership with access to NHS pension scheme, still self employed, but benefitting from some of the benefits of being part of something more structured. Importantly these "chambers" appear to be able to set fees for the groups of locums working within. They also provide a clinical governance framework which may facilitate matters when it comes to revalidation.
The first such "chambers" model was set up by Dr Richard Fieldhouse, Gp, and current chief executive of the NASGP.
His Pallant Medical Chambers have grown and now are involved in helping to set up local chambers in a number of areas. He has produced an FAQ document which I have copied into this newsletter.
It may be possible to get Richard to come up to the north east and share his experience in the near future. In the meantime if you have any questions about this model these should be directed to him via email.
http://www.pallantmedical.co.uk/intro.htm
I should stress that I am NOT proposing that NELG becomes a "chambers"- we are too big and our purpose is to provide mutual support etc as outlined in the membership and home pages (and our constitution soon to be approved).
Paula Wright
NELG chair
Pallant Medical Chambers uses a very well tested and implemented session schedule, but we leave it to our individual chambers to decide the rates for each particular type of session – although we’re here to help you decide using our experience!
This becomes the responsibility of the new chambers, under the direction of the Chambers Lead. Potential members apply via the Pallant Medical website, and we ensure that all their details have been collected and we advise you whether we believe there is enough work coming into the chambers to sustain a new member. We’ll then work with you to arrange a time for you to interview new applicants. Once you’ve decided that you want them to proceed with the application, we’ll organise their references etc for you and we’ll take it from there.
This is a member of your local chambers who acts as your chambers clinical governance lead. Their role includes interviewing new applicants, chairing monthly meetings and managing complaints. They receive a reduction in their chamber’s fees which equates for an honorarium for this work. If you’re interested in being, or even sharing, the Chambers Lead then let us know.
You can benefit from working as part of a growing network of chambers, whilst benefiting from our experience and expertise, using the systems we have developed from without having to invest the significant amount of time, energy and money that is needed to set up a successful chambers (we estimate we have invested £70,000 so far in development alone (not including on going management) we continue to invest in improving our offer to members and practices.
We’re keen to expand our network across the UK. Working in a locum team like Pallant Medical Chambers is a fantastic way to work as a GP, and a key lesson we’ve learnt over our 5 years is that it requires an enormous amount of work and effort to achieve our very high standards. As well as the obvious benefit of hoping to pay ourselves back for our investment (which we hope to do in 2011!), we firmly believe that within the next few years – mainly due to revalidation – chambers like ours will be the accepted way of working as a locum and we believe our model offers the most comprehensive solution to the dilemma of independent peripatetic locum GPs working within a managed environment.
Yes – you’ll still be able to contribute to the NHS superannuation scheme and you are liable for your own tax. The Chambers Managers facilitate all your bookings and bill the practices on your behalf; the practice writes the payment out in your name and either pays the full amount direct to you your bank account or we’ll deposit the payment for you in to your bank account
Pallant Medical Chambers is on the MPS’s Practice Scheme so, if you’re with the MPS, you’ll pay less as you will be charged the previous year’s rates (i.e. increases in rates are delayed for year).
Firstly each chambers decides its own rates as we have learned that it is much better for individual chambers to choose rates that are appropriate for the area that they work in. However, as the members within each separate chambers operate as a single trading entity, we are free to set rates within each chambers.
Ideally 3 or more, but we would consider just one (we’ve started several chambers with members who’ve moved to a new area from an existing chambers). Starting as a small group, you’ll be able to start chambers meetings and educational meetings, whereas a single member could take a while to help recruit more members.
Initially we would work closely with you helping you set up the chambers, visiting as necessary. However we fully recognise the need for local expertise. Once we have a good number of members (about 40 or so) in a geographical area we plan to recruit a local Chambers Manager. In addition, once we have a group of around 6 chambers in a region we will work with you to aim to identify a local Chamber’s Lead who could become a Clinical Director for that area.
Although possible, this is only going to be realistic if you’re an organisation like a PCT due to the massive set up cost involved. In order to implement independent chambers comparable to Pallant Medical Chambers, it may be feasible to offer a management consultancy service plus the selling of systems. In addition the local group would have to pay for an ongoing manager that would prove very expensive for the first 20 members. We suggest that the costs would be prohibitive for a small group. Because of this we have focussed in helping chambers set up as part of Pallant capitalising on the investment that we have already made.
Once there is a small core group (say of around 3 individuals) who want to commit to working as a Pallant Medical Chambers, Richard Fieldhouse or one of our other clinical directors and Ali Lewis (one of our Chambers Managers) will work with you to find a day to come to your area and go through all that’s needed to set the group up. Prior to this we’ll collate some basic information about the core members and put together some practice ‘marketing packs’ to introduce your current practices to the Pallant way of doing things. We’ll get you to place your existing bookings etc onto our IT system and – for no fee - we’ll take over all your billing/banking of your existing bookings etc.
• The fee will more than pay for itself in terms of freeing up more time to work locum sessions, increased volume of work, more booked
• You are getting the benefit of our experience and systems as part of this fee
• The initial ‘core’ group of members pay 5% for the first 6 months.
• Additional new members then pay 15% for their first 150 sessions (or 5% less for a year for work booked at a practice that they’ve introduced to their chambers).
• sessions and potentially higher rates.
• Long term regular cover / Maternity leave cover is charged at 5% reduction. The 10% fee is tax deductible.
• Chamber’s Leads pay 5%
If you have any other questions then please don’t hesitate to ask!