What are terms?
When a locum GP starts work with a practice, both parties need to agree what the work will entail. Agreeing on terms with a practice is a way to keep patients safe, make the most of the session that the locum GP works, and make sure that the practice gets all the support it needs.
Terms don’t need to be complicated. They might be as simple as a document that defines:
- when the GP starts work (eg days and times),
- how many patient contacts the GP locum can manage during one session,
- whether the GP includes admin (or catch-up) time within the session or rate,
- what the GP locum would like to happen if the practice needs to cancel,
- how much the GP charges for a session,
- whether or not the locum will be claiming the NHS pension.
Even the simplest set of terms is an absolutely vital document for GP locums for their, and their patients’ safety. It’s easier to negotiate down from a term than to refuse work that you did not foresee.
Why set terms?
Terms are also vital for locum GPs as proof that they are working in a self-employed, rather than salaried, capacity. In a salaried role, the practice offers a GP their terms in a contract for a salaried role. Then the GP negotiates to change terms.
In a self-employed role, the GP offers a practice their terms for sessional work. Then the practice negotiates to change terms.
How do I set terms?
The NASGP would not advise any locum to book a session without terms, which is why we created a ‘terms generator’ in LocumDeck for members. By answering a few questions, locum GPs can produce their own terms and conditions in a matter of minutes.
What follows is a summary of the terms that we included in our ‘generator’, explaining their importance and helping you decide how to work safely as a GP locum.
Types of terms
We would recommend all GP locums to arrange in advance how much time they’d like to spend with each patient. Ten minutes is a clinical standard for face-to-face, but particularly at the start of a career, a GP might prefer to have 15 minutes. Phone consultations might not take as long, but again an NQGP might prefer to take more time than an experienced GP – say, ten minutes rather than five.
It is also completely acceptable for terms to state that the locum will work in the same way as all the other GPs in the practice – just remember to find out what that entails before you start.
Terms should also cover catch-up time, and admin time.
Admin time covers all the paperwork generated during the consultations – for example, you might want to define the maximum number of prescriptions you can write or review safely during one session.
The easiest terms of any freelance work are the hours of work. Most practice managers are perfectly happy to negotiate what time the GP locum starts work.
We recommend that you offer to turn up early to work, especially before your first session at a practice. Turning up 15 or 30 minutes before a session usually leaves enough time to get set up, but if you are hoping to do long-term locum work at a practice you could even offer to pop in the day or week before your first session.
Ask the practice manager what would be most convenient for them.
Arguably the most important terms for locum GPs cover the number of patient contacts per session. ‘Patient contacts’ might include face-to-face, phone or video consultations, but because of the different demands from these different types of patient contact you might want to cap the maximum number of contacts you can manage before the session begins.
In 2020, the NASGP published an update on key terms for GP locums working through the pandemic. This helped GPs define whether they wanted to work in-person or remotely, how to restrict appointment times to reduce the risk of infection, and how to adapt terms during shielding.
These continue to be available on our website, nasgp.org.uk. In 2021 and 2022 we recommend that you include clear terms about PPE requirements (eg fluid resistant mask, single-use gloves and apron) – whether you are happy to use practice-supplied PPE or prefer to bring your own. We also imagine that some locum GPs may wish to add terms around vaccination and immunity (for example, declaring that you have had both doses), and we will keep members updated on these additions as and when we publish them.
Cancellations are unavoidable sometimes, but they are always disruptive. We advise all our members to include a cancellation fee in their terms. We believe this can reduce the risk of cancellations, and it also compensates the GP for the inconvenience (like loss of income if they cannot find a new booking for the same time).
The NASGP’s terms generator includes a sliding scale model that helps GPs charge rising rates for cancellations as the session gets closer (within a month, a fortnight and a week).
Part of the appeal of locum work is that no two days are the same. To keep this sense of variety a pleasure, rather than a chore, we would recommend that before you start work at a new practice, you make it as clear as possible what you are willing to do during a session.
You should also use your terms to clarify which tasks you are willing to accept on the day, and which need to be arranged in advance.
Most GP locums are happy to undertake ‘extras’ like:
- Home visits
- Cremation forms
- Death certificates
- Private work
- On-call duties
Some GPs can cover this work within their fee for the session, and others will offer these ‘extras’ for an extra fee. GP locums may also wish to offer support for other GPs (e.g. scripts, documents, or admin) as an extra, if this is not already covered.
We recommend that GPs include terms that will improve the quality of their practice – for example, asking for feedback from patients or staff about their work during the session.
We also advise GP locums to make the requirements for appraisal and revalidation part of their terms. Although this might not seem like a major concern for NQGPs, adding this line to your terms will save time in the future.
Practices ought to pay locum GPs within 30 days, so we recommend you state this clearly in your terms. You can also use your terms to highlight your membership of the NHS Pension Scheme and protect your benefits. For example, the NASGP’s terms include the right for a GP to charge a fee for loss of NHS pension benefits following late payments by the practice.
This article first appeared as a chapter in MPS and NASGP’s ‘Becoming a GP locum’ by Dr Richard Fieldhouse, chair of NASGP.
Medical Protection is a trading name of The Medical Protection Society Limited. MPS is the world’s leading protection organisation for doctors, dentists and healthcare professionals. NASGP is the independent membership body for general practice locums in the UK, founded by locums for locums.
You can read and download ‘Becoming a GP locum’ in its entirety at nasgp.org.uk/resource/becoming-a-gp-locum-free-pdf-download