A discussion about the pro’s and con’s of a Chambers model

A description of a current Chambers model from Richard Fieldhouse

Like GPnetworks, we are NOT an agency and all locum work is superannuable and taxed as self employed.

ALL our members have ALL of their work booked through the chambers (it’s basically like a locum co-operative) by our chambers managers. Our rates within individual chambers are the same – they’re fixed – separate “single undertakings” (i.e. conventional independent locums) can not covertly fix their prices between them, but because a chambers is a “single undertaking”, locums within it can as rates are expressed overtly and trading is done collectively through the single undertaking.

We have a flexible range of sessions that practices can choose and each session is a fixed price. Practices LOVE this – they can budget ahead, know exactly how many hours of cover they can afford, all billing/invoicing and pension forms is done centrally (and on the same day each month!) – they can see exactly what they are going to pay for and there are no surprises when the invoice arrives.

Members love the simplified & standardised sessions too, and our 5 chambers managers ensure that both practices and locums understand fully what each and every session entails.

We have a sophisticated IT system that handles all the complexities of every booking (availability, confirmation, billing, locum/practice preferences, IT system, superannuation forms etc). Our chambers managers pay all the cheques for the full amount for each session direct into our personal bank accounts.

The prices each chambers charges for the locum sessions are around the same or around 10% higher than other locums, but this rarely seems to put practices off (quite the opposite – year on year we’re turning more and more work away, and across all our chambers we need to recruit 50 members just to cope with demand!).

All members are interviewed, and all members must attend at least 50% of their local chambers meetings (attendance is actually around 70-80%). At these meetings, significant events are presented, feedback to practices is organised, decisions are made, bookings etc etc are discussed. Summer parties, skittles, events all organised. Central information system collating all useful local info.

Members are now also being involved in a new professional scheme within the chambers – partnerships. These partners, or group of partners, are developing a specific-, general- or non-clinical area of autonomy and expertise with the aim of benefiting the rest of the chambers community. We also find that because our members aren’t professionally isolated, they usually more attractive to practices looking for salaried GPs or conventional partners.

Our chambers managers pay all fees from practices direct to our bank accounts, they organise the meetings and Ocado delivery for pizzas etc, personally teach all new members how to use our IT system, organise feedback from practices for appraisal and handle ALL our paperwork, including organising our IT system log ins at every practice and our smart cards.

Members are charged an average of 10% + VAT of their locum earnings for all of this. Some – the leader of each chambers – 5%, and new recruits in an EXISTING area 15% for first 150 sessions, 10% all else. All this is fully tax deductable. Because of the slightly higher rates, efficiency and dedication of our 5 chambers managers to book as many if not all available sessions (chambers managers have direct access to every members delegated availability) through their fantastic working relationships with practices, these fees seem to be more than offset by higher net earnings. Thay can also offer much better continuity of bookings too for locums and practices, so even more better value.

Whatever pricing structure locums go for to pay for their service, my advice is to use one that practices are prepared to pay for that delivers very easy, fast, effecient, simple, standardised sessions using the least number of different quality-assured locums who all know each other and really enjoy what they do.

Richard

32 Replies to “A discussion about the pro’s and con’s of a Chambers model”

  1. I seem to manage fine with getting work/attendingNPLS’s/organising my business so tying myself into a model such as this isn’t particularly attractive to me at the moment but I can see that for some it’s a great idea.Time to engage in CPD is precious and needs to be flexible and I wouldn’t want to be boxed in to having to attend 70% of the chambers’ meetings.

  2. I have no problems in organising my practice, learning and billing which I can do much more effectively and without unwanted added costs and meetings. Good CPD is readily available without having to pay for Chambers ‘Managers’ to organise it. I would be suprised if Practices want added costs of belonging to a Chambers organisations in these cash limited times.

  3. Hi Alison, I think a lot of people do manage their self-employed locum business really well, despite having to have worked out how to do it the hard way. Quite a few of our members – including me – were the same, but the huge advantages for us all have been much greater than the sum of the parts.

    The ‘compulsory’ attendance at meetings is 50%, and we facilitate around 11 of these per chambers per year. We’ve never had to enforce this rule, and feel that our members realise that the more they put in the more they get out – which probably explains why attendance is much higher than the minimum.

    Half of these meetings aren’t actually classed as CPD, although they often turn out to be. These internal chambers meetings are more to discuss feedback to/from practices, issues relating to practices (good and bad), best practice, niggles, significant events, work issues, new prescribing/guidelines, PCT involvement – lots of business oriented info rather than actual learning.

