The inquest into the very sad death of Mr David Gray after being injected by a lethal dose of diamorphine by a GP locum has now begun. It’s widely envisaged that the 10 day inquest will focus on the fact that the locum, Dr Daniel Ubani, was not used to working in the UK, having only travelled from Germany the day before, had been trained outside the EU, and English was not his first language.
But there are elements to this case that will resonate with many UK trained and resident locums. With anything up to 15,000 GPs working as locums in the UK at any one time, working often in excess of 30 different surgeries a year, in several different PCTs using any one of around 9 different IT systems, often isolated from other GPs and poor or absent methods of locum induction, Britain’s locum GPs should congratulate themselves for this not happening more often.
Although fortunately such tragedies as this are highly unusual, it’s safe to say that underperformance – or perhaps better described as enforced underperformance – is an all too common situation faced by GP locums. Even our profession’s own Royal College’s consultation document recognises that locum GPs will find periodic revalidation more difficult than a conventional GP. This isn’t for want of trying – GP locums are on the whole a very enthusiastic group of highly qualified professionals. It’s root, however, is institutionalisation. The number of GP locums has soared, yet absolutely no investment has been made to support locums whilst in practice (there are some locum support organisations, but practically all are run voluntarily), to develop systems that would fully enfranchise such GPs into the systems and processes of the NHS (for example, GP locums are still excluded from receiving essential prescribing information otherwise easily accessable by any other GP) or to teach GPs in training how to work in so many different practices.