- Give locums access to your practice induction pack
- An induction process is key to ensuring your locum spends their time in the safest, effective and efficient way possible.
- The CQC has advice on the key features of a practice information portal.
- The NASGP has developed a Standardised Practice Information Portal (Spip). If you’re using NASGP’s Spip, you can give them access to it prior to their arrival so that they can hit the ground running.
- IT systems
- It can only take a few months to lose familiarity with a clinical IT system, and the same IT system is often set up in a different way in different practices. So always worth checking when your locum last used the system you have in your practice, and offer them a quick refresh session if they feel they need it.
- If there are certain things you expect all your locums to do with your IT system, add this to the ‘Spip notes’ in the IT section of your Spip.
- Make sure the locum’s unique login and password is ready and enabled.
- Why a GP locum’s work is more risky
Do you get your own username and password when signing into practice computers? Sick of always being signed in under various combinations of ‘LOCUM1/DRL/LARRYLOCUM’? Perplexed as to how it’s your first time at the practice but looks like you (DRLOCUM) have seen this patient twice already this month? Irritated because you can’t work out who all the other freelance GPs are who’ve already seen this patient? Demoralised for not having the fundamental means for recording auditable medical notes? Struck off for never having officially been enabled to record a consultati…OK, you get the idea.
Secret passwords and usernames are essential to working as a GP – recording contemporaneous medical information in the patient’s notes is a vital part of clinical management; and a medico-legal requirement. And if your password isn’t secret, and call me paranoid, someone else could falsify records in your name. So how come freelance GPs are so rarely given their own? Come on chaps, stand your ground and insist on one! Some of the clinical systems are pretty easy to set up, whereas others aren’t. For example, the procedure for setting up passwords on Microtest can be quite tricky. So we’ve been working with them (and what nice people they are) to make the procedure easier.
@NASGP Huge risk area. I had my name signed to referral letter for a pt I'd never seen. V diff to ensure audit trail in such a setting...
— Dr Catherine Harkin (@buletproofcardi) March 13, 2015
Meanwhile, here is a download to place under the noses of any defaulting practices.
Equipping the room
May sound obvious but it is astonishing how often this doesn’t happen and there is a mad dash to find which room is free, causing stress to the staff, followed by more delays as the chosen room is unlocked and set up.
- It is often a marker that the hastily chosen room will not be fully equipped, probably because everyone else in the practice knows where the prescription paper/pregnancy testing kits/swab etc are kept and so can just quickly grab them. Not so for the locum.
- Having to interrupt a surgery to look for equipment has several implications, ranging from the inconvenient and frustrating to the unsafe.
- It delays the surgery causing frustration to patients, and then the practice when patients start to complain
- Disrupts practice staff who have to interrupt their tasks to help locate the missing items
- Undermines the locum in front of the patient
- Annoys the locum who will move you down their preferred list for future bookings
To get the most out of your freelance GPs and minimise stress to your practice staff and disruption for patients, it is helpful to have the following in place in time for your GPs to smoothly start their session.
Nominate a staff member as a point of contact during the locum's session
Have you ever had a job where you shouldered enormous responsibility, making key decisions every 5 minutes but were just left in a room to get on with it on your own with no familiarity of the wider premises or staff? It is not possible to work optimally in those conditions.
- A welcome induction tour is more than just a professional courtesy. It allows the locum to be given a quick induction tour of your premises and a familiarisation with key staff on duty.
- The basic welcome induction tour should include
- Important safety features like location of emergency equipment, fire exits, panic buttons etc
- A brief nod and familiarisation with other GPs, nurses, secretaries etc
- Shown to their room, navigating any locks and doorcodes
- How the visiting GP can access toilets and refreshments
- A final check that the computer system is accessible and the room is adequately stocked for a smooth-running surgery.
- A point of contact for any enquiries during the session
Up-to-date information about your practice processes and referral pathways
- Have a practice induction pack available. We think Spip is the best. Developed from our years of having to interrupt our surgeries and practice staff to ask them questions about administrative procedures, it is easy to use, online, centralised and comprehensive.
- Ensure locums have access to a modern internet browser
- Modern browsers can be downloaded. They do not have to be the default browser and can sit alongside older browsers that may be needed because of NHS software legacy issues.
