Starting your career as a locum

Dr Lynda Carter explains what you need to do to prepare for taking on your first locum work bookings.

Dr Carter: 'Working as a freelance locum GP means you find your own work, and negotiate your own rates' (Photograph: UNP)
Dr Carter: 'Working as a freelance locum GP means you find your own work, and negotiate your own rates' (Photograph: UNP)

Before you start out as a locum GP, you need to think about which model of working will be best for you, and what paperwork and equipment you need to have before you are ready to take on bookings.

Then there is the matter of how best to prepare for the first session you do at practices that are new to you.

There are three models for working as a locum GP: being freelance, getting bookings via an agency or joining a locum chambers.

Freelance locum
Working as a freelance locum GP means you find your own work, and negotiate your own rates.

If working for NHS organisations, such as GP practices, you can base contributions into your NHS pension on the fees you earn (the primary care organisation whose performers list you are on pays the employer's share of your contributions).

Some people prefer to get work from locum agencies. You do not have to find your own work and the rate of pay will have already been decided. However, the disadvantage is that you cannot make NHS pension contributions based on agency earnings.

You can be self-employed, paying tax on your profits, or you can choose to channel your locum earnings through a limited company that you set up and of which you are a director.

Companies are subject to corporation tax on their profits (rather than being taxed under the self-employment rules) and can be more tax-efficient.

However, company directors have more administrative, legal and financial responsibilities and cannot pay into an NHS pension based on a salary.

If you are thinking about setting up a limited company, discuss it with your accountant and financial adviser first to see if it will suit your particular circumstances.

Locums' chambers
A chamber operates on the same principal as barristers' chambers. All members are self-employed and independent of each other while the chambers staff deals with all the administration.

The most well-known locum chambers is Pallant Medical Chambers set up by Dr Richard Fieldhouse (chief executive of the National Association of Sessional GPs) and colleagues in southern England.

Advantages of chambers include somebody else booking in work for you, you can still pay into your NHS pension and you already have a peer support structure in place for CPD and preparing for revalidation.

Disadvantages include paying a percentage of your earnings to the locum chambers and the possible loss of flexibility.

As well as deciding which model of working suits you, there is lots of paperwork to sort out, not to mention ensuring you have all the equipment you need.

You should collect together your Postgraduate Medical Education Training Board Certificate of Completed Training, GMC certificate showing you are on the GP register, your primary medical performers list confirmation letter, proof that you have medical indemnity cover, Criminal Records Bureau or Disclosure Scotland check result and your CV.

Even your serology is useful to have as some locums have been asked to confirm their hepatitis B status.

Preparation
When preparing your doctor's bag, think about what you need in a typical surgery session and for home visits.

Items to include are stethoscope, auroscope, opthalmoscope, BP machine with large cuff, thermometer, peak flow meter, tongue depressors, tape measure, latex gloves and lubricant jelly.

Some locums carry medications and if you do this, you need to have a system to check they are still in date (more complicated if you want to carry controlled drugs).

Some practices will be happy for you to use their drugs if you need something in particular for a home visit. If you are going to be doing home visits, discuss whether you should carry medications or not with the practice in advance.

A computer with internet access - important for generating invoices and NHS pension forms, keeping up to date and emailing in connection with bookings - is essential, as are a mobile phone and landline.

A reliable car to get you where you need to be is also essential. For home visits it is probably a good idea to invest in a satellite navigation system.

Your first few locum sessions may seem a bit daunting, but there are things you can do to help them run more smoothly - see box left.

  • Dr Carter is a sessional GP in West Yorkshire.
  • Book your place at our 'Maximise Your Potential As A Locum' conference on Wednesday 6 October in central London by visiting www.gplocumsevent.com
First time at a practice?
  • Design your own checklist for what you need to know at the start of each session to make sure it runs smoothly.
  • Arrive early to give yourself time to familiarise yourself with your room and to check that the computer is running.
  • Are you familiar with the computer system? If not, you may want to arrange a separate time or an earlier start so that a staff member can show you how to use it. Email in advance to check that the practice has set up a password for you.
  • Is there a locum pack? Some practices have a pack of information ready to give to locums which includes referral pathways, useful phone numbers and so on.
  • Check your room to ensure you have prescription forms, printer paper and fit notes.
  • Find out how you call in patients.
  • Check how to organise bloods, X-rays and ultrasounds and what the practice's protocol for referral letters is.
  • Do you know who to contact during the session if there are problems?

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