    The other alternating half of these meetings are strictly CPD, where we invite guest speakers (and hopefully soon some of our memebrs in our partnership scheme who’ve taken on a leadership portfolio in clinical areas) or organise small SDLGs. Local non-members are invited to the speaker meetings, held at Pallant House Gallery in the restaurant with delicious food from Field + Fork – yom yom.

  4. Hi Mike, again that’s great that you manage your own service really well – it’s not easy! Actually practices seem to have no problem – indeed in Bristol where we’ve recently set up a chambers for some locums there, the practice managers are actively recruiting members for us simply because the standard of service they receive from us is so much better than they’re used to.

    A lot of our new members have been referred to us via their appraiser or GP trainer, so are quite new to locuming and have no idea about how to organise themselves so they particularly find it invaluable.

    A very recent phenomenon is the number of GP partners who’ve resigned from their practices to join us – 7 in the last year (and all bar one younger than me – i’m 44) – various reasons and one of those cited is that all the management aspects are done for them. And I guess too they’ve seen the locum service from the other side.

  5. I am really happy with the way gpnetworks currently works and would not like to change to a chambers at present

  6. The arguments are fairly balanced each way. Regarding fee structure, GP networks could just publish fees (what locum will accept and what practices will pay). As for the rest of it, it’s a service for the locums. It should be paid for by the locum. There is no extra sump of cash in most practices, quite the reverse in fact.…

  7. I found this article which is informative

    http://www.support4doctors.org/detail.php/17/might-chambers-be-a-way-forward-for-locum-gps?category_id=13

    Today we have 45 members, across ten chambers, working with 150+ practices. Weve booked over 16,000 GP sessions (surgeries) for our members and arranged 150 clinical meetings including 25 speaker meetings.

    Our chambers are in Chichester, Southampton, Worthing, Winchester, Guildford, Gloucester, Portsmouth, Kingston, Northampton and Bristol.

    The area that causes me concern is that if this model was so good why after 5.5 years have you achieved just 45 members accross 10 cities? I don’t know the date of this article but GP Networks has arranged far in excess of the 16000 sessions and I personally believe offers a far better model to its members. Its simply the attempt to monetise what GP Networks do, which is causing them to re examine their model. I personally believe a subscription based model for both practices and locum GP’s would be the best option all round. I also whole heartedly agree with the contributor who stated that in this cash strapped times value for money is top of the list. A chambers model only adds cost in my opinion.

  8. Thanks AB, all good questions. That article was written about a year ago – things are changing all the time and we’ve had quite a recent growth spurt – members are now I think about 60 with 5 new coming on board over the next few weeks – if you click on my name and click on “members” you’ll see the current list. Unfortunately one of our staff has been off for 6 months but is now back and firing on all guns, so full steam ahead again.

    I think the reason this discussion has been started is that because gpnetworks is such a fantastic service and has a lot of dedicated members, but unfortunately it is under threat because (and I don’t mean this in a pejorative way) its income stream is not sustainable and therefore it is looking at other models. I have offered my input here as the chambers is completely sustainable and no-one can withdraw its funding because it is paid for by its users. it will always go on and is not dependent on other income.

    Pallant too has looked at a subscription service (that’s how we started) but is not sustainable for the level of service that our locums and practices want – value for money is precisely why the chambers model is so successful and why other groups in the UK are adopting it.

  9. I think this discussion is most useful.

    Its clear that GPnetworks and Pallant offer two very different services and GP’s can use either or both.

    Someone in a previous discussion, likened our service to a dating service. Although the analogy is not perfect, I like this a lot. They said that they like the way we put people together and let them get on with it.

    This kind of sums up what we offer (albeit with a few useful features pegged on like A salaried jobs board, A Clinical Data Research tool, Private Calendar notes to you can align your private life schedule with your working life schedule and Appraisal support tools).

    Pallant are offering a far broader service that encompasses quality assurance and governance – at a price.

    Both have something to offer – and both have pro’s and con’s.

    In my many conversations with Practice Admin staff and Principles, I have come to realise that when GP’s and Practices use Agencies, they always seem to think that it is the other party that is funding the agency – when in fact it is both !

    One of the things that will help GPnetworks to secure the backing of its members is openness about who is paying for what and how much.

  10. Richard, please could you explain why a subscription based service was unsustainable for pallant and could be similar for gpnetworks. I realise it is difficult applying this to gpnetworks without seeing the actual accounts or knowing if everyone is prepared to pay (hence the discussion !). There are hundres of dating services !!

  11. The trouble with a subscription based service in our context is that for the practice, they don’t want to have to be making a payment on top of having to pay for the locum, whether or not they end up booking one – period.

