There is little or no mention of GP locums during GP training, yet there is an estimated 17,000 GPs working as locums - around 1 in 4 GPs - in the UK, carrying out an estimated 80 million NHS consultations a year. So a pretty vital part of the GP workforce.
What is a locum GP?
Locums are fully qualified GPs who have to undergo the same training and have the same appraisal requirements as practice-based GPs, are usually self-employed (unless they work for an agency) and generally provide medical services at, or for more than, one single organisation.
What’s it like being a locum?
The basic unit of currency of being a GP is consulting with patients. Many locums love their job because they get to work as clinicians without the other duties of running a practice that they may feel do not match their skills. Some GPs have an aptitude for being clinical leaders and managers within practices and that’s wonderful, especially if they are complemented by other GPs who just want to focus on more direct patient contact.
Locums can work in up to 40 practices a year and up to a 100 different consulting rooms, across different CCGs, federations or equivalent, and using different acute hospitals. The plus side of this is that we get to see lots of variation in practice processes and service provision so we can act as cross-pollinators of good practice.
The downside to this variety is that, though we come armed with the medical knowledge, we may not come loaded with the highly localised non-clinical knowledge about how your practice works and interacts with local services. For practice-based staff, a lot of these processes may seem automatic and you may not recognise that they are alien to newcomers. To quote one practice manager “I’ve worked here so long, I don’t know what you need to know.”
The good news is that with some thought and preparation, you can equip all GPs working in your practice with the essential knowledge they need to run a safe, efficient consultation.
Out of the loop
Locums can miss out on information about educational events, local referral and prescribing policies, changes in services, or anything else that a practice-based GP would receive every day (sometimes to the point of overload!). In our experience though, very few locum GPs have an NHS email address, let alone appear on local service distribution lists, and so would rarely receive updates. So the safest assumption to make is that if you inform a locum of a recent change to any local clinical service, it’ll be the first they’ve heard of it.
But perhaps even more important is the professional isolation experienced by locum GPs, and highlighted in an extensive piece of research by the Royal Medical Benevolent Fund that found locum GPs to be the most isolated professionals in the NHS. A central tenet of NHS appraisal is to participate in significant events and colleague feedback, as well as to reflect on the outcomes of these, all of which is much more effective if done in a supportive environment with other colleagues.
So wherever possible, including locum GPs in any opportunity to learn and reflect on their performance will no doubt help them to improve their effectiveness and safety.
But what about continuity of care?
Although continuity of management via up-to-date, accurate, relevant information in the medical records is vital for patient care, there are important groups of patients in whom continuity of relationship will also be important e.g. the frail, palliative care etc
But for many other patients, so long as there is continuity in the medical records, seeing a different GP can be a great positive. As well as being an adequate temporary replacement, a locum can also be a fresh pair of eyes, can break a stalemate in a frequently-attending patient with unmet needs, reaffirm to the patient their own GP's management, or allow a patient to ask about something they are embarrassed to ask their usual GP who has known them since they were born! It’s surprising how often we hear “I didn’t want to mention this to Dr Green - I’ve known her so long, I feel embarrassed.”
And of course we know from recent research by Dr Roope in Bristol that locums have the edge in diagnosing some cancers.
Who’d want to be a locum?
It’s a great job and there are a huge range of excellent GPs who opt to work as locums for different reasons
- the newly-qualified GP scouting practices
- the multi-role portfolio GP
- the practice-based GP doing extra locum sessions
- the career locum who values the work-life balance
- the newly retired GP
- increasingly, we note there are mid-career ex-GP partners wanting to restore a more equitable balance to direct patient contact.
- Who wouldn’t want to be a locum?
Why don’t you get a proper job?
Locuming is a proper job. Locums are a vital, flexible part of the workforce. Working alongside and in balance with practices, well-organised, well-engaged, and properly equipped locums can be absolute life-savers in supporting practices.
Aren’t locums bloodsucking, responsibility-shirkers who are destroying the NHS with their high fees?
Judging by media coverage, you might think this….
You won’t be surprised to know that we don’t agree.
Whilst we can’t speak for every locum out there, our collective experience of 35 years of locuming and dealing with hundreds of locum and practice-based colleagues, has taught us that there is no reason to believe that locums are any different in their attitudes to pay and taking responsibility for patients than GPs working in other settings e.g. the vast majority are extremely dedicated, hard-working and motivated in providing the best patient care within the constraints of the system they work in.
On the question of fees, we all have to ask what is a fee which reflects the value of GPs?
Locums use their income to fund their professional fees (GMC, medical indemnity etc), CPD, appraisal, annual leave, sick leave, study time and business costs to enable them to look after your patients to at least a standard equal to that you’d expect from your patients’ regular GP.
In times of falling practice incomes, it is tempting to point the finger at areas of high expenditure and seek to reduce them. And of course, the funding available to primary care affects us all and that does come into fee negotiations. But it must be realised that devaluing fellow GPs pay and questioning their commitment to patient care creates a damaging impression and risks in turn devaluing the whole profession.
What does the NASGP do?
Founded 20 years ago, the NASGP is an organisation that seeks to support locum, salaried, retainer and returner GPs to allow them to provide the best patient care.
In 2017, we also launched Practeus - free to practices - the embodiment of our work of creating sustainable partnerships between GP locums and practices.
This means working with practices to foster understanding between locums and the practices and patients we serve.
The NASGP Code of Good Practice is a good summary of our aims