LMCs (local medical committees) are the statutory bodies that represent the interests of all GPs at a local level, and as membership organisations their strength lies in their ability to represent the entirety of the profession. Sessional GPs, including salaried and freelance and locum GPs, constitute an increasingly large segment of the workforce, yet sessionals are often under-represented on LMCs.
Given the funding and workforce crisis in general practice and the expanding role of LMCs in responding to local challenges associated with fully devolved commissioning and acting as the interface between practices and new models of care it is more important than ever that there is good communication and engagement between sessional GPs and LMCs.
For sessional GPs, by not engaging with their local LMC, they are missing out on a range of support and opportunities.
Sessional GPs also have a great deal to offer LMCs; they often have experience of working in many different practices and so can offer advice/opinion on issues that face many GPs across their area. They may work part time or hours different to practice hours, and/or because of a particular special interest may be best placed to attend meetings on behalf of the LMC.
This guidance provides practical solutions to address the barriers to engagement that sessional GPs and LMCs have reported to the BMA.
Get in touch with your LMC
If you have never heard from your LMC, it may well be that they simply do not have your contact details. Get in touch with them to make sure you receive any future communications.
Find your LMC’s contact details
It can sometimes be difficult for an LMC to obtain accurate details for the sessional GPs in their area.
To get in touch with sessional GPs LMCs could:
- Ask the area team, commissioning support unit or local service agency (or equivalent body in the devolved administrations) to pass contact details of GPs on the performers list to the LMC. PCOs may wish to include an option on their performers list registration forms, for both new applicants and when checking details of those already on the performers list, allowing GPs to give permission for the sharing of their contact details with the LMC.
- Alternatively, ask the area team or PCO to forward a mailshot about the LMC to GPs on the performers list in their area. LMCs could use this to publicise details of their open meetings more widely.
In Cambridgeshire, the LMC executive met with a panel of sessional GPs to explore means of improving communication to more isolated areas of the profession. They found that many routine messages were not reaching locum GPs.
This culminated in the creation of their ‘LMC locum link’, which is a specific email list that locums in the area can sign up to. Messages are now passed on via the LMC locum link, including ones from practices seeking locum cover and advertising job vacancies.
- Ask GP practices to tell their sessional GPs about the LMC and its work. It may also be worth approaching local Out of Hours organisations and prisons that employ GPs.
- Many areas have local sessional GP groups. The LMC could establish links with the group(s) in their area and could establish a directory of groups on the LMC website, which would help with networking. LMCs could also arrange to attend som group meetings.
A number LMCs have told us that linking up with an existing local sessional GP group was particularly effective. Many of these sessional GP groups have existing websites or social media resources, which can be a valuable means of communicating with constituents and disseminating relevant LMC information.
In Somerset, sessional GPs meet every six weeks for an evening meeting. The meetings are a supportive environment and a useful networking opportunity, providing a place for local sessional GPs to discuss items that they consider to be of value. They have regular attendance from LMC officials, which improves the level of engagement with the LMC.
- Approach any locum chambers or locum agencies in the area.
- Approach local VTS and offer to do a session for the VTS programme on the work of the LMC. This could be part of a general programme informing GP trainees, many of whom will be sessional GPs of the future, about contractual options and working post VTS. Local GP trainers can introduce GP trainees to their LMC and bring them to the LMC meeting as an observer. LMCs might also want to consider co-opting a GP trainee onto their committee, as an observer, to gain experience.
Highlighting the mutual benefits
Sessional GPs being involved in their LMC has a number of mutual benefits:
Benefits to sessional GPs of being part of the LMC
- Provision of up-to-date information and support on any changes that affect the way GPs work
- Help to mediate between employers and salaried GPs
- Support and advice on performers list issues
- Education and career development opportunities
- Networking opportunities
- Giving voice to the concerns of sessional GPs arising from their clinical practice and taking up issues directly with relevant organisations
- Providing a supportive and pastoral role if a GP has difficulties with their CCG or area team
- Providing the opportunity to undertake GP leadership roles.
What sessional GPs can offer LMCs
- For locum GPs, experience of working in many different practices, thus the ability to offer advice or opinion on issues that face many GPs across their area
- Sessional GPs may work part-time or hours that are different to practice hours, or have a special interest in a particular area, and therefore be best placed to attend meetings on behalf of the LMC
- Sessional GPs may be able to take on an office bearer’s role because of flexible working, whereas GP principals find it difficult because of practice or other commitments
- This may lead to sessional GPs undertaking local and national roles such as representing their LMC on GPC.
Encouraging sessional GP participation
Many LMCs have told us that sessional GPs in their area appear reluctant to get involved with the LMC.
