Being a GP locum was once seen as an unusual career choice or 'stop gap' between jobs, but it has now become the first preference for many GPs. It offers incredible flexibility, the chance to experience a range of working styles and clinical environments and provides the opportunity to determine your own working patterns and hours.
However, to get the most out of being a GP locum it is important that you set your personal terms and conditions of work so practices understand how you are prepared to work and you can judge whether a particular post is suitable for you.
There are two perspectives on terms and conditions, that will perhaps divide opinion among your colleagues.
The traditional view is that a GP locum should be willing to undertake any reasonable work that would usually fall under a regular GP’s scope of practice. So, for example, before locumming became so common, if a GP partner was attending a training day and required a doctor to cover their day's absence the locum would simply cover all of their normal duties. This would include all appointments, phone calls, test results, correspondences, home visits and prescriptions.
More recently, many locum GPs have migrated towards setting more fixed terms and conditions of work and only accepting work that corresponds to these.
Many GPs feel this benefits both the practice (because the practice then knows what to expect and understands what work it can delegate) and the individual doctor (it means you can work in a more structured way and have more control over the work you do).
What should be covered by terms and conditions?
Examples of term and conditions could include start and finish time, number of appointments, acting as duty doctor, or the number of home visits you will do in a particular time frame.
This is up to you now you are technically your 'own boss'. Setting reasonable terms and conditions is vital in helping you have a sustainable and safe practice as a locum.
Other things you will want to consider as part of your terms and conditions fall broadly under the following categories:
- Do you charge an hourly, session, or fixed half-day or full-day rate?
- What are your charges if your agreed session time over-runs?
- Do you charge an additional cost for home visits, or charge for mileage/travel/parking?
- Do you offer any form of reduced rate or 'deal' if you receive a bulk booking?
- What is your policy on payment terms? How quickly should practices pay you and what happens if they don't pay in this timeframe?
The work you will undertake
- Will you do telephone triage? Some doctors prefer not to do phone triage (and this also may not be included in their indemnity package), so you should include your position on this in your terms.
- Will you specify a limit on how many patients you see in a standard surgery, or home visits you will undertake? Or the length of time you expect each home visit to take?
- How long is a 'session' and how many appointments does this involve? Many locums will state that a session should include a 30-minute period at the end to allow for over-running, paperwork and other admin.
- Should you have a protected break or are you OK undertaking admin tasks over this time if you work on a fixed daily rate? Do you want catch-up slots to be planned in for your surgeries?
- Will you undertake repeat prescribing? If so, is this something you charge for as an extra service?
Other terms of work
- What is your policy on cancellations? How much notice does the practice need to give you if they want to cancel and how much notice will you provide, barring unforseen circumstances such as illness, if you are unable to do the work?
There has been a recent trend, especially in urban practices, for GP locums to decline to undertake home visits. We all know the pressures GPs face, and ultimately this puts additional pressure onto other doctors in the practice or patients end up being seen by out-of-hours services. A practice may be unlikely to employ a locum regularly who has inflexible or unrealistic terms and conditions, so you must bear this in mind.<
How much should you charge?
Setting your rate, this is a personal choice. The BMA has issued some guidelines and factors to consider, this includes:
- Your knowledge and experience
- Professional expenses, including medical indemnity, GMC fees, etc.
- Travel expenses (if you are not charging separately for these)
I would also recommend asking any locum colleagues working in similar areas to yourself about how much they charge.
It is also worth having an honest conversation with a friendly practice manager if you feel able to do this. They will usually share what they are paying other locums, whether it be freelance doctors or via an agency.
You may not feel it is necessary to work via an agency if you are negotiating directly with practices, but agencies can help supplement a portfolio career.
A good agency can introduce you to options and practices tailored to your preferences and secure excellent rates of pay. However, there are two important things to bear in mind about agencies.
Firstly, agencies tend to work on commission and can be surprisingly aggressive in securing work on your behalf, particularly for surgeries that require last-minute cover.
Secondly, if an agency introduces you to a particular GP surgery, the agency will normally have included in their own terms and conditions that you will exclusively work through the agency for that practice until you resign from the agency. For example, you could not work a shift as an agency GP and then directly arrange personal freelance work with the same practice.
Although it is uncommon, practices can occasionally pay late, not at all, or the incorrect amount. This will almost always be as a result of administrative error, so don't panic. I would recommend a polite email to the practice manager, and then if required, the senior partner. But because this can happen, it is a good idea to have your policy about late payment set out in your terms.
In summary, locum work is an enjoyable and flexible way of practising family medicine. To get the most out of it, remain flexible yourself and try and accommodate the particular needs of both your employing surgery and patients themselves.
- Dr Piggott is a freelance GP