Our guide for practice managers who browse, book and work with GP locums: find out why practices use GP locums, what NASGP and LocumDeck are, and how to make the most of the GP locums you book and work with.
What is a GP locum?
Fully-qualified GPs
In order to work as a GP locum in the United Kingdom, the locum must be a fully-qualified doctor who has successfully undertaken their GP training. It currently takes three years to train a qualified doctor to become a GP in the UK.
Twenty thousand in the UK
The GMC – the doctors’ regulatory body – estimates that there are up to 20,000 GPs who perform locum work in the UK. Around 17,000 of these do it as their main job.
Thirty practices a year
Some GP locums like working in the same practice as often as possible, and so over the course of a year may only work in one or two different practices. These GP locums are often referred to as ‘long-term’. But for other reasons, some GP locums work in lots of different practices, up to maybe 30 or 40 different practices a year. This may be through choice, because they like the variety, or maybe because they are trying to work out a nice practice where they would like to settle down as a partner or salaried GP.
Agency, freelance or chambers
A common perception is that all GP locums work for locum agencies, but in fact most work as independent self-employed GPs, and manage all their locum work themselves. A relatively new way of working as GP locums is through a locum chamber such as an NASGP Locum Chamber, which some describe as being like a ‘virtual practice’, or others described as working as part of a cooperative. Locum agencies can charge the practice up to 30% of the GP locum’s local hourly rate for the service that they provide, whereas locums working through a chamber either pay a percentage of their own income to fund the chambers, or their CCG will cover all costs.
No paid holiday or sick leave
Either way, GP locums are not entitled to paid sick leave or holiday, and have to pay for all their own training. Although GP locums might enjoy not having to take responsibility for maintaining a GP practice, their time is instead focused almost entirely on direct patient care.
Newly-qualified GPs
The three years of training that most new GPs have to undertake takes place in specialised training practices that all have to offer a high level of support, with regular inspections and resources to ensure that the doctor is training in a safe and relatively standardised environment. So starting out as a GP locum, in practices that are often struggling to recruit, without any of the assurances of training practices, can be quite a stressful experience to say the least.
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Why are GP locums important?
One in five
So many patients are seen by GP locums; a recent survey in a leading GP newspaper suggested around 20% of all NHS consultations are performed by locums. Going by the 2021 record of 367m appointments, that’s approximately 73 million NHS consultations a year.
Fresh pair of eyes
But it’s not just the sheer number of patients seen by GP locums; there are other important factors too. What GP locums lack in being able to provide regular continuity to patient care, locums help in being able to bridge the gap between their regular GP, offering a fresh pair of eyes on patient management and care. In fact some research has suggested that some cancers are more likely to be picked up if the patient has seen different doctors.
Flexible support
Working in so many different practices can require a certain mindset, so GP locums are often well-equipped to be adaptable to different types of session and working environment. Clinics that run at unusual times of day, holidays or weekends may all be something that the locum may be very familiar with. It won’t do any harm to ask.
Why are GP locums good for my practice?
GP locums support practices
This sounds obvious, but a well-organised practice can make very good use of an enthusiastic and well-prepared GP locum. GP locums are proper members of the team and not simply there to keep plates spinning until the patient can see a regular GP. As far as any patient is concerned, it should make very little difference which GP they are seeing if the right preparations have been made and the notes are clear and informative. It’s all about engaging GP locums inside and outside the practice, and if you play your cards right, your locums will soon be asking you about opportunities for partnership or salaried posts.
GP locums help maintain continuity
It seems almost counterintuitive to think of GP locums as contributing towards patient continuity, but patients often seek out a new GP to ask for a second opinion or to seek reassurance about treatment plans. If the locum strikes a good working relationship with the other clinicians at the practice, they can function as a very powerful way of offering that reassurance as and when needed, and helping patients continue with their management plans.
GP locums become new salaried GPs or partners
Think in terms of there being two types of GP locum; those that are looking for a permanent post, and those that don’t know they’re looking for a permanent post. To encourage a locum to be your next salaried GP or partner is easy – you just have to make working at your practice more enjoyable than working in any other practice they work in!
GP locums offer their feedback on how you compare to other practices
It’s well known that familiarity can cause complacency. People just get used to doing the same thing, and don’t necessarily notice subtle changes in quality or service. It can be very hard to be objective if you’re so used to a particular system. Whereas for locums, this is precisely the opposite, and may have many different parameters to compare the same type of service. Whilst respecting the professional constraints of not divulging sensitive or specific information about another practice, feel free to ask about how your service might compare to that of a similar service provided by another practice. There’s often much one can learn.
