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Locum toolkit

Just because GPs receive little or no specific training on how to work as a locum, doesn't mean it wouldn't have come in very useful.

From managing your locum practise, avoiding risk, working in dozens of different surgeries from the uber-organised to the downright chaotic, handing over care and creating an excellent rapport with patients requires a lot of skill. And every craftsman requires tools. So NASGP have produced a huge range of practical, adaptable forms to help you in your day-to-day work.

Locum tools

A cancellation can be devastating for a locum GP, particularly if it's last-minute. You may have put off other work in order to undertake the planned work, and of course may have dependents, a mortgage, loans. Same applies to anyone, which is why you have legal rights in this situation.

Firstly, refer to the terms and conditions that you agreed to - if you used the NASGP's model T&Cs, you will have a cancellation clause that means the practice must pay you a certain figure if cancelled within the agreed time limit.

If there is no agreement in place and the practice does not pay appropriate compensation the locum may be able to pursue a claim for breach of contract in a small claims court - have a word with your BMA or MPU Industrial Relations Officer or, if you get no joy, your local Citizens Advice Bureau should help you out.

See more in the NASGP Locum Toolkit

Funding for locum appraisal was withdrawn by the NHS in 2013, but that doesn't mean you can't try claiming it from a CCG or other local PCO.

Complete NASGP's locum rates calculator to help you work out your baseline hourly or sessional locum rate. Once you've done this, you can then tailor the rate according to your experience, skills and different practices you work in.

View locum rates calculator

NB you can now set your T&Cs online in NASGP's LocumDeck.

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
  • duties
  • 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.

Working in different practices, do you ever get that 4am brain worm about a patient you saw the day before? At NASGP, we're used to this experience, so have developed a tool that may not only keep those brain worms away but also help you improve patient care and help generate evidence for appraisal.

 

Pesky little buggers...

Pesky little buggers...

It's imperative that all GP locums receive a flu vaccine at the earliest opportunity to prevent us acting as an unsuspecting viral vectors as we move from practice to practice, typically working in 30 different practices a year.

As GP locums, we are arguably at our most needed during flu season, so it's in everyone's interest that we all get vaccinated.

Since 2016, it's also in a practices interest, since NHS England are incentivising practices to vaccinate 75% of all their front line staff.

Fortunately, employing surgeries are often fairly obliging when it comes to vaccinating ocus, and it really doesn't cost that much to get a shot from local chemist. But if you're minded to get it for, this download, even if it doesn't get you the money, will at least raise this as an issue.

You can now automatically add this to your T&Cs in NASGP's LocumDeck.

Locum toolkitDo you get your own username and password when signing into practice computers? Sick of always being signed in under various combinations of ‚ÄėLOCUM1/DRL/LARRYLOCUM‚Äô? Perplexed as to how it‚Äôs your first time at the practice but looks like you (DRLOCUM) have seen this patient twice already this month? Irritated because you can‚Äôt work out who all the other freelance GPs are who‚Äôve 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‚ĶOK, you get the idea.

passwordSecret passwords and usernames are essential to working as a GP ‚Äď recording contemporaneous medical information in the patient‚Äôs notes is a vital part of clinical management; and a medico-legal requirement. And if your password isn‚Äôt 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‚Äôt. For example, the procedure for setting up passwords on Microtest can be quite tricky. So we‚Äôve been working with them (and what nice people they are) to make the procedure easier.

Meanwhile, here is a download to place under the noses of any defaulting practices.

 

 

With over a thousand downloads, we've now automated our manual invoice and is now all part of LocumDeck.

There's an awful lot of confusion and inconsistency about what training is statutory, what is 'required', what is needed and what a practice wants or expects.

But what we do know is that NHS appraisal is a statutory requirement, so we have provided a template for you to adjust to your own needs, sign, and give to any practice who asks for it to reassure them that your NHS appraiser is satisfied that you are fulfilling any necessary requirements to practise as a GP.

 

Hepatitis B immunisationIt's now a requirement of the Care Quality Commission CQC that every member of staff working in a GP practice has an up-to-date Hepatitis B status. The MPS have prepared a summary of why this is needed, as part of the CQC's Cleanliness and infection control (Outcome 8, Regulation 12) "People are cared for in a clean environment, and are protected from acquiring infections".

If you're a chambers locum or are employed as an agency locum, they'll no doubt otherwise notify every practice on your behalf. Otherwise it's a sign of a well organised locum to provide this in advance of working.

If you're employed by a practice as a salaried GP, you'll be entitled to free immunisation status checks and boosters if they're a good employer. As a locum, unless you can persuade a friendly practice, you'll have to arrange this yourself with your own GP as a private service.

Added to this, the Green Book states:

Healthcare workers in the UK and overseas (including students and trainees): all healthcare workers who may have direct contact with patients’ blood, blood-stained body fluids or tissues, require vaccination. This includes any staff who are at risk of injury from blood contaminated sharp instruments, or of being deliberately injured or bitten by patients.