Read on for helpful tips to encourage sessional GPs to engage with the LMC.
- If the membership of the LMC is not covered by working in a levy paying practice (for both salaried and locum GPs), then set the levy at an affordable and reasonable rate or consider removing it altogether.
Some LMCs, such as Londonwide, hold the view that working in a levy-paying practice effectively means that the sessional GP is an LMC member and should not be obliged to pay an additional levy.
At Hull and East Yorkshire LMC, the levy for sessional GPs has recently been removed. This move was intended to encourage greater involvement from sessional GPs. They have also argued that, as LMC funds are calculated by the number of patients covered, the levy is paid by practices and not the individual GP. They noted that this decision had freed up staff time previously spent chasing up the sessional GP levy fees.
- Publicise the services the LMC can offer to sessional GPs. For example, ensure you disseminate the LMC newsletter to as many sessional GPs as possible. Advertise, well in advance, the dates for the open meetings of the LMC and ensure that sessional GPs understand that all GPs can attend these meetings. Publicise elections as widely as possible and make clear that sessional GPs are entitled to stand and vote.
- Set up a visitor scheme to allow sessional GPs who might be interested in getting involved to attend an LMC meeting as an observer - this is a good way of creating a better understanding of how the LMC works. Alternatively, the LMC could hold an 'open day' meeting for sessional GPs, to introduce them to the LMC.
- Often a personal approach goes a long way - LMC officers could encourage sessional GPs they know to stand for election.
- LMCs can include sessional GP-specific items in newsletters and have a sessional GP area on the LMC website.
- Set up mentoring for sessional GPs who are new to the committee, or who might want to consider running for officer roles.
- GPs can be reluctant to stand for election against incumbents. LMCs should consider setting limits on the number of years that one individual can stand for an elected post.
Both the secretary and deputy chair of Derbyshire LMC are sessional GPs. Following their efforts to encourage sessional GPs to stand for representation, seven out of 27 LMC members are locums or salaried GPs.
As such, they have been able to move forward with a number of projects specific to sessional GPs, including the production of guidance and a locum handbook template for practices to complete and give to locums working in their practice.
In addition, they have independently attended local sessional GP groups to discuss the work of the LMC and encourage engagement. They suggested that their success has been due to their 'effort and enthusiasm to engage with this group'.
- Look at when the LMC holds its meetings. Sessional GPs can find it difficult to attend LMC meetings, especially when they are held during working hours, either because of difficulty in persuading their employers to give them leave to attend, or because of concerns about loss of income. LMCs could hold meetings outside of office hours to make it easier for sessional GPs to attend.
Representing both sessional and partner GPs
One reason that some sessional GPs may not be involved with their LMC is the (incorrect) perception that LMCs only represent GP partners, or that they are unconcerned with sessional GP issues.
To counter this perception, you could:
- Make sure that you have a protocol in place to make sure that whenever the LMC is representing two different LMC constituents (especially when the two constituents are an employer and employee) the cases are dealt with independently by two different LMC staff members. If this is not practical, LMCs can consider asking a neighbouring LMC to represent one party throughout the dispute.
- Consider reserving seats on the committee specifically for sessional GPs.
- Consider setting up a sessional GPs subcommittee.
Cambridgeshire LMC is able to reserve a certain number of seats at election time for sessional GP representatives - though these constraints are often not needed. This is intended to ensure that the voices of sessional GPs are heard at committee meetings and their concerns are adequately addressed.
- Adopt a checklist when considering key agenda items, so that you consider the impact on all different groups of GPs, eg. GMS contractors, PMS contractors, APMS contractors, salaried GPs, locum GPs, etc.
- Reserve space on the agenda for issues specific to sessional GPs to be considered by the committee. This option should be used with caution though, as there is a tendency for standing items to be addressed perfunctorily in meetings, especially if they are placed late in the agenda. Placing them higher up may encourage greater discussion and consideration.
Morgannwg LMC has chosen to establish a specific non-geographical constituency for five sessional GP members and has a standing item on sessional GP matters on the agenda for meetings. It has made use of social media to contact sessional GPs, with a dedicated twitter account (@swansessGPs) and a website.
What can sessional GPs do?
Better participation and representation for sessional GPs requires engagement from both sides.
The professional and personal advantages of engaging with LMCs are outlined earlier in this guidance. Without being a member, you will not be able to access any of the services that the LMC can provide on your behalf.
Sessional GPs should normally join the LMC in the area in which they work. Some GPs, especially freelance/locum GPs, work in more than one area and it may not be immediately obvious which LMC they should join. If you are in this position, you could join the LMC that you feel best represents where you work.
Download the guidance
Sessional GPs and LMCs - working together more effectively, updated May 2017.
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