Sessional GPs - My experience of life as a locum

Dr Nonye Agomo describes the ups and downs of opting for sessional work after her GP training.

Dr Nonye Agomo: ‘My biggest tip to would-be locums is to document in detail everything you do’ (Photograph: JH Lancy)
Dr Nonye Agomo: ‘My biggest tip to would-be locums is to document in detail everything you do’ (Photograph: JH Lancy)

Being confronted by the stark reality of few practice posts has driven many a newly qualified GP into working as a locum.

The advantages include the variety as you move from practice to practice, the flexibility of not being at the beck and call of an employer, and the freedom of not taking on a partner's business responsibilities.

But what is life as a locum GP really like? This is how it was - and is - for me.

I can still recall the shocked expression on the face of a colleague at my training practice two years ago, when I announced that I had an interview for a salaried GP post. The colleague thought this might not be a good move immediately after completing my training.

'You have to work in different practices, with varying patient population groups and to learn what kind of a GP you are,' she recommended.

When I did not get the job, I made up my mind that I would work as a locum and I have really enjoyed myself.

Invoicing and admin
My first job was to cover for my former trainer who was at a trainers' workshop. It was nice to work in the same practice and a good way to launch myself into the admin side of freelancing, with the practice manager guiding me on invoicing and other matters. I then obtained regular work at a couple of practices.

But one locum job ended rather unceremoniously, after I was booked to cover for a GP and I dared to telephone them at home to confirm the provision for emergency cover.

This made me a bit wary of GP principals. For a while it suited me that I did not usually see much of them. Looking back, I had expected, as a newly qualified GP, to interact with senior colleagues, but I soon realised that the whole point of employing a locum was to provide cover and not interruptions.

I quickly learnt that successful locums are punctual, fulfil their tasks as independently as possible and get along with patients and practice staff. It is also inadvisable to be too rigid about seeing 'extras' and signing occasional prescriptions for the nurses. But my first few months were far from bleak. In one practice where I worked regularly, I was treated as part of the team - invited to teaching sessions and to the Christmas party.

I will not forget one kind gesture by a practice I covered for while the team were off on an 'away day'. Not only was I given detailed instructions for parking and logging on to the computer, I also found a tasty snack had been left for me.

It is the small things that make locum work pleasant. Things like being offered a coffee and made to feel welcome, especially when you are new and working in unfamiliar surroundings. One not so great experience was a session at a practice where I had been offered a permanent post. Unbeknown to the staff, I had been successful at the interview and was doing a trial locum shift. The receptionists were the most unhelpful I had ever come across. It was as if they were doing me a favour, rather than me helping the practice out.

At the end of the session, I asked them about the local area and explained that I had been offered the post. They immediately apologised, explaining that they were fed up with being nice to the many different locums turning up for sessions. Learning about the turnover problems meant I became more sympathetic. I declined the job.

Sources of locum work
  • Training practices, neighbouring practices and word of mouth
  • Local out-of-hours organisations
  • Locum agencies

Salaried post
I did eventually get a part-time salaried post as a result of doing locum work. The practice had made a good impression on me, including offering me tea on my first day. I am still at this practice but I do locum work elsewhere on occasion. Freelancing has enriched my experience of different practice populations and computing systems and offers plenty of variety. I have had mostly positive feedback from patients.

One experience will stay with me. The patient was elderly, on the palliative care register and died at the start of a long bank holiday weekend. No GP principal from her practice was available to confirm her death, so the body could not be moved to the funeral home. As the most regular locum at the surgery, it fell to me to confirm the death. This was stressful but her family's gratitude made it worthwhile.

In general, out-of-hours sessions can be exhilarating, but you can feel even more isolated than in daytime work.

What advice can I pass on? My biggest tip to would-be locums is to document in detail everything you do. Bear in mind that your recall may be poor if you are asked about a particular case months later. You are covering for others, so it is important that the permanent GPs can follow your train of thought in the notes and understand your management plan for the patient.

Finally, make sure you log bookings meticulously and keep a back-up on your mobile. If there is a mix-up that is your fault, apologise. To make up for arriving late, say, reduce your fee or offer a free extra hour.

  • Dr Agomo is a part-time salaried GP in north London

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