Working as a locum doctor offers greater flexibility and variety than being a practice partner but, in the MDU’s experience, there are aspects of locum work that mean you are at greater risk of medico-legal problems than permanent members of staff.
These factors include:
- You are in unfamiliar surroundings where it may not always clear how local procedures operate, such as IT systems and practice policies and procedures. You may not know who to ask if in doubt.
- It’s likely that your patients will not have met you before and this could make them more anxious. They may also be unhappy that their preferred GP is unavailable, making them less likely to tolerate misunderstandings and perceived errors.
- For the same reasons, you will not have built up a rapport with the patient or be familiar with their previous medical history, so clinical decision making may be more difficult.
- You may be unfamiliar with strategies used in the practice for managing a particularly challenging patient.
These types of difficulties can make you more vulnerable to a complaint. Not only that, but if you have moved on from the practice when the complaint is made, you may not find out about it until much later.
Some practices may try to resolve the patient’s concerns without informing the locum at all.
All doctors are expected by the GMC to regularly reflect on ‘your standards of practice and the care you provide, reviewing patient feedback where it is available’. (Good medical practice paragraph 22). So it’s important to be involved in responding to complaints about the care you’ve provided. Not only that, but it is obviously in the interests of all doctors to try to resolve complaints to the patient’s satisfaction.
A complainant who remains dissatisfied could escalate their concern to the Ombudsman, GMC or even make a claim.
Steps locums can take
So how can you mitigate the risk of a complaint as a locum doctor and what should you do to try to ensure you are informed of complaints? The following suggestions may help:
1. Be proactive
Ask the practice manager to send on feedback and let you know about complaints from the start so that you can contribute to the practice response. Ensure the practice knows how to contact you when you move on and avoid using unmonitored email addresses for your freelance work.
2. Don’t be thrown in at the deep end
Ensure the practice provides a suitable induction which should include running through key policies and procedures, computer systems, who to contact for help and the handover/referral of patients. You should always be set up as a separate user on practice computer systems so that any entries in patient records can be accurately identified.
3. Raise concerns if appropriate
If you believe facilities, systems or equipment at a practice pose a risk to patient safety, bring this to the attention of the practice manager or the practice principal. If nothing is done, contact your medical defence organisation for advice on how to take the matter further. Record your concerns and the steps you have taken.
4. Play an active role in a complaint investigation and response
If you are made aware of a complaint then ask to contribute to the response and to have access to the relevant records. If it is logistically possible, ask to attend any significant event meeting or at least ask to see the minutes if a meeting is held in your absence. You might also offer to attend a meeting with the patient to discuss their concerns further, if the practice believe this is warranted.
5. Learn from your experience
You may have moved from the scene of a complaint or another adverse incident, but you should still reflect on what happened. Provided you respect patient confidentiality, it can help to discuss the case anonymously with a trusted GP colleague, or with your colleagues in a locum GP group, if you belong to one. If any learning points arise, address these with relevant CPD such as reading or online tutorials. Document your reflections and actions in your appraisal folder.
6. Protect yourself
If you don’t find out about the complaint until later, make sure that you keep a record of when you were informed. Any further response to the patient should make clear when you were first made aware of their concerns. You should also consider getting advice from your medical defence organisation as it can be harder to resolve complaints at this stage.