When the going gets tough

Managing your own wellbeing can be difficult as a locum, as prioritising your own health and safety over the needs of a practice could sour your relationship with that practice. However, it is important to ensure that you are practising in a way that is compatible with your own personal safety and wellbeing, and that of your patients. Dr Rachel Birch, GP and medicolegal adviser at Medical Protection, outlines three potential dilemmas that locum GPs could face.

What to do if you are unwell?

You have been unwell since the weekend with a chest infection. You are on antibiotics but they are slow to work and you are still feeling very tired and you don’t feel well enough to work. You are due to be duty doctor the following day at a single-handed practice where the partner is away on leave. The practice manager has telephoned you every day for the last three days to ask if you will be well enough, and you have consistently advised her it is unlikely. However, she tells you she can’t find an alternative locum.

What should you do?

If you feel that you are too unwell to go to work then you should trust your convictions and not do so. If you do go to work, you could be posing a risk to patient safety through your ill health. Although it is inconvenient for the practice to have to find a locum at short notice, patient safety is paramount, as well as your own health needs.
The GMC states that if a doctor’s judgment or performance could be affected by illness, they should seek advice from and follow the advice of a qualified colleague. They expect GPs to be registered with their own GP and not rely on their own assessment of their health.

Request for house visit in thick snow

An elderly housebound patient in a rural area calls the practice asking for a home visit. The practice senior partner asks you to visit the patient, as the rest of the practice team is busy. The patient lives in an isolated area, one hour’s drive away from the practice on difficult roads. It has snowed heavily all week and you are unsure if your car will survive the trip.

What should you do?

It is important to be as prepared as possible for poor weather and ensure that your car has been recently serviced and the tyres are in good condition. Locum GPs do have a personal responsibility to ensure that they have effective transport, within reason, to carry out home visits.

However, in severe weather, it is important to make a risk assessment of any request for a house visit and consider the safest way to provide care, both for you and the patient. Is the visit essential today, or can it wait until the weather improves? Would telephone advice suffice? Does anyone at the practice have a 4x4 vehicle and could they take you to the visit? Do the other GPs know the patient better and the whereabouts of their possibly remote cottage? In exceptionally poor weather, in cases of urgent clinical need, you may need to seek assistance from the emergency services in reaching a patient.

If you are traveling to visit patients in poor weather, ensure the receptionist knows where you are going and when you expect to be back, and what action to take if you don’t return. Ensure your mobile phone is fully charged and take jackets and snow shovels in your car.
The GMC states that doctors should raise concerns if patients are at risk because of inadequate premises, equipment, resources, policies or systems - the same advice would be applicable if you feel your personal safety is compromised. You should discuss any concerns with the practice manager.

Concerns about visiting a patient alone

You are a female locum GP and have been allocated two home visits by the male senior partner. You have reviewed the cases before you go out on your visits and there is an alert on the records of one of the patients, stating that he should not be visited by unaccompanied female staff. On closer inspection, it appears he has a history of violence towards women and was removed from his last practice list for aggressive and threatening behaviour.

What should you do

You should raise your concern with the senior partner and suggest that he carries out the home visit, in return for your doing one of his. This would be the easiest solution. If he cannot be contacted, you should assess the urgency of the visit - can it wait for discussion with him on his return?

The practice has put the alert on the record for a reason and it is important not to ignore this. If the visit is essential and urgent, consider whether to take a male member of staff with you or even, in rare situations, whether to ask the police to attend with you.
Locum GPs should not find themselves in a position that compromises their personal safety. Most practices have zero tolerance and lone working policies to protect their employees, including locums, from risk of personal danger.

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