Exclusive - GP training failing to prepare locums

GPs' careers could be wrecked and their patients put at risk because their training fails to fully prepare them to work as locums, a report warns.

Richard Fieldhouse

The report by the National Association for Sessional GPs (NASGP) comes as the GPC announces plans to consult in the New Year on making local, regional and national GP committees more representative of sessional GPs.

NASGP chief executive Dr Richard Fieldhouse said that GPs start their careers with no experience outside 'gold standard' training practices and are often ill-equipped to work with different IT systems in practices with variable standards and ways of working.

The report, GP Locum Core Competences, says locums now account for about 25 per cent of all GPs working in the UK. It calls on the RCGP and BMA to ensure all GPs qualify with an understanding of the realities of 'non-practice-based working'.

'GPs need specific training to develop the special clinical skills required to work as a locum: creating instant rapport, rapid history-taking, quick management planning and bearing risk and uncertainty; ensuring safe hand-over,' the report says.

But it warns that GP trainers are unlikely to have any recent locum experience, and says the RCGP curriculum 'does not mention locums'. It adds that 'governance systems are geared to practice-based GPs'.

Dr Fieldhouse said that while GP training practices are well run and well regulated, locums often work in practices 'where no-one else wants to' or where GPs have been suspended.

'Locums can work in 35 different practices in a few months. If they are not skilled to work in different environments, they can have major problems,' he said.

The report calls for greater promotion of organisations to support locums, such as 'self-directed learning groups' and 'locum chambers'. It calls for sessional GPs to be included on primary care organisations' mailing lists to ensure they are not left unaware of relevant information.

GPC negotiator and sessional GP Dr Beth McCarron-Nash said proposals to extend GP training to five years may leave GPs feeling more prepared. But said she had heard 'no anecdotal reports of GPs not feeling qualified to work as a locum'.

The GPC consultation would gauge 'grassroots opinion' from GPs and help the GPC devise a 'gold standard' for LMCs on how to involve and represent sessionals, she said.

She did not rule out the possibility of a separate GPC negotiating team for sessional GPs, although she said a unified team would be 'stronger'.

Dr Fieldhouse welcomed the consultation and hoped it would boost support for sessionals.

Dr Gurav Gupta, a salaried GP from Faversham, Kent, said: 'I did not feel that I was adequately prepared by the training during my VTS to start life as a salaried, locum GP.

'The training scheme was geared towards academics and management only to a certain extent. I feel that newly qualified GPs just out of VTS should be more involved in training of registrars.'

What locums need
  • Information and training about the realities of non-practice-based working.
  • Negotiation courses to raise confidence and avoid exploitation.
  • Opportunities to acquire basic familiarity with clinical software systems, including locally used but otherwise uncommon systems.
  • Mentorship for isolated locums, who lack the support enjoyed by doctors embedded in a single practice team.
  • Specific training to develop the special clinical skills required to work as a locum: creating instant rapport, rapid history-taking, quick management planning and bearing risk and uncertainty; ensuring safe hand-over.
  • Support to facilitate the inclusion of locums in professional communities. Locums need to protect themselves from professional isolation.

Source: NASGP report, GP Locum Core Compentences


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