25 March 2015
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Advice for locum, sessional & out of hours GPs

It is recognised that GPs working as locums or working in out of hours (OOH) or sessional work may face specific challenges in fulfilling their professional competence scheme (PCS) requirements. For example, it may not be as feasible for these doctors to attend CPD meetings in order to achieve external credits as they may have to cover the hours when the practice doctors are attending these meetings. Locum doctors report difficulty in trying to find internal credit activities they can participate in when they are not aligned to any one practice. Difficulties in completing an audit are also reported for the same reason.

It is important to note that while a doctor is on the Medical Council register they have an obligation to maintain a minimum level of competence, regardless of their working situation. With this in mind and while also recognising the challenges facing doctors working as locums, OOH or sessional doctors, there are options for fulfilling your professional competence requirements.

Included below are some of the common issues reported in relation to achieving the PCS requirements and then some proposed suggestions or alternatives.

External credits

Problem: I find it difficult to attend seminars/ meetings as my work means I am usually covering for other doctors while they attend these CME events.

Suggestion: eLearning modules that have an assessment element are equally as acceptable to record as attending events in person. eLearning modules offer a viable alternative as they can be accessed where and whenever suits the doctor. ICGP eLearning modules are free to all members and cover a wide range of topics.

Problem: I am not an ICGP member. Are there any other eLearning modules I can access?

Suggestion: You can record any eLearning module for external credits once you feel it is relevant to your scope of practice and once there is an assessment element and a certificate is issued to you upon completion. Other suitable eLearning modules are provided by BMJ and GP Buddy.

Internal credits

Problem: I cannot get into a CME Small Group.

Suggestion: You could try forming a journal club with other GP colleagues. Discussions on the articles read and how they apply to your practice can be recorded for internal credits. The likelihood is that there are other GPs who are in the same situation so if you do not know of any in your area, perhaps you could approach your locum agency to see if they have a way of putting you in touch with other locum GPs or you could post an ad in the Classifieds section of the ICGP website.

Problem: As I am not based in the practice, I don't get to participate in practice meetings or case discussions.

Suggestion: Discussions you have with a pharmacist, counsellor or other health professional about patient care can also be recorded for internal credits. When recording this, you should record who you had the discussion with and a brief summary of what was discussed.

Discussions do not need to take place in person; these can be held over the phone or you can plan to have regular case discussions with colleagues in different locations via Skype.

Other Suggestions:

  • Remember that any activity that involves you having to reflect on and evaluate your own practice can be recorded for internal credits. So if you identify any improvements that could be made and make a change to how you practice, once you document this, it can be recorded for internal credits.
  • Perhaps joining a relevant committee could be a something to consider. You can record one internal CPD credit per committee meeting, up to a maximum of six credits per PCS year.
  • If an appropriate situation arises, you could carry out a Significant Event Analysis. This exercise is also good practice. A sample document for recording a significant event analysis can be accessed here.

Audit

Problem: As I am not based in one practice, I am finding it difficult to carry out an audit. I cannot see how I can carry out my re-audit as I will no longer have access to the same patients I used for the initial measurement stage of my audit.

Suggestion: The audit is about you measuring what you are doing in relation to a particular aspect of your work, checking the guidelines to see what you should be doing and then putting changes in place so that you are more closely following the guidelines in the future . The re-audit then involves you checking to see if you have put these changes in places. It is not about measuring to see if there has been a change in outcomes for patients; it is about you changing what you are doing. Therefore, you are not required to see the same group of patients that you used for your initial measurement. For example, if you are doing an audit on asthma, one of the criteria is that all patients with moderate to severe asthma should receive an influenza vaccination every year. Your audit could include you checking to see if you are advising all patients with moderate to severe asthma about the influenza vaccination. The re-audit would then involve you checking to see if your rates of advising patients has increased not whether the initial group of patients have since gone on to receive the vaccination.

There is a sample audit on Antibiotic Prescribing available on the website which outlines how you can adapt your audit depending on your work circumstances.

Important to note

If you know that meeting the requirements is going to be a challenge, it is a good idea to come up with a plan at the start of the PCS year (i.e. in May) for how you are going to achieve your external and internal credits and your audit. Fulfilling the personal learning credits should not be an issue but it is no harm to plan for this as well. While the PCS deadline for recording has just passed in May and professional competence could be the last thing you want to think about, putting a plan in place early can help put you in a confident position facing into the new PCS year. This means that you can avoid facing panic and stress towards the end of the year or if you happen to be randomly selected by the Medical Council for an audit. This is all the more pertinent now as the 2015-16 PCS year is the final year of the 5-year cycle for the majority of enrolees who enrolled in the first year of the scheme i.e. 2011-12. This means that it is the final year in which you can make up for any shortfalls you may have incurred in earlier years.

Plan ahead

  • If you are thinking of forming a journal club or discussion group, agree on a regular day and time to meet each week or agree on a list of dates for meetings at the start of the year. It is always good to plan for more meetings than you think you will need. That is to say, don't plan for just enough meetings to get you the minimum amount of credits you require. Things will invariably crop up that can make it difficult for you to attend all of the meetings that you had planned on attending so plan on attending extra.
  • The ICGP run a Summer School at the end of June. If you attend all three days, you can record your participation for 18 external credits. This means that you have almost all of your external credits for the year achieved and you can then start thinking about meeting other requirements. It is also a great opportunity to meet up and network with other GPs as locum, sessional and OOH doctors can miss out on interaction with colleagues, especially if they are not able to join a CME Small Group.
  • Decide on your audit topic at the start of the year. The guideline from the Medical Council is that audit should take approximately 12 hours work over the year so it is something you should be starting in May. By doing this, you can plan for you re-audit in the current PCS year so you are not playing catch up in the following year.