Sessional GPs - Why a locum's work is more risky

Locums must heed the higher risk of mistakes compared with other GPs, says Dr Judith Harvey.

GPs live with risk. It is what we do everyday when deciding which treatment options are the best for our patients. Being a locum ups the stakes, although the risk level can be managed.

Allowing yourself to be logged into practices' clinical systems as 'locum' rather than with your own unique log-in, is akin to a warning siren because the resulting audit trails are open to challenge.

Never undertake something beyond your competence. Just say 'no'. It is better to clarify the practice's expectations by agreeing a job description in advance. Use a booking form: the National Association of Sessional GPs (NASGP) has a standard one. Otherwise, what if you arrive on a bicycle and find you are expected to visit a patient on a remote farm?

Be alert to being 'forced to underperform'. If the practice's urine test strips are out of date and it does not have a pulse oximeter, your best may not be good enough.

I set out for my first morning as a locum with a stethoscope and diagnostic set in my handbag. Two days later, I had a backpack with sphygmomanometer, peak flow meter, thermometer, tape measure, drugs directory and in-date dipsticks. And I know locums who wheel suitcases containing laptop, printer and dictating machine.

Then there are the insidious, harder-to-avoid and more difficult-to-manage risks you cannot put on a tick list.

Time pressure is one. Everything takes longer if you are new to a practice, and running behind puts you under pressure. That is when doctors make mistakes. You are not listening as carefully or thinking as clearly as normal.

You are tempted to cut corners. And the longer your patients have been waiting, the worse you feel and the less forgiving they are if they think something has gone wrong.

This is challenging if, like me, you are a slow consulter. Seek help. Discuss the problem with fellow locums. Video some consultations and ask a GP tutor for advice on consulting more quickly but effectively.

Then there are the attempts to exploit your goodwill. We all want to receive grateful thanks from practices. But treat requests such as 'Could you possibly ...?' and 'Would you mind just ... for me?' as red flags.

Can you really safely squeeze in a patient who arrived late? Should you comment on an X-ray report pushed under your nose between consultations because the patient is creating hell at the front desk?

Handover is another bear trap. Ask what the practice's handover system is, and add a belt if the braces seem frayed. Remember that handwritten notes can get lost. For example, the receptionist who promised to pass on information goes off sick. The secretary, like you, is only temporary and leaves your letter in a heap as she assumes you will be in tomorrow to sign it.

Do not be afraid to duplicate information about a patient whose condition worries you. If your note fails to reach the right person at the right time, this could cost the patient their life and you, your career.

Signing repeat prescriptions is a minefield. Partners may be happy to scribble signatures on a thick pile in 10 minutes, but as a locum, you need to look at the patients' notes - especially if you suspect the practice's repeat prescribing policy is not robust enough.

Life is risky, so analyse the dangers and do what you can to reduce them.

  • Many of the risks we face are well publicised in GP and by the NASGP.
  • Locums have a responsibility to make themselves aware of the risks and to take steps to manage them.
  • You can only practise as well as your working environment allows. Make sure you have got the right tool kit.
  • To a locum, every patient is a new patient, and so takes more time. Time pressure is a big risk.
  • At the end of your session, ensure safe handover.
  • Resist being charmed into doing things that you do not have the time or the qualifications to do properly.
  • Be very careful when signing repeat prescriptions.
  • Dr Harvey is a freelance GP in London

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