Dr Judith Harvey explains why it is vital to devise a support system for the freelance GP workforce.
Today around 100,000 patients will consult a locum GP.
Locums keep the show on the road. At any one time a quarter of the GPs at work will be locums. Yet the RCGP curriculum has little to say about them.
How much training in being a locum did you receive during your registrar year? If you were lucky, you listened to an hour's talk from a locum.
How much time did your GP trainer spend discussing locum work, and whether you were suited to it, and how to adapt your skills to non-practice-based consulting? Probably very little, as few trainers have been locums recently. Did you have a chance to shadow an experienced locum? Probably not.
So thousands of young GPs start their careers unprepared for sessional work. They may not work as locums for long, but they will be very vulnerable during those first months. And a serious complaint at this early stage - already a risky time for complaints - could blight their careers.
Not so long ago, the often-repeated NHS mantra was care 'from cradle to grave'. For most patients, and for most GPs, those days are gone, but it is still the philosophy that underpins our training.
Continuity of care
Potential locums - and that means all GP registrars - need to learn about continuity of care, but they should also gain practice in consulting the way a locum does - from a standing start and with only one chance to help the patient. This also applies to experienced GPs who decide to take up locum work. Creating instant rapport, rapid history taking, quick management planning and bearing risk and uncertainty are skills that need to be developed. Likewise, locums must know how to ensure a safe handover.
Locums are self-employed. They do not have a practice manager to remind them about tax and hepatitis B. They make their own arrangements for national insurance, health insurance and pensions. They need to know how to set up systems to ensure financial prudence and probity.
Partners start a new general practice job perhaps once or twice in their careers. Locums do so every few days. Especially those coming straight from the protected environment of a training practice, they may take on trust that they will be given a realistic workload, be paid promptly and not expected to take undue risk.
Faced with the real world, too many crumple into learned helplessness. GP training should prepare young doctors so they are confident about negotiating with canny or hard-pressed practice managers. Training courses should offer opportunities to become familiar with different clinical software systems. Some of this also applies to older GPs moving on to freelance work.
Introduction to practices
Experienced locums can suggest the less obvious things, such as recommending that each locum provide practices with a CV and a photograph to introduce themselves to staff and patients.
Locums can work much more effectively with primary care organisations' (PCO) support. Some PCOs have actively engaged with locums in their area, using performers lists to ensure that all GPs, not just principals, are in the information loop, but this is patchy. For example, 80 per cent of locums were omitted from the NHS 2010 flu pandemic email.
How many miss out on all the other information and resources other GP principals take for granted?
There are self-directed learning groups, set up by sessional GPs themselves, within reach of most locums. Wise PCOs foster these groups, seeing the value of the education and support that they offer.
Taking the idea further, some locums have established chambers through which their work is booked and which provide clinical governance, education and support, as well as day-to-day management of working arrangements. This is a model that addresses many of the problems presented by locum work.
A GP appraiser who understands what it is like to be a locum can provide invaluable feedback and direction. The GPC and RCGP are both working to ensure that revalidation, when it comes, is fair to non-practice-based GPs, testing the skills locums particularly need and demanding evidence that they can reasonably expect to collect.
It has taken a while, but the profession is gradually seeing locums as more than a spare wheel. The RCGP has consulted on how revalidation can be made appropriate to locums. The GPC's sessional GPs subcommittee includes powerful advocates, complemented by the effective lobbying role of the National Association of Sessional GPs. But locums are still under-represented on LMCs and the GPC.
Locums need to put themselves forward for office. There should be no empty places around the table for lack of locums prepared to represent their colleagues and work for recognition of the special role and needs of a vital sector of the GP workforce.
- Locums contribute greatly to patient care.
- Traditional consulting skills need to be adapted to locum work.
- If they are to be well prepared, GPs need advice and support in practical aspects of life as a locum.
- Political representation and lobbying are important to ensure that the profession values locums and takes account of their particular skills and needs.
Dr Harvey is a locum GP in London.
This article originally appeared on www.gponline.com.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…