When working as a locum GP, negotiating acceptable pay, terms and conditions is essential for job satisfaction, morale, self esteem and to prevent 'burn-out'.
Ideally, clinical governance visits, the QOF and the probity section of appraisal would include questions about how principals treat their sessional colleagues and whether they themselves would work for the terms and conditions they offer. Locums working as appraisers should encourage appraisees to reflect upon this.
Job applicants tend to state their current pay rate as a starting point for negotiation, though as a locum GP, you might agree to be more flexible on pay, where a practice is outstanding in its level of locum involvement.
However, bear in mind that locum pay does not include holiday, sick or maternity pay, nor funding for continuing professional development. Calculate your tax, National Insurance, pension, medical defence cover, GMC subscription, course fees and other costs before entering into negotiations.
Some practices offer a sessional or daily rate rather than an hourly rate. If this is the case, talk to the practice's other locums or salaried doctors to clarify the true length of sessions and calculate the hourly rate; you may find that you would be doing nine hours' work for five hours' pay.
Other practices may book a locum for two hours at an hourly rate but give them no time for administration, such as referral letters or seeing extra patients. They may be disgruntled when you submit an invoice for the full three or four hours you have worked.
If you find work through an agency, it will take a cut of pay, so your earnings may be less than you would receive via direct bookings; however, some agencies offer good rates. It is as important to negotiate with agencies as when booking direct and not unreasonable to say 'that's less than I normally charge, can you renegotiate with the surgery?'
Joining a sessional GP group prevents isolation and aids locums in ascertaining local rates and developing negotiating skills, as well as helping with preparation for appraisal and revalidation. Ask your GP tutor (via the PCT) for information on local groups. Also consider joining the NASGP and the BMA (request the Sessional GP Handbook) and asking a friend to practise negotiating with you.
Setting a bottom line
When negotiating with a practice, decide the minimum terms and conditions for which you would settle; it is then easier to say 'no', if the offer does not reach this. Consider the practice partners' pay and salaried rates, your experience may exceed theirs. You may also have experience of effective systems that could benefit the practice.
Settling for pay, terms and conditions below your 'bottom line' is demoralising and practices may adopt this as their standard rate in negotiations with other locums. Do not disclose your bottom line, ask what is on offer. You may find that the practice pays more than you were expecting.
The art of negotiation involves balancing your needs with those of the person with whom you are negotiating. Emphasising your unique selling points (USPs) (for example, intrauterine system fitting) makes it easier if you cannot meet a practice's request for another duty or skill such as extended hours.
If a maternity locum includes diabetes responsibility, but you lack expertise, seize the opportunity, sit in on a session, check protocols and liaise with the practice nurse. Do not simply refuse a job due to an unfamiliar computer system, show enthusiasm and request a training session.
Before taking a job, agree what your role will involve. You will need a clear contract stating duties, including appointment lengths, catch-up slots, administration time, time set aside to see extra patients and for doing repeat prescriptions.
Clarify that you will not be the 'duty doctor', providing telephone triage, doing visits or supervising (FY2 or registrars) unless this additional responsibility is negotiated. Check if an on-call bag is provided for visits and how visits are allocated: being called, mid-surgery, to treat a patient in anaphylactic shock at a cottage hospital you have not been told you are covering can be traumatic.
Repeat prescribing is risky as a locum; you cannot assume that the monitoring of repeat prescribing is rigorous. By signing a prescription, you accept personal responsibility for the patient having had reviews and monitoring. Check notes, results and if necessary correspondence. Staff may challenge you for charging for the time it takes to do this, but never jeopardise patient safety.
Your locum contract should include cancellation charges as practices may cancel at short notice ('the GP has decided not to go on that course after all'). Emphasise you will not cancel except for emergencies and illness, quoting your (hopefully, low) cancellation rate.
Always demand written confirmation of dates, times and rates, in case of double booking; communication breakdowns can occur if several staff are booking locums.
A minority of surgeries are slow to pay locums. Having a contract can help and sending your 'locum A pension form' (which demands date of payment) can act as a prompt. A PCT finance department letter reminding that these forms must be submitted by the end of the first week of the following month can be used to drive home your point, or write to the partners and consult the BMA.
- Dr Miller is a freelance GP in west London
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