But what if all GPs were locums?

Crazy as it sounds, this is a rhetorical question I often hear, and you may have heard it too. Though it doesn’t seem to be asked as a genuine question, more as an attempt to somehow justify the fact we absolutely need GP partners and salaried GPs and, by implication, that we therefore have to tolerate with everything that such practice-based GPs have thrown at them. Someone has to do it.

Another reason I hear this question could be - and I appreciate that this is probably just me being oversensitive - because it’s quite a cheap way to put me down, as if the choice I’ve actively made to work as a locum is somehow selfish (more on selfish later). It’s an attempt to defend the status quo, and to diminish those that don’t.

Either way, what this rhetorical question definitely is, is what Daniel Dennett, philosopher and cognitive scientist, would call a ‘deepity’. A deepity is a proposition that seems both important and true, achieving this effect by being ambiguous. On first hearing it, its meaning seems earth-shatteringly true; on another, true but trivial, and finally, manifestly false. Colonel Kurtz’s  “Do you know that 'if' is the middle word in life?” being a typical example.

Should you ever be at the receiving end of this deepity (and if you’re a locum, you already are) here’s a sure-fire way to respond. Simply ask what if all doctors were GPs (so no consultants)?. Or, what if all A-level students only wanted to study medicine (so no nurses, or farmers). What if we all shopped at Waitrose? Or if we all went to Cornwall on holiday? What if no GPs were locums (Isn't that an equally daft and awful thought?)?

The big surprise to no-one here is that we are all different, and making a career choice that you enjoy, that keeps you sane at the same time as doing a fantastic service to struggling practices is absolutely the right thing that you must continue, and don’t let anyone make you feel bad about doing so. Diversity is what makes general practice go round (did your deepity alarm just go off?!).

On that subject of diversity though is that other deepity: because you don’t offer continuity, you’re not really doing a proper job. On continuity, NASGP has made itself very clear.

Sadly, speculation surrounding the sudden mass conversion of all GPs to working freelance and the romance around continuity of relationship are diverting us from the real issue - GP locums are a significant, valuable and flexible part of the GP workforce.

So what one single thing would actually make a real, tangible difference to the quality and performance of the 17,000 GP locums performing 65 million NHS consultations every year? What is that one single constant frustration as a locum GP, often working in 30 different practices each year?

By the time we qualify as GPs, we have some 20,000 ‘bits’ of clinical information stored in our brains at any one time that we can retrieve 24/7 to make a clinical diagnosis within seconds. But how we then manage that patient is entirely dependent on several hundred bits of non-clinical information that is different for each practice we work in.

For the last two years, the NASGP has been very busy developing a significantly updated version of its standardised practice induction pack. Launching later this August, practices will be able to create a centralised updatable directory of services that, even if only partially completed through crowdsourcing amongst regular practice staff, can be easily shared amongst all clinicians working in that practice. Rather than an unfamiliar GP’s consultations being fraught by complications relating to lack of local knowledge, instead we will soon have the correct information at our fingertips, no longer having to break off to attempt to extract this from a bewildered receptionist.

Richard Fieldhouse

Freelance GP locum since 1995, living and working in West Sussex. NASGP chairman.

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1 Response

  1. Christine Paterson
    I've been a locum for 25 years and worked in four different countries and dozens of different practices. The Truisms for me are - No-one can put me down if I don't give them permission to. And, secondly, it is always the unhappy trapped and jealous partner GPs who try to put me down with their comments such as the one at the start of this article. To the question - what would happen if all GPs were Locums? My kind answer would be - I don't know and I'm too busy enjoying my work/life balance to consider it. And my not so kind answer would be - Ask someone who gives a shit.

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