A good locum is never short of work because locuming is a special skill. Walking into an unknown practice to see 30 unknown patients and departing four hours later, leaving not only those patients but also the staff with positive impressions, is a challenge. But for those who can develop the flexibility, being a locum is not just satisfying, it offers an interesting way of life.
Locums forgo the traditional reward of general practice, the long-term relationship that GPs develop with patients. Patients rarely choose to see a locum.
So the task is to make the 10 minutes that you and a patient spend together rewarding for both of you. You can give patients the opportunity to tell their story afresh. At least you can offer a new view of an old problem. Perhaps you will spot a missed diagnosis.
Locums are never - well, rarely - bored. Is the surgery full of patients expecting antibiotics for a cold? Perhaps you can change the culture of the practice and persuade at least some of them there is no magic bullet for viral illnesses. Struggling with a badly organised practice? Can you find an acceptable way to offer advice so that when you or a colleague next work there, things function a little better? Is the clinical care substandard, even dangerous? Dealing with colleagues' incompetence is not easy, but it is a professional obligation and potentially saves more lives than all the statins you will ever prescribe.
Concentrate on care
Not being tied to a practice has advantages. Unlike a partner, you can walk away from a practice you never want to work in again. Managing practices in the 21st-century NHS is increasingly onerous. Locums do not have to do it - you can concentrate on patient care.
Nor do locums have to negotiate holidays with three other partners with school-aged children. You are your own boss. This has its own responsibilities, but allows you to devote more time to seeing patients and you can more easily fit work around family and other commitments. Take a holiday any time you wish.
Being a locum combines well with a portfolio career. Work as a GP three days a week and as a dermatologist or a tree surgeon on the other two. Or spend six months as a full-time GP in the UK and six months with Medecins Sans Frontieres in Angola. You can even drop out to climb in the Andes, fence in the Olympics or write your novel without fractious negotiation with partners about time off. True, you will not be paid if you stop work to have a baby or study law, but if you plan your finances carefully, you can make space in your life for anything you want to do.
If you are a newly qualified GP, you may envy friends who move straight into partnership. But they miss the opportunity to broaden their experience. You may be a locum because there is nothing else available, but make the most of it. If you have spent your time so far in suburbia, try a taste of the inner city, or head for the hills to sample rural practice. You can try big and small practices, APMS practices, those designed for the homeless, practices with traditional lists and those where part-time GPs see most patients.
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You can come to grips with different medical software and different ways of recording consultations. Is nurse triage as good as doctor triage? How can a practice ensure safe handover? Is treating diseases of the rich appealing, or do you prefer to confront the problems of the poor? You can try out practices to see if you would like a salaried post or partnership there. You will have a range of models to draw on in designing your career and later on, locuming can be a rewarding way to wind down to retirement.
For practices in a jam, a locum is a lifesaver. Being welcomed by a practice with a doctor off sick and a waiting room full of patients is a good start to the day, and leaving with thanks ringing in your ears is a great goodbye. It is nice to be needed and good locums always are.
- Dr Harvey is a freelance GP in London