As a GP, if you're exposed to continuing risk of infection, you should have a single booster dose of vaccine, once only, around five years after primary immunisation. Measurement of anti-HBs levels is not required either before or after this dose.

Read this FAQ to find out

  • How often you need a Disclosure and Barring Service DBS check
  • Where and how to get one
  • How it works if you work for a locum agency
  • And what the CQC say about it
Read the FAQ

With pressure for appointments increasing, it can be difficult to ensure that a patient of concern has access to the follow-up you had intended. Try using this form to flag up to reception when a patient really needs review.

 

 

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.

Part of NASGP's Spip Toolkit

 

Podcast on locum GP exit feedback

 


More tools for practice managers

 

 

Our hugely popular locum pension spreadsheet has now become LocumDeck  - completely free to NASGP members Within seconds, generate online automated pension forms, complete with paperless electronic signatures, including invoicing, bookkeeping, T&Cs, document manager and optional online 'Instant Book' booking.

See more NHS pension FAQs

 

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!

This FAQ on long-term locum work is from the perspective of being a GP locum in the same practice for a 'long time', rather than about choosing working as a GP locum as part of your career portfolio.

It explains it from four different perspectives - NHS pension scheme, HMRC tax perspective, employment law and 'mission creep', and there's even an audio podcast too.

A long-term locum post at a practice often starts off as a short-term venture, but with significant recruitment problems in general practice at the moment, it's likely the practice will want to hold on to you and keep you coming back.

Alternatively, your stint at the practice could have begun very much with the long term in mind. Either way, the longer you're at the practice, the more your role will slowly change from that of ad-hoc short-term locum to being part of the practice team. As this process goes on, not only will your significance within the practice develop in the eyes of patients and staff, but certain regulatory factors will also come in to play.

There are four areas that need careful consideration the longer you work for the same practice.

Tax purposes

  • The decision of whether you're self-employed or an employee for tax purposes is ultimately¬†down to HMRC, and depends upon factors such as if you¬†run your business for yourself and take responsibility for its success or failure, work for several practices¬†at the same time, and you can decide how, where and when you do your work etc. More details are available on the GOV.UK website.
  • Or you may have already set yourself up as your own limited company.
  • Use HMRC's employment indicator tool¬†to give you a clearer understanding of your tax status.
Our advice is to ask an accountant if you're unsure in any way.

Employment law

Although your work at the practice may have begun with you being self-employed, or employed by an agency, certain factors in the way you work with the practice may, over the duration, inadvertently give rise to you becoming an employee of that practice in terms of employment law.

If you're employed by the practice, you can have access to certain rights such as Statutory Sick Pay, protection against unfair dismissal, the right to request flexible working and quite a few other rights.

Employees have a contract, and this can be written or verbal. Consider adding this to your own T&Cs.

NB you can now set your T&Cs online in NASGP's LocumDeck.

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
  • duties
  • 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.

What makes you an employee for the purposes of employment law can depend on about 15 different factors.

To protect both the GP and the practice, we advise having a conversation about your duties with the practice manager sooner rather than later, and taking any necessary legal advice, to make sure both parties are clear about your contractual status.

Long-term status for the purposes of NHS pensions

Mission creep

There are as many reasons for working as a locum GP as there are GP locums. Some of us enjoy working in lots of different practices: spreading best practice; supporting practices in difficulty; offering patients a fresh approach to their care; a second opinion, and focusing on direct patient contact. Whereas others love continuity of care, building therapeutic relationships with patients and getting more involved with the running of the practice on a day-to-day basis.

Often, if just covering a few sessions for a practice, one would expect to simply deal with the patients seen in surgery that day and any necessary paperwork resulting from those consultations (such as writing referral letters etc), and this is what one would generally be charging the practice for.

If working again at that practice over the coming weeks and months, one would expect to results of investigations, tests and referrals to start returning to the practice. These results and correspondence would either go back to that patient's usual GP (if there is one) or one of the other practice GPs. But if no-one is available, and especially if you requested these tests, it's quite likely that these results will be given to you to deal with.

Of course, this may well be all part of what you really value in working as a GP, but it does take time beyond that which you may have initially agreed, and could start to eat into the time you'd normally allocate to your other roles. By being such an obliging GP, no doubt too you could soon become the go-to GP who all the staff find so helpful, and find your workload rising exponentially - greatly increasing your value to the practice, but also having a potentially huge impact on your work-life balance.

Set boundaries

All of this is quite containable to begin with, but if not controlled early on could just get out of hand. Our advice is, if the same level of workload is set to continue, after a certain amount of time and/or workload e.g.

  • two sessions a week for six weeks, or
  • six sessions a week for two weeks

To either

  • negotiate more pay, pro-rata, or
  • reduce the number of patients seen during a session and replace that patient-contact time with administration time.
Consider adding this to your own T&Cs.

NB you can now set your T&Cs online in NASGP's LocumDeck.

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
  • duties
  • 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.

It's safe to say that as GPs, we often have a great sense of duty to practices and can find it exceptionally hard to refuse help when our input is genuinely needed. But if we neglect to contain the expectations of practices to a sustainable level that each of us can comfortably manage, it could just end up with us becoming the patient. And that's of no use to anyone.