GP locums spread best practice
GP locums can work in different CCG areas and therefore will come across experiences and services that are not on anyone’s radar locally. Asking them about what sort of different services are available outside the area can reveal some particularly interesting ideas that could be adopted locally.
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What is the NASGP?
We got started in 1997 because, as locums, we felt isolated and unrepresented by the medical establishment, and after asking for help it became apparent that the best way to do this was if we set up our own national, not-for-profit membership organisation.
Gave GP locums access to the NHS pension scheme
The first thing we did was to lobby the government and the British Medical Association to make sure that we could also contribute to the NHS pension scheme.
Here to help GP locums and salaried GPs be the best they can
We have set up an extensive website with thousands of pages consisting of articles, frequently asked questions, a podcast and a fantastic national system for booking and invoicing GP locum sessions called LocumDeck.
Offer free membership for practices
Unlike an agency, NASGP’s LocumDeck is free for GP practices to use. Practices pay the locum’s fee, nothing more, and we also offer practice managers free demos and in-person support by phone and email.
Produce tools to help you get the most out of your GP locums
We have created all sorts of resources for you including very simple downloadable templates to help them manage home visits, explaining what a GP locum is, equipping a room ready for the locum, and much more.
Charge GP locums £12 a month
And for GP locums we only charge a very modest £12 a month, and with this they get LocumDeck completely free. In some parts of the UK CCGs fund full NASGP membership for any locums working in their patch.
What obstacles do GP locums face?
Professional isolation
Because many locums work in lots of different practices, providing support to practices wherever and whenever they can, as and when needed, they often sacrifice long-term meaningful relationships with staff at any particular practice. It is not unusual in any business to not be conscious of colleagues when they are not around, and so for this, and all sorts of other reasons, locums can be very professionally isolated and can go days or weeks without talking to other colleagues. This has implications both for professional isolation but also, for some, social isolation.
Here at the NASGP, we have been very proactive in setting up all sorts of locum groups across the UK, and more recently have been focusing on providing a much more organised infrastructure called NASGP Locum Chambers. Chambers provide a much more formal and organised framework within which locums can still work in lots of different practices, but have regular contact with their colleagues.
Lack of support
As anyone who works in the NHS knows, it is completely overstretched and overworked. CCGs are far too busy balancing their budgets and making commissioning decisions, and practices have got too much to do already. Quite rightly, practice managers prioritise the welfare of GPs, nurses and non-clinical staff, and it’s therefore quite understandable that the welfare of locums is overlooked. Out of sight, out of mind. GP locums look after their own wellbeing and understand that isolation can be one of the costs of choosing a career with a lot of independence; never the less, this choice can take its toll.
Unfamiliar surroundings
GP practices are very complex organisations, each run differently and often with the person in charge of a particular system or process not necessarily being on the premises all the time. The practice itself does not have much choice about what services they are funded to provide, so even individuals who work at the same practice full-time can struggle to keep up to date with everything necessary. Practice managers rely on robust systems in place to signpost all the different services available to patients.
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What to look for in a GP locum
Wears a name badge
NASGP recommends that locums wear a clearly labelled name badge attached to their shirt or blouse before they enter a practice so that they clearly stand out. Not only does it identify them to staff members who otherwise wouldn’t recognise them, it also really helps when they are in a consultation with a patient, or speaking to other clinicians during their stay at your practice. It’s well recognised that patients are more at ease when they know the name of the person that they are talking to.
Brings a door plate
Equally, a door plate should be attached to the GP locum’s consultation room door whilst they’re working in it. Although it might be tempting to print one out onto a piece of paper or even hand write one on the back of an envelope, it leaves a much better impression if the locum invests in a professionally made version that they can carry around with them from practice to practice.
Presents a professional profile
This is usually an A4 laminated card produced by the locum or their locum chamber. It usually includes a photograph, alongside a list of their professional qualifications, their training, special medical interests and some personal information such as hobbies or interests. All of which produces a very quick summary that the patient can read before they see the doctor, to put them more at ease.
Comes to meetings
GP locums often report feeling very professionally isolated, and can sometimes go from week to week without talking to another clinician. So inviting them to the occasional practice meeting can make them feel much more at home. Not only is it a great way for the locum to find out more about what is happening locally in their local health economy, but also a great way for the locum to spread best practice that they have picked up from other GP surgeries.
Comes to coffee breaks
As well as formal meetings, informal coffee breaks can be a very welcome break from a busy surgery, but also a great way to network with other colleagues in the practice. It’s a great way to find out what’s going on, and of course a great way to meet new colleagues that may well one day become a fixture in the practice.
