WhatsApp doc – should group messages and emails for locum work come with a health and wealth warning?

Instant messaging platforms like Facebook's WhatsApp are fun and easy to use, but should GP locums be using them to book work? Here we argue that what you gain in convenience, you more than loose in the ability to control significant aspects of your freelance GP practise.

GP locums have been using email listservers for over a decade to allow practices to inform them of available work. Recently however, advertising platforms like Facebook's WhatsApp have become popular, allowing practices to quickly publicise available sessions for 'free' to sometimes hundreds of GP locums at a time. At first glance, this may seem like an attractive, easy and effective way for locums to get work, but there are significant problems with this approach that GP locums should be aware of before adopting such a system that so obviously plays a significant role in their livelihoods and their longer term career.

On first inspection, these locum listservers could be seen to save practices time and money when advertising unfilled sessions to locums, so that many local locums receive a message (or email in the case of list servers) of those available sessions. As well as sometimes raising some funds for those who own the email listservers, or creating advertising revenue for shareholders of the platforms, it also allows new locums to the area to compete directly with more established locums.

Rather than practices and locums operating in a level and transparent market, our concern here is that locums are unwittingly supporting a market controlled by, and therefore biased towards, practices. By having such easy instant access to a very large number of locums, practices are able to dictate their rates and terms, if not directly then certainly indirectly by influencing the flow of job-related information. In certain cases these market forces have reportedly allowed practices in some areas to keep rates artificially low for 4-5 years.

Such a scatter-gun way of advertising individual sessions, especially in cases where this is done at a fixed time every day, allows practices the advantage of rapidly collecting many ‘bids’ over a very short period of time. In this way, practices have the benefit of knowing the availability of potentially dozens of locums and knowing what price each locum would charge for that session (general practice is quite unique in accepting that purchasers of services in an open market can sometimes dictate the suppliers rate, specifically, locums. The only other market we can think of where this might happen is babysitters. This behaviour is as incongruous as you - a homeowner - dictating what you'll pay a plumber to fix your boiler. It would never happen.). And because all the locums know that they’re competing against each other for the work, they will naturally, perhaps unknowingly, tend towards offering themselves at their cheapest price.

In these cases, the local 'locum market' therefore defaults to a transactional basis of low cost and availability, with many quality factors (experience, continuity, skills, reliability, familiarity etc) being left aside, and local locums competing against each other on the practices' terms rather than their own.

Such is the strength of advantage to the practices that there have even been instances reported to us of a practice using list servers to re-advertise a large number of sessions already booked with another locum, in an attempt to get a better rate, and of practices playing off locums against one another.

It is deeply concerning that large groups of professional GP locums are having to operate in ways that on first impression seem to save time but in fact serve only to work against them. Ultimately, the practices themselves also lose out if one considers the potential impact on GP locum morale and retention, practice efficiency and even patient safety of using a system that is not designed for the nuances of placing skilled professionals into complex, safety-critical workplaces.

These are difficult times for general practice, and it's painful how low morale has sunk, so to see such well-meaning and simple solutions further undermine locum's livelihoods and working conditions - many of whom may be relatively vulnerable being newly qualified, new to locuming, or new to an area - is unsettling at a time when we desperately need more GPs engaging on equal and professional terms with practices.

Why listservers and group chat platforms can be bad for practices:

  • Encourages the behaviour to book the cheapest locum, not necessarily the best suited.
  • Negative impact on culture of engagement between locums and practices, discouraging teamwork and goodwill.
  • Not designed for the nuances of placing skilled professionals into complex, safety-critical workplaces.
  • Platforms not integrated into any practice or locum systems or processes.
  • Poor provision for including significant locum variables (experience, continuity, terms, conditions, preferences, compliance documentation etc).
  • Little or no locum continuity – have to re-educate for each session – no built-up trust.
  • Booking process still takes time to await responses, screen applicants and manage the details.
  • Reduces GP locum morale and retention.

Why listservers and group chats platforms can be bad for locums:

  • Primarily serves practice short-term need.
  • Drives price down.
  • No inbuilt focus on quality or safety.
  • Often non-standardised booking process with unclear terms of engagement exposing locum to risk of carrying clinical responsibility while working in a way they have had no control over.
  • Wastes time chasing work with little chance of winning.
  • Discourages teamwork and goodwill between practices and locums.

Are there any alternatives for practices and locums to quickly find each other?

Since 2002, the NASGP has advocated the GP locum chambers concept, and in 2016 launched LocumDeck as a means by which individual local GPs can also have a far greater control over their working lives – both based on quality, welfare and income – and allow locums to work in a more balanced market, rather than one completely controlled by local practices.

Both locum chambers and the online booking feature of LocumDeck use what NASGP term "proactive booking", where GP locums define their T&Cs and safe working boundaries in advance and then publish their availability, which practices can then quickly book. It's the opposite way round to the traditional, reactive booking described above and is a potential win-win for both practices and locums, incorporating the speed and convenience that practices need with a robust booking process and a clear, shared agreement of workload and terms. It can take a while to get established if you don't have the good fortune to already have a chamber or many LocumDeck colleagues in an area, but once established these more balanced, transparent ways of engaging with practices can provide real benefits for the entire local healthcare community.

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