NASGP were informed today via Pulse that the BMA have produced a new BMA locum practice agreement. NASGP has not had previous sight of this, and we were not involved in its development or publication.
NASGP has long argued that professional terms of engagement for placing highly skilled GP locums into complex, varied and safety critical environments like GP practices is an absolute prerequisite for locum morale, practice efficiency and patient safety. It’s why we built our LocumDeck and Spip, which already include a set of T&Cs that can be adapted by locums.
And it is of great concern that the institutional neglect of training to be a GP locum results in the reported 40% of locums not currently using such Terms.
So this long overdue document from BMA is a very welcome addition to available T&Cs for locums, especially as this will bring this important issue to the attention of a wider audience. There’s some good grounding in defining self-employment and making sure those markers are in place.
But there are some important omissions and missed opportunities to resolve common problems that practices and locums encounter.
Although we haven't had enough time to fully digest its implications, or test it out in the field, we do of course have some initial observations.
- We note the downloadable Word document is still in DRAFT (heavy grey watermark on printing), and there are some typos still, so a final version may still be in the offing.
- The document's opening ‘Services to be provided by the locum’ omits visits?
- These T&Cs will have no benefit for locums and practices working through online booking platforms or agencies; locums working via these platforms/agencies are working under 'agency terms', whereby the platform’s and agencies own centralised T&C’s will override any T&Cs that the locum provides.
Two important issues which are commonly encountered by locums are the
Late payment of locum fees by practices
- This can have a significant impact on the locum’s livelihood and NHS pension contributions being made within 10 week deadline.
- No mention of provision for this, which surprises us. Late payment charges can act as a deterrent to late payment but they also go some way to compensating the locum for lost pension and the time associated with seeking payment.
- On the other hand, it is stated that “The Practice shall be entitled to deduct from any sums payable to the Locum any sums that the Locum owes to the Practice at any time.” We think this is open to interpretation and open to misuse by the practice against the locum.
Late cancellations by practices
- These can be financially devastating for GP locums. The standard wording on this contract is very light on this, suggesting that either party can cancel provided reasonable written notice is given.
- A Cancellation fee is only mentioned as an “optional extra” if both parties agree.
NASGP argues that there is an imbalance when it comes to late cancellations which favours practices.
- A late cancellation made by a practice has little or no impact on the practice. However this can be immediately financially devastating for a locum.
- On the other hand, a late cancellation made by a locum has immediate impact on both parties - the locum losing income and risking reputation damage, and the practice losing cover for its patients.
- There is already a strong professional disincentive for the locum to not cancel, since the GMC take a dim view of patient care being adversely affected (GMC duties of a doctor: “Patient safety may be affected if there is not enough medical cover. So you must take up any post you have formally accepted, and work your contractual notice period before leaving a job, unless the employer has reasonable time to make other arrangements”)
For these reasons, a late cancellation initiated by a locum is unusual and will usually only be entered into for significant, unavoidable reasons such as illness, or an adverse life event; in our experience we have heard all too often that a practice has cancelled a locum at the last minute because they’ve found a cheaper one, often facilitated by the facelessness of WhatsApp groups.
So there’s an imbalance - we hear more from GP locums working via online platforms about practices being easily enabled, as a feature of the platform, to cancel GPs at the last minute.
It would have been helpful if the BMA could have recognised this imbalance and sought to introduce balance by making more of late cancellation fees as a deterrent to this behaviour.
CQC status of the practice
- There’s a clause about the practice immediately cancelling the locum’s contract if the locum is in trouble with the GMC, but nothing about if the practice is in trouble with the CQC.
- The GDPR Schedule 1 data legislation - whilst we all recognise as part of Good Medical Practice that patients’ personal and confidential data is strictly confidential and needs adequate measures to ensure it is safely protected and we sure that the Data legislation schedule is probably meant to reflect this. However, this is written in legal language which makes the schedule difficult to understand what it would mean in day to day application. The plain english explanatory notes briefly say it is important to read it carefully and understand the obligations but there is no plain english translation to illuminate what this means in day to day practice.
Such can be the huge variety and number of practices that a locum works in - not unusually around 30 a year, often booked at short notice - a standalone document like this can have limited utility in a practical sense. Getting confirmation that the practice accepts them, and even getting a copy to the practice in time for agreeing the session, are all very limited by such a document - again, a reason why NASGP’s LocumDeck was created to unequivocally link in each locum’s T&Cs as an integrated part of the booking process.
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