Comes to significant event meetings
Mistakes happen, so GPs and other colleagues in the practice often get together to discuss all the different variables that might have led up to the incident, and explore ways on how to stop it happening again. Because locums work in so many different practices, they often have a unique insight into errors and potential solutions. It’s also a great way for the locum to collect evidence for their annual appraisal to show that they are participating in quality improvement activities.
Before you book a GP locum
Plan ahead
Working as a GP locum isn’t just a job, it’s a career that requires three years of additional vocational training. That’s why NASGP always refers to our work as ‘sessions’, and never uses ‘shifts’. Rather than approaching the concept of locums in your practice as simply GPs to call in to replace someone else in the event of illness, perhaps plan to discuss as a practice if there are opportunities whereby you can engage a locum on different terms, for example to take on a special role like women’s health, visits or triage.
Get insurance quotes
Speak to a specialist locum insurance provider like Practice Cover to see how much it would cost to put a policy in place should any of your regular GPs go off sick and need longer term cover.
Add staff to LocumDeck
Make sure practice admin staff know how to find a GP locum at short notice. Practices used to keep details in a special book in the practice manager’s desk, but with much greater governance around data and security, especially where personal data is concerned, an online locum portal like NASGP’s LocumDeck, with inbuilt security, nominated access and booking functionality, is a more modern and safer solution to manage GP locums.
See what your colleagues are saying about LocumDeck.
When you book a GP locum
Agree terms and conditions
Always make sure the GP locum sends you their T&Cs in advance of confirming a session. In NASGP’s LocumDeck you can view the locum’s T&Cs in advance of making an ‘Instant Book’. As well as all the obvious benefits of having a set of clear T&Cs, it also suggests that the GP locum is organised, avoids unnecessary risks and pays attention to details.
Define tasks
There are dozens of different ways to define a ‘morning surgery’, given variables like appointment lengths, breaks, numbers of patients, paperwork, visits, triage, telephone calls, private medicals, on call, ‘extras’, results and miscellaneous paperwork. LocumDeck takes in these factors, plus another 30 or so variables related to how and when a GP locum can work.
Confirm everything
Never rely on details passed verbally or via instant messaging apps like WhatsApp as these can never clarify all the complexities necessary for a safe booking. Each and every session should be confirmed with all aspects of the session clearly defined ready for the doctor’s arrival, and where online locum platforms can come into their own. Using LocumDeck ensures that the GP and practice both have clear, saved, in-writing information that can be used in light of complaints or disputes over invoicing. LocumDeck is independent of GPs and practices: it stores rates and terms on record for as long as you need them. It also saves GPs and locums time scouring inboxes and messages for key information such as addresses, start and finish times, and other essentials. You can read more on the risks of using WhatsApp, texts and emails on nasgp.org.uk.
Before the GP locum arrives
Set the GP locum up
Smartcards need activating so that the locum can log into the clinical system, document managers like Docman need access given to them and you may even need to create a login for the GP locum to get into Windows. It goes without saying that for all the usual Information Governance reasons, GP locums must always be given their own secure and confidential usernames and passwords in every case. Given how time-consuming this can be, we recommend doing it the day before
Introduce the GP locum to staff
As well as being of obvious practical and logistical benefit for all staff to know that a GP locum has been booked and can therefore be put to good use, it’s also nice for the locum to feel they’re expected and are going to be providing a worthwhile service.
Open up the room
Make sure the GP locum isn’t turning up to a cold unprepared room, especially if it’s their first time at your practice. Open the blinds, turn the lights on, boot up the PC, make sure that there are no mouldy coffee cups and that the desk isn’t untidy.
Make them a cup of tea
In our experience this is the one thing that locums talk about the most about practices. That someone they’d never met before had time to think of making them a quick hot drink. We call this a“critical non-essential”. The GP could have been travelling for well over an hour to get to you and is probably quite nervous about starting work in a new practice. It’s something we always want after a journey, but it’s often too embarrassing to ask for. It shows real thought. When we survey our members this always comes up top, and cite this as a top reason to return back to a practice.
If in doubt, delegate
We know practice managers are beyond busy and so do NASGP members. Many of these tasks could be handled by a good receptionist so rather than skip the welcome, and miss out on making a good first impression, print out NASGP’s pre-arrival checklist and delegate the aforementioned tasks to a colleague.
Our unique LocumDeck platform has been created with busy GP practices in mind. It is transforming relationships with GP locums – handling bookings, admin and terms. Much more than a booking engine, it’s about effective partnership and patient care. We know the pitfalls, so LocumDeck automatically guides both parties through the engagement. It means everyone can get on with doing their best work.