    The funding stream BEGINS with the practice so you do not want to put up any barriers to them picking up the phone or sending an email when they need a locum. Practice managers are incredibly busy people under a lot of pressure to deliver value for money, so when they want locums they want to spend as little time booking them as possible (a chambers can book and confirm 5 locums instantly); when the locums turn up they want to know that they can trust them (a chambers interviews all members, all members know each other and learn and do professional development together – they have all met!); if there is a problem with a locum the practice must be able to contact someone immediately to sort out the problem (the chambers managers are skiled at this and turn disasters into success – they have intimate access to every members work diary and contact info); if there is a significant event the practice wants it managed (sig events are dealt with by each chambers and formally reported back to the practice); the pratice wants to know exactly how much they’re going to be charged (the chambers can standardise rates); when the bills arrive they want them in one go, preferably on the same day every month, not dribbling in over a 4 month period (we bill last day of the month, so practice managers can do all their invoicing in one go); all invoices are clearly printed and include clearly printed LocumA forms.

    And as for the members, by paying a tax-deductible % of their income when and only when all the cheques have been paid into their account seems to be the fairest easiest and most palatable way of doing it and keeps it very simple.

  12. The chambers model sounds very seductive but how much flexibility do you lose by joining? Obviously the rates are fixed but what about the availability. Can you choose when you work and manage your calendar like on GP networks or are you expected to commit to a certain number of fixed sessions a week and to include some OOH/advanced access?

  13. Thanks Richard for making it clearer. I have been discussing this with my husband who is an accountant and he agrees with Richard that practices should not pay, as it puts them off using the service, and as Richard states the funding begins with the practice. My husband compared it to tesco.co.uk or amazon.co.uk charging you to use their site. So, Joe, if only locums contribute to a subscription, what amounts are we talking about?

  14. Basically we provide an online diary, and each member sets up each session themselves – start time (8am, 9am, 10.30 am – whatever they want), finish time (2 hours lates, all day, on-call). Whatever days of the week they want to. I open my availability up from 8am to 12 Tuesday am, 2-6.30 pm; Weds = 9-1; Thursdays 9.30 to 13.30 (kids to school in am). Our IT system (Locum8) knows my postcode and all practices postcode, so length of journey, what each IT system each practice has, the IT systems I use, my preferred practices, practices i’ve blacklisted* (none) etc

    Members must put all their availability through the chambers (that’s the only way it can work – my colleagues then automatically benefit from being able to do the session if I can’t). Initially we let members book their own sessions but most very soon completely gave up on that as the advantages of having all the back up of the managers, but also lost out from non-standardised sessions so rather than turning thinking they’d be doing a 12 -patient session it turned into 15, with no one to sort the problem out.

    One or two have asked to book their own sessions but it goes against the ethos of working as a team, so we now gently insist.

    Chambers is very much a lifestyle choice, so there’s no tie-in and indeed have been [too!] successful at getting our members salaried posts and partnerships.

    Once a session has been booked though, that member has committed themselves to do it – same with any locum session. Cancelling a session is professional suicide. So if a member leaves, we ask for 3/12 notice and we can sort the rest. That said, issues do arise and because our chambers managers have instant access to everyones availability and current sessions, when we do need to swap (illness, funeral, volcanoes, kids dentist, job interview) we’re usually able to do so seamlessly.

    We don’t book OOH usually but do for some members – not that many members do or feel the need.

    So, extremely flexible and arguably far more so than if you try to do it yourself!

    *if a member is blacklisted by a practice, we have a very robust procedure that allows that member to investigate the problem and a chance to resolve it – 100% success rate, usually ending up with the member becoming their pet locum!

  15. Hi NJ – we are not looking at a model where only locums contribute, we are looking at a shared model where practices and locums contribute equally. We think £10 per month is a reasonable rate, and are thinking of offering 3 month, 6 month and 12 month contracts.

    Given what Richard at Pallant is saying, do people think we have a viable model to continue running our service ?

  16. £10 a month (which is tax deductible) is a very reasonable rate as far as I am concerned. I can’t think of many practices who would cut themselves of from your service for this sum either. You can always continue to market yourselves as free for the first six months to new practices / new locums to that they get used to your service and how it operates.

  17. Thanks AB – I think the issue of giving free accounts is tricky once we commit to a fair subscription model – but we could look at either a very short-term free account or a functionally impaired free account.

    Examples are:

    1 weeks free subscription
    Forever free account that only allows 2 logins per month

    Joe

  18. The way that we formulated our sustainable financial model for the chambers was from the opposite way. We drew up a list of what it was our members wanted, worked out how much this would cost to deliver, and then presented the members with the cost for the service i.e. you want ABCDEFG and that’s going to cost £X.

