Clear Terms & Conditions protect you and your patients
There is huge variability in how different practices and locums work. It is essential for the smooth running of your practice and for your patients’ experience and safety that when engaging a locum, each party clearly understands and agrees on the work that is expected.
And it also goes without saying that properly worded T&Cs can safeguard both practice and GP in terms of employment and tax law too.
Have a written agreement
The best way to ensure this is with a written agreement, negotiated and finalised in advance of the locum session.
If you're doing any sort of locum work, you'll definitely need your own personalised Terms and Conditions that will protect both you and the practice you're working for. NASGP's model T&Cs has been specifically developed for us by a specialist employme law firm, and allows you to not only fully adopt all its recommendations, but also to add any necessary clauses, and tailor it to suit your personal needs.
- cancellation policy
- employer's pension contributions
- legal employment status
- tax status
- payment terms
As an NASGP member, go to your T&Cs generator, choose your settings and then save. You'll then be given a unique link "View my TCs" which will automatically be added to your automated invoices and session request emails, or you can paste the link into your own website.
As an added bonus, you can update your T&Cs as often as you like, with each change being saved in an archive accessible by your practices for extra confidence.
Make sure all staff on duty understand the work expected from the locum
It is a matter of safety to ensure that all relevant staff on duty such as receptionists, practice nurses and other GPs, also understand the terms of the agreement and the work expected of the locum. You can then avoid either underusing the locum or overloading them with work beyond what was agreed.
A session is generally considered to be around four hours. Often a locum may be working two sessions in two different practices in one day so it is important to realise that session finish times are very important to a locum.
Generally, you can either reach an agreement on a sessional fee either on a time-basis (an agreed fee for specified number of hours) or based on a defined workload eg: number of patients to be seen.
The time-based approach still needs scrutiny of the workload as it is in no-one’s interest for an inappropriately high workload to be squeezed in. This leads to long waits for patients and a very unhappy locum who will be thinking of the impact on their next practice or who’s going to collect the kids from school and making a note not to work at your practice again. Although the locum may well charge extra for overrunning due to a high workload (assuming they actually have the capacity - they may well be expected elsewhere as duty GP), it’s still not acceptable practise since this can lead to lapses in patient care.
The workload-based approach has the advantage to the locum and the practice that each party clearly understands the boundaries. A practice would not normally be charged for overrunning, unless because of unusually high patient demand (eg multiple acutely unwell patients requiring the lengthy process of hospital admission) or because of delay caused by the practice e.g. poor preparation by the practice such as inadequately equipped consultation room or locked out of the computer system.
The NASGP Terms and Conditions template is a useful starting point in work negotiations and once agreement is reached, can be used as written confirmation of agreed work.
Most locum GPs would consider their core work as seeing a predefined number of patients in timed appointment slots in a surgery, and/or on a predefined number of visits and dealing with the paperwork of organising investigations and referrals relating to those patients.
- Start and finish time of surgery
- Number of appointments
- Length of each appointment
- Special cases where longer appointments needed
- Practices will often know of patients with complex medical problems, mobility issues or mental health issues where GPs require longer appointments. In fairness to these patients, the locum should be given the same conditions.
- Patients requiring interpreters
- Number of visits
- Whether visit to one nursing home to see more than one patient counts as “one visit”
- Cut off time for notification of a routine visit
- Time required to travel to visits.
- Arranging referrals and investigations arising from patients seen by locum during a session
Extra work a practice may need
Much of this “extra work” may seem automatic as your practice-based GPs quietly work away in the background, often late into the night! But actually these tasks are critical for safe patient management. Each time a doctor is asked to sign a prescription or deal with a phone call or a query from a nurse, they are taking on full clinical responsibility for that patient. This requires close attention, access to medical records and time. This is especially onerous to a doctor who is unfamiliar with your practice procedures.
So it is important to discuss and agree with the locum what “extras” will be provided and whether this will be as an integral part of the session fee with time allocated to these tasks or whether they will be charged at an additional rate. Again the NASGP Terms and Conditions is a useful template for these discussions.
- Extra patient contact
- Seeing extra patients
- Dealing with telephone contacts with patient outside of the agreed surgery
- Extra non-contact patient management tasks
- Signing repeat prescriptions
- Signing prescriptions on behalf of nurses
- Dealing with clinical letters
- Dealing with results
- On call duties
- Clarify times, whether on call in addition to a fully booked routine surgery or emergency appointments only
- Dealing with nurse enquiries
- Supervising trainees
Any special enhanced services
- Maybe your locum is able to undertake enhanced services like minor surgery, fitting contraceptive implants or offering services related to their special clinical interest.
Any important exclusions
- Occasionally there are some services GPs are not able to offer e.g.
- may not be an “authorised” cervical smear taker
- may not have IUD training
- may have conscientious objections to requesting terminations.
How to discuss fees with locums
Agreeing locum terms and conditions is a balance between getting the best for your practice whilst also recognising that you are dealing with a professional who is going to have the responsibility of managing your patients.
Agreements need to be clear and fees need to balance the practice circumstances whilst recognising the professional running costs of a GP. Locums have to fund their own professional costs (GMC, medical indemnity etc) CPD, appraisal, study leave, annual leave and sickness cover.
Competition law prohibits the direct publication of suggested fees for locum work by membership organisations. However the BMA together with the NASGP have issued general guidance on how to consider agreeing a fee.
Factors such as anticipated workload, the locum’s experience and what other GPs are paid may be part of the negotiation.
It is a statutory requirement, if engaging a locum who is paying contributions from that session in to the NHS pension scheme, to pay them the employer’s contribution. The locum invoice should clearly state the separate charge for the employers pension contribution and then the locum is obliged to hand on this employer contribution alongside their own employee contribution to the Area NHS team.