- Many locums will have secure cloud-based reference materials that they will use during surgeries - almost akin to their own portable consulting room - it really helps if they can access this properly.
They - being a GP, nurse, locum or new team member - could just ask the receptionist, but
- the receptionist may not know the answer. Often this is the case, and a time-consuming game of "Pass the parcel" ensues, taking up time of multiple staff. This is no bad reflection on anyone in the practice team; it's just there's so much to know and it's always changing, so it is not reasonable to expect the duty admin team to be 'know it alls'.
- it wastes time - not just the person seeking information (often a GP in the middle of a busy surgery), but the receptionists too.
- it undermines the GP-patient relationship: "...if the GP doesn't even know how to refer me to physiotherapy, how do I know she's even made the correct diagnosis? I know, I'll rebook to see another GP!".
Learning from feedback and follow up
- Locums have to gather feedback from colleagues and patients once in every 5 year revalidation cycle - just like practice-based GPs.
- They will need to work in co-operation with their employing practice to achieve this.
- It is hoped that all practices would see locum GPs as professional colleagues and members of the primary care team and support them with their revalidation requirements
- So vital is this feedback to learning and revalidation- we can’t work without it! - that many locums now specify this support in their Terms & Conditions.
- The NASGP has produced the following advice to locums about carrying out patient and colleague feedback surveys.
Facilitating patient follow up
- Like any GP, locums will come across patients of concern and wish to learn from the outcome of a treatment or referral. As a locum may not have ongoing access to your practice or medical records, they may need to do this by contacting the practice at a later date.
- This is the natural behaviour of a committed, reflective professional and is the mark of a quality locum.
- Different practices have different strategies for identifying a locum who makes contact in this way to ensure they are not breaching confidentiality e.g. asking for the practice record number of the patient concerned as this is a detail that is only known by someone who has had access to the practice records, having a named individual who liases with locums and recognises them.
- It would be of help if each practice could let the locum know of their practice procedures on this important matter.
Giving feedback to locums
- Fairly given, constructive feedback can be a great way of improving quality for your locum and your practice.
- If done well, it can also win you the admiration and loyalty of a locum.
- Many in the health service realise that we still have a long way to go before we catch up with other safety critical industries in how we perceive feedback and complaints. It’s hard to give and receive negative feedback and our natural psychological tendency as human beings is to try and simplify and individualise “blame”.
- If something has gone wrong in a patient’s care and a locum was involved, it may seem easier to conclude that it must be the locum’s fault and not book them again.
- In reality, mistakes rarely happen purely because of the actions of one individual.
- Individualising blame misses out an opportunity for the practice and locum to learn what really happened and look at the whole system and sequence of events that led to any mistakes.
- NHS Scotland has developed an excellent tool for looking at system wide problems called enhanced significant event analysis, and we recommend this approach to our members
Locums work in anything up to 40 different practices a year, and capturing feedback is a great way for practices to benefit from our wide range of experience and seeing everything with a fresh pair of eyes.
Want to get some feedback from a practice, and even use it as a reference? We've developed a new online electronic form to make this a lot easier.
Simply send this page's link to the GP or practice manager you want a reference or feedback from, and we'll do the rest!
There is no consistently set minimum number of sessions you should work per year across the UK.
To remain on the performers list in England, you must be performing at least one session a year.
Structured reflective template (SRT) for appraisal
But anyone in England/Wales working less than 40 sessions in the year of their appraisal will need to submit a ‘structured reflective template’ (SRT) with their appraisal to demonstrate their continued ability to provide safe care.
- See NHS guidance "Supporting doctors who undertake a low volume of NHS General Practice clinical work"
- AppraisalAid | Structured reflective template for doctors undertaking a low volume of NHS GP clinical work
- Oh - and we mustn’t forget that feedback means positive as well as negative!
Receiving feedback from locums
- Locums get a very intimate view of your practice. They sit in your consulting rooms, try and navigate and learn about your systems and talk very closely with your patients. And they do this in up to 40 practices a year, perhaps across different CCGs.
- This gives them a unique and valuable perspective.
- Some practices try and capitalise on this by soliciting locum feedback with exit feedback forms at the end of a session.
Pay in accordance with your agreed T&Cs
Late payment causes work and stress for both parties. Delayed payments can adversely affect the locum’s NHS pension contribution by breaching the scheme's payment deadlines.