Locums - The challenges of being a GP locum

Locums need a range of skills to practise effectively, by Dr Richard Fieldhouse and Dr Judith Harvey.

Working as a locum requires the skill to manage a one-off consultation and ensure a safe hand-over of patient information
Working as a locum requires the skill to manage a one-off consultation and ensure a safe hand-over of patient information

Locum doctors are the profession's spare tyre: there when they are needed, ignored when they are not.

Many GPs start their careers as locums, to gain experience or from necessity. Locum work is part of portfolio GPs' working lives and is a common pre-retirement step. For some GPs it is a long-term career choice.

Being a locum is very different from being based in one practice. Partners rarely step outside their own consulting room, but locums may work in a different practice every day of the month. Every practice has its own way of doing things.

Clinical software, referral pathways, secondary care facilities, the primary care organisation: all may change from morning to afternoon.

Working as a locum is not everyone's cup of tea. Locums forgo the classic source of GPs' professional satisfaction: continuity of care. They do not have the cushion of belonging to a practice team. They need to be independent, self-confident and flexible. They have to be well organised and must have sound business sense.

Living with risk
They must be able to live with risk. Locum work is not for those who suffer sleepless nights about the day's consultations or worry about periods of unemployment.

Successful locums enjoy the variety, the ability to control their own working life, the opportunity to combine general practice with other interests.

They relish the challenge of practising under difficult circumstances and of successfully managing a single consultation with a patient they have never seen before and may never see again.

Locums have to develop the ability to size up a practice, to slot into its team, and to protect themselves from risks in practices with poor standards and systems.

They need the confidence to insist on adequate time to work safely and to refuse to do something they consider professionally risky.

They have to assess patients rapidly, all too often with inadequate records, to devise an effective management plan, to write notes knowing that the patient will see a different doctor next time. Locums have to ensure that concerns they may have are safely handed over.

GP training does little to prepare registrars for locum work. Although 25 per cent of GPs will work as locums at some stage in their career, the RCGP curriculum does not mention the word 'locum'.

Many registrars will go straight from training to locum work. A couple of hours' discussion on the vocational training scheme won't help much when doctors move from a high-quality supportive practice to working alone in an environment that may be chaotic or downright dangerous.

Locums are vulnerable to complaints, and practices may fail to tell them when something goes wrong, regarding them as suitable scapegoats. Professional isolation is a major problem. Partners work with colleagues and are showered with professional information. Locums are often forgotten.

Enforced underperformance - being unable to practise to the best of one's ability due to limitations outside one's control - is a constant threat for locums.

Poor practice organisation, substandard medical records, broken equipment, or even just untidiness, all make it more difficult to do a decent job.

Revalidation
Revalidation presents locums with a new challenge. The profession's governance systems are geared to practice-based GPs. The evidence can be difficult for locums to obtain, and the norms against which it will be measured are those of GPs working in a very different environment. The special skills that locums require are not tested.

The shortage of partnerships has forced a lot of young GPs into locum work. In a buyer's market, exploitation is a fact of life. Work can be hard to find and remuneration poor.

Fortunately, support for locums is increasing. It is hard to believe that until the National Association of Sessional GPs (NASGP - formerly NANP) took up the cause in 1997, locums could not obtain their own BNF or join the NHS superannuation scheme.

NASGP continues to lobby, to support, to advise on good practice and to develop models, such as locum chambers and the affiliate freelance GP scheme, that maintains the independence of locum work but provides administration, education and governance backup.

Deaneries may offer educational programmes to support locums. The GPC has a sessional GPs subcommittee, and LMCs are starting to recognise their obligations to locums working in their area.

Most immediate for locums is their local self-directed learning group: a regular meeting place where freelance GPs can share education and information.

Every year, hundreds of GPs enter the locum market unprepared. They need training in managing an effective one-off consultation and in ensuring safe hand-over.

They need guidance on how to manage the business of being a locum, how to negotiate, how to ensure that neither unemployment nor overwork threaten their health and happiness.

They need the confidence to assert their rights and fulfil their duties. Like the spare tyre, they keep the wheels turning.

LOCUM SKILLS
Skills required by locum GPs include:
  • Flexibility
  • Self-confidence
  • Independence
  • Organisational skills
  • Business sense

Dr Fieldhouse is a locum GP in West Sussex and CEO of the NASGP. Dr Harvey is a freelance GP in north London and an NASGP member.

Resources

The NASGP

The NASGP is the only independent lobbying and information service for sessional GPs (locums, salaried and retainer GPs). For further information visit www.nasgp.org.uk

The NASGP does not necessarily support or endorse the opinions or information on this page.

 

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