    My feeling is that if you start by asking members what it is they want to pay you’ll end up with a figure of £Y which is always going to be a lot less than you could comfortably run a sustainable service for – you may end up only being able to offer A, maybe B.

    I guess the question here is what are the aims and objectives of those who are running gpnetworks – what sort of business/service do you really want to deliver to locums and practices, and feel confident in delivering. Then work out how much that will cost to deliver. It’s great canvassing opinion and is an essential part of developing something like this, but as a good friend and business colleague of mine says, a racehorse designed by committee is called a camel ;o)

  19. I would be happy to pay £10 per month and would consider more
    if necessary to keep gpnetworks up and running.

  20. NJ – if gpnetworks were to cease trading, how much do you think your income will be affected? Would it be one, maybe 2 less sessions a month? Would you need to spend more or less time per month managing your bookings, advertising, marketing yourself etc

  21. Richard – I think all of my bookings are done via gpnetworks. A few practices request me directly thro them using gpnetworks system, and I am almost certain that all of the others (except one) check my availability on gpnetworks and then contact me by email. I would have to spend a lot of time doing all that you suggest above. This is what it was like when I last locum’d 10 yrs ago. It is so much better now with gpnetworks. I am not sure re the commitment to chambers, I like being independant though the cons involve mainly revalidation and it must be great to have someone to do all those pension forms!

  22. i do not feel the chambers model(needing regular commitment) or a fixed fee version of gp networks would work for members who may already have a regular part time position or longer term locum and are only looking for `top up’ infrequent sessions. this is a shame as it has been a great service.

  23. Anon – the great thing about a chambers model is that it can be completely flexible. What ever way it’s done, it has to accommodate the completely varied way in which SessionalGPs work.

    In our chambers model we have members who have a regular fixed [salaried] commitment outside the chambers, so only average one, sometimes 2, top-up sessions per week.

    For long-term locums* the fee paid by the practice is 5% less, and the member’s management fee is also 5% less.

    *obviously, ‘long-term locum’ can be an oxymoron, and be aware that both the inland revenue and superannuation people may deem you to be technically employed.

  24. Hi NJ “I would have to spend a lot of time doing all that you suggest above.”

    Which is why I therefore agree with you that whatever happens, gpnetworks must continue to provide atleast the level of service it has been doing. From what you’ve said, it sounds to me the level of service you’ve enjoyed from gpnetworks is worth far more than you’ve been paying. If gpnetworks were to cease trading (heaven forbid) I suggest your income would drop by a significant amount – at least several thousand pounds a year, probably a lot more? You’d probably be a lot more stressed and have to spend more time thinking about the mundane issues of finding work etc etc rather than earning money doing [clinical] locum work.

    The reason you can only pension 90% of your work through NHS Superannuation is that its widely considered that 10% of a locum’s working time is spent on admin & professional development. Which is precisely why in our chambers we charge 10% management fee, as we take on that 10%

    The way our particular chambers has come to a very robust level of funding from our members, is to see how much extra income our services brings to our members, then charge them a management fee that reflects that extra value – it’s an extremely simple formula, but it’s incredibly robust and it means the services that a chambers can provide for its members are guaranteed to continue at at least the current level, but probably even higher as chambers can continue to develop more and better services (see our newsletter/blog for some examples).

  25. Richard, do practices get to choose a preferred locum or do the Chambers Admin staff put in who they think best suits/most needs the work?

  26. Hi Anon, we go very much with who the practice asks for – if they ask for a specific GP, we book that GP for them. Sometimes they’ll say “Please can we have Dr A, or if not Drs B, C or D, or if not any of your other GPs”.

    Sometimes we’ll go even further to offer greater continuity and swap members around (always done with the agreement of all parties, and the reply is pretty much always a ‘yes’ as everyone benefits from a system whereby practices and members can get better continuity.

    Even if a practice doesn’t specifiy who they’d prefer, Locum8 still ranks a member higher in preference if they’ve worked at that practice before, or more recently, or is familiar with that practices IT system.

    Ultimately the chambers manager decide with the practice manager who is booked where, not Locum8 (our IT system) – Locum8 is there to speed things up, place entries in members calendars and make sure they’re paid!

    In addition, when a member has added dates to their diary our chambers managers will let a practice know so that that practice can then book them.

    When a new member starts with us, we simply adopt all their existing bookings for them with their existing practices, and if it’s a practice that’s new to our chambers, that new member is automatically made first choice by Locum8 and that member pays no management fee for any sessions from that practice for one year.

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