Listen to our podcast on long-term locuming

Locumdeck's Bookkeeper updates itself completely automatically from the rich information generated from all the travelling and locum work you do, and also allows you to add other financial data too to cover all your self-employed work. At any time, you can export any data you need, and also generate a smart financial report for your accountant or financial advisor.

Bookkeeper is integrated into LocumDeck - click on the Bookkeeper tab at any time to integrate the pages of information within.

Automatic

  • Smart session counter to help you work out the number of 4-hour equivalent sessions for indemnity purposes.
  • Number of sessions worked.
  • Total amount earned.
  • Breakdown of employer pension contributions.
  • 'Reimbursed' travel costs as applicable (not part of your pensionable pay).
  • Paid/unpaid status of invoices.
  • PDF copies of all invoices and automatically completed Locum A and B forms.
  • Mileage (automatic)
    • Between home and practice
    • Between practices
    • Individual journey details

Manual

  • Cremation fees
  • Medical reports
  • Private work
  • Lecturing
  • Appraisal
  • Work invoiced outside of LocumDeck
  • etc
  • Export reports
    • Fees
    • Earnings (by date worked)
    • Invoices and pension contributions
    • Mileage
  • Mileage (manually added)
    • Visits
    • Other work travel
  • Expenses
    • Subscriptions
    • CPD
    • Admin expenses
    • Travel expenses (other than mileage)
    • etc

So much of Bookkeeper has been made possible from generous feedback from our existing users of LocumDeck and the support of Liz Desnely and her team from Honey Barrett.

Even as a GP locum there are some simple and affordable steps you can take to reduce the risk of losing out financially if you can't work through illness.

Your ability to receive income whilst off work through ill health whilst working as a GP locum very much depends on your employment status i.e. whether you're an employee, self-employed or 'worker'.

Remember that your legal employment status is something that is not necessarily determined by you, and is different to your tax employment status and your NHS pension employment status.

This FAQ is from the perspective of being a GP locum in the same practice for a 'long time', rather than about choosing working as a GP locum as part of your career portfolio.

It explains it from four different perspectives - NHS pension scheme, HMRC tax perspective, employment law and 'mission creep', and there's even an audio podcast too.

View FAQ

I work for a locum agency

I'm self-employed

  • If you're locuming in different practices using your own Terms and Conditions, managing your own bookings and determining the way within which you work, either manually or through platforms like LocumDeck, then your employment status is likely to fall within the self-employed status.
  • In which case, you don't qualify for SSP in that role.
  • But if you already have a Locum Insurance Policy, then this could cover you for up to ¬£3,000 a week or 75% of your earnings for a year if you‚Äôre ill or injured and can‚Äôt work.

I work for an online locum platform

What about Permanent Health Insurance and Critical Illness Cover?

These are policies for much longer long-term benefits. Read this for more information:

Should locum and salaried GPs get income insurance?

 

Practice tools

Are you a sessional GP?

In which case, please join our Facebook group (clicking on this link opens a new tab).

Download this template and adjust it to suit your practice's own needs.

We recommend printing it out (maybe as the b-side on the back of other patient information?) to be handed out to patients as they arrive.


More tools for practice managers

 

 

Home visits are some of the most complicated activities that GPs do. Away from electronic records, usually after a busy surgery, through traffic, to sick or frail patients, often with multiple problems and anxious carers.

Our template helps you make the whole process go much more smoothly.

And don't forget, your Spip practice pack can be accessed via smartphone too.

 


More tools for practice managers

 

See also

Avoiding pitfalls on home visits

These allow clinicians to make a physical record of every consultation that needs referral, reducing the likelihood of a referral going missing.

 


More tools for practice managers

 

 

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.

 


More tools for practice managers

 

 

 

 

The best person to let you know when a room needs reequipping is the last person that used it. Print some of these out and pin to each room's notice board.

 


More tools for practice managers

 

 

 

 

Patients usually prefer to see their usual GP, but that's not always possible. So it can be really handy to give them a good explaination of what a locum GP is, and how actually seeing a locum could be advantageous too.

 


More tools for practice managers

 

 

 

 

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.

Part of NASGP's Spip Toolkit

 

Podcast on locum GP exit feedback

 


More tools for practice managers

 

 

IT systems

If you come across any more up-to-date Emis Web videos, please get in contact and we can add them here.

Want to get to grips with the basics of Vision? Sign up for five free Vision training modules, covering navigation, recording data, prescribing, results, referring and DocMan attachments.

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We asked David Hindmarsh from GP Templates Ltd to see if he could add some locum induction templates to his ever-growing TPP SystmOne YouTube channel, and he's willingly obliged.

SystmOne YouTube channel

Below we've embedded David's 'basics' YouTube channel, and by clicking on the arrow in the top left hand corner, you can easily see David's other SystmOne videos as and when they're added.

Don't see what you're looking for in the NASGP locum toolkit, or have a request? Leave a comment below and we'll get back to you.