These surgeries will all have met the RCGP’s strict standards for training practices, all with the intention of providing our new colleagues with the best opportunity possible to launch their careers in one of the best jobs going - being a GP.
But like a leader of the opposition forgetting to mention the financial deficit, there’s one thing, one very big thing, the college has forgotten to include in its GP training curriculum - how to be a locum GP.
What’s so special about working as a locum GP that it needs to be part of the curriculum? All GPs will become practice-based at some stage, won’t they? That’s the whole point, isn’t it? Locuming’s not a real job, after all.
Well of course it is; it’s a completely valid, legitimate, and vital way of working and deserves total recognition as such. But there are also a significant number of core skills needed to work as a GP locum, as outlined in a joint document between the RCGP and NASGP first published in 2010.
In fact, to ignore it, and not even explore all the different development needs that any locum might need in order to do their job, is like learning how to drive a car but neglecting to learn how to use the brakes.
With estimates (estimates, not facts - even the government has a blindspot for locum GPs) putting the number of locum GPs at around 15,000 in the UK, around 50 million NHS consultations a year are being performed by locum GPs who have had absolutely no, or extremely little, induction into the complex and complicated ways of working as a locum GP.
Existing GP locums will recall the hurdles they’ve had to overcome to develop some or all of those skills, often in isolation. Taciturn reception staff, alien IT clinical systems, inaccessible referral forms, frustrated patients who’ve been told that you’re “not a GP, just a locum”. If your first few months of locuming were tougher than you’d expected, it’s because you were on a steep learning curve.
With this though, we also need to be mindful that even the most experienced GP locum can unexpectedly find themselves in a position of enforced underperformance; inadequate notes (we don’t know what we don’t know), receptionists with prescribing access rights, incumbent partners undergoing performance issues. It’s a minefield, and is not easy to navigate as an isolated locum. The path through to safety involves improved collaboration with practices and wider support through our professional bodies.
Working contact with any practice should include a complete and thorough induction, access to a standardised practice pack, unique logins wherever a GP works; simple, readable profiles that explain who - not what - the locum today is. And care continues after the consultation too. If there’s feedback, any feedback at all, mechanisms need to be in place for locums to receive it.
Locums need support beyond working in practices, and if it’s not given, it needs to be taken. Gaining professional support and recognition from our practice-based colleagues, together with our professional bodies, is part of improving our ability to care for patients and support general practice.
It goes without saying that for practices and our professional bodies to recognise and respond to the role of locums as a valuable and integral part of the workforce, they need to hear from us. We have first-hand knowledge and experience of the core skills needed to be a locum GP. This could be very difficult if we work in isolation, but there are over a hundred sessional GP support groups around the UK, with over 1 in 10 of these now a chambers that give advanced support for their members.
Lastly, our profession has got to start recognising that locum GPs are not just a convenient stop-gap or a pool of lost, uncounted GPs. As an engaged, supported, well-equipped group of flexible GPs, we are an integral part of the solution to support and strengthen general practice. ●