Locums are a very rich and diverse workforce, so it comes as no surprise to Isobel Heyworth when she is asked by a new practice if she can supervise a medical student.
I’ve certainly known a number of fantastic locum colleagues who, having done years of medical education in a salaried or partnered role, have continued, despite shifting into locum work, especially if they stayed at one practice. Similarly, as a clinical lecturer at the University of Manchester, fresh-faced GP ST3s are as keen to hear about ways into teaching as they are about locuming in my experience. Despite this, I know first hand that medical schools have been very slow to offer formal opportunities for locums as clinical placement supervisors, and does seem like a waste of some incredibly experienced clinical educators.
Much of this has been historical. Universities pay practices for each placement, and teaching is negotiated in turn by the practice as part of a GP's weekly workload. In addition, part of the payment is for the premises, as well as the other healthcare learning opportunities a student might be beneficially exposed to – nursing clinics, pharmacist clinics, practice manager etc. Just the thought of paying one-off locums directly for teaching a single session in a semester block is enough to send the Medical School Admin in to meltdown, to say nothing of how to adjust learning experiences, ensure the safety of the student environment and quality control each locum tutor. Never the less, medical schools are growing, and in combination with a melting pot of increasing GP workload pressures and reduced funding, traditional GP Clinical Placement tutors are in increased demand, and new workable models are being actively sought.
...there was a very real enthusiasm to teach, but responses stressed the importance of parity with the clinical hourly rate as well as the importance of extra time to allow the teaching to take place.
Consequently I was asked by my university employer to consider exploring the feasibility of GP locums as Clinical Placement Tutors. This in turn lead to the distribution (with the help of the NASGP) of an anonymous survey about locums' attitudes and incentives towards undergraduate teaching, that you may have seen or even taken part in.
51 responses from locum GPs were analysed. You can read the full paper, co-authors and references here. The majority of respondents were very happy with their role and recommended a locum career to students due to flexibility, workload autonomy and patient care, with reduction of admin and bureaucracy. Challenges of locum work were described as isolation, disrespect and difficulty of knowledge updates.
Further results showed that there was a very real enthusiasm to teach, but responses stressed the importance of parity with the clinical hourly rate as well as the importance of extra time to allow the teaching to take place. Our locums not unreasonably, expected payment comparable to their clinical rates, as well as three or more blocked, catch-up slots per session to allow for the teaching component to be successfully delivered. Pay per hour was found to be more important than pay per patient, fitting with a group often juggling many different roles or a portfolio career who value a density of work followed by free time over a more relaxed working day but less long-term flexibility. Finally the preference of previously knowing the practice in which they might teach was also a very influencing factor in the results.
Despite its small size and limitations, the study demonstrates that a good proportion of GP locums are willing and keen to teach. They have the autonomy, flexibility and portfolio careers that are often associated with excellent promotion and retention of a GP career. A previous, limited small pilot has shown that GP locum placement tutors can be successfully used if they are prepared to accept pay below a clinical level. However, our study shows that this would be generally unacceptable to locums without other considerations given for their additional teaching role. The primary one of these would be blocked-off sessions in combination with a supported, respected and teaming working environment, which maintains their autonomy and flexibility of working.
Given the well documented need for increased GP numbers, anticipated to be realised by an increase in quantity and quality of GP placements in medical school by policy makers, this paper recommends that the funding disparity of undergraduate placements between primary and secondary care must be urgently resolved with primary care receiving the funding equal to that of hospital placements. This would enable the extra slots or increased payment that GP locums have stipulated here in order to become seriously involved in teaching, increasing the much-desired placements with a motivated and rising GP workforce, promoting and thus, it is hoped, increasing numbers of qualified GPs.
Never the less, it must be noted that such extra funding would likely enable remaining practice-based GPs to re-evaluate the business case for taking students in the first place, no longer forcing them to run education at a loss, re-establishing the popularity of traditional teaching placements and likely eliminating the need for a new model at all.
Dr Isobel Heyworth