Multisource feedback will be one of the many tools we’ll all be required to be using as part of revalidation. But locums need to realise that they’re exposed to a different set of variables when it comes to consultations than a practice-based GP.

• What sort of practice are you locuming in, and what is the reason? A lot of the reasons behind why practices require your services may be a sign that you’ll be working in a dysfunctional environment
  • Practice unable to recruit a partner or salaried GP – perhaps there’s a good reason they can’t find a suitable candidate.
  • Usual GP off sick – was it stress related due to the practice, and were they practicing and peak capacity prior to their absence?
  • Holiday – usually a good sign, showing that the practice plans their GP cover. But if the patients have worked out that their usual GP is off for a few weeks, they may be turning up in force for a second opinion, or for an easier ride. You may be that ticket to that referral they’re desperate for, or a new GP to hoodwink into prescribing the medication that their usual GP refuses to prescribe. You may have to dash their expectations, and that never goes down well in a feedback form.
  • Last-minute ‘desperate’ booking? Practices who have to call in a locum last-minute are usually running at peak capacity anyway, with little or no slack in the system. Why have they been unable to organise some internal cover if it’s that important? Is there a wider organisational issue that suggests other more fundamental issues in that practice? ‘Siege Mentality’ is the scourge of many a practice, and bodes ill for a smooth surgery.
  • Maternity cover. This sounds straight forward, but realise that the normal incumbent’s usual clientele are devotees of the absent female GP and may be disappointed by middle-aged male GPs! And for some reason, maternity locums are often subject to mission creep.
  • Suspended GP. This speaks for itself; if a practice has reached the point where one of its usual GPs – and this could of course include a previous locum – is suspended from work, that practice is likely to have major ongoing issues for some time whether they recognise them or not.
  • Practice rarely use a locum? These can vary – either you’ll have the red carpet treatment and treat you like royalty, or you’ll be something the cat brought in and they won’t have a clue what to do with you. So feedback from these practices can vary enormously, from “she was a pleasure and we’re extremely grateful for the high level of care she showed”, to “Who?”.

Now that some of the practice’s variables have been taken into consideration, we can think about patient variables.

Your session was booked weeks ago.

• So you’re expected at least. The absent GP will be holiday, educational or maternity leave, so likely to be atleast a well run practice. Indeed, if it’s to cover an appraiser, educational lead or for educational events this suggests it’ll be an above average practice.
• Patients here are generally healthier, so will present with less ‘pathology’ and because of good contemporaneous notes you will be less stressed and will get better feedback…
  o …but remember too that they’ll have much higher expectations, and likely too that theyre will be more worried well – so be prepared for some critical comments too.
• If the practice doesn’t often use locums, be prepared to see more than your usual dose of chronic and untreatable conditions, and probably every heartsink in the district. The longer you stay, the faster word will get round that there’s a new GP I town. Drug addicts usually come out when you’ve been there over 3 days, with heartsinks after a week.
• Feedback will be affected either way. Some will see you as their second opinion, valuing your different approach to their problems. You don’t necessarily have to do anything differently, but just offering a different opinion, or reinforcing the same previous advice, or simply speaking in a different tone can all have a new affect on your patient. But similarly, having had high expectations of you as their fresh new GP who may not have heard it all before, their hopes of a different therapy or a radical cure, you may have dashed their expectations.

Booked within the last 24 hours?

• It’s unlikely that your patients will have been told that they’re seeing ‘just a locum’ before they arrive at the surgery. Obviously this may delight them, but equally they could be very disappointed (a patient once took a swipe at me for not being the female GP she was expecting!).
• They may have waited weeks to see their usual GP – and now they’re seeing you. If the receptionist isn’t up to speed, and you’re presented as ‘the locum’, they may not even know that you’re a GP.
  • In these days of electronic check-in, the first they know that it’s not their GP will be as they enter the room.