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Practices can learn a lot from their locums

Locums can offer practices valuable feedback and may bring new skills to the team, says Dr Judith Harvey.

Every now and again consider paying a locum an extra hour to get some constructive feedback (Photograph: Istock)
Every now and again consider paying a locum an extra hour to get some constructive feedback (Photograph: Istock)

Employing a locum costs lot of money. Make the most of it. Locums are more than a stop gap. They are a valuable resource: highly-trained GPs who often have a lot of experience that can be useful to your practice.

Advantages for patients
A locum is not the patient's usual doctor. A consultation with a locum is different from one with a doctor they know, but that is not necessarily a bad thing.

A locum is a fresh pair of eyes and may spot something that familiarity has rendered invisible to a clinician who sees the patient regularly. Examples of this could be slowly enlarging girth due to an ovarian cyst, increasing slowness and coarsening skin due to hypothyroidism or the heavy facial features of acromegaly.

Humbling though it may be for GP partners to acknowledge the fact, for some patients a locum is a welcome opportunity to consult with someone else.

Patients who have lost confidence in their usual doctor can be grateful for the opportunity to tell their story to a doctor who is not approaching the consultation with years of baggage.

Having a new listener may lead to new ways of tackling intractable problems, and so refresh a relationship with the practice from which all optimism has been drained. And a locum offers staff members who are also patients at the practice an opportunity to consult with someone who is not their boss.

Informal monitoring
That fresh pair of eyes also sees what the patients and visiting primary care organisation staff see when visiting the surgery.

Staff standing on the pavement outside the practice smoking, year-old posters in the waiting room, spelling mistakes on the LED display, an abrasive receptionist, dangerous electrical fittings are, for example, all things which give newcomers a bad impression of the practice. It is better to encourage locums to tell the truth than to let the practice's reputation with patients slide.

Remember that experienced locums have seen the inside workings of dozens of practices. Before they leave your premises, pick their brains.

Every now and again consider paying a locum for an extra hour to get feedback.

What do they think you are doing well? What aspects of the practice would they commend to other practices? Then find out what isn't so good. Are there things that have worried them? If it is obvious to a locum that two of the partners aren't on speaking terms and the practice nurse isn't pulling her weight, the problem needs to be tackled.

If locums tell you that the patients' notes are hard to navigate, or they are unhappy with the way repeat prescriptions are managed, find out why and ask for their suggestions about changing your system.

  • Locums are expensive: make the most of the opportunities they offer.
  • For patients, locums offer a fresh pair of eyes.
  • For practices, locums can be a useful sounding board.
  • Locums work in a lot of practices. Their experience can be useful to your practice.
  • Today's locum may be tomorrow's salaried GP or partner.

Make friends with your locum
If locums tell you it is impossible to locate important pieces of equipment (often the foetal monitor), they may have an idea for solving the problem. And be prepared to raise your areas of concern.

Maybe your system for handover doesn't seem as robust as it needs to be. How do other practices handle it?

No practice wants to spend more on locums than it has to, but creating a good relationship with locums can be useful. The temptation is to run such a tight shop that the practice has no slack to call on when, for example, one partner goes down with chickenpox. A locum who knows the practice team can fill the gap at a time of crisis.

Future team members
Locums may have skills none of the practice's GPs possess but which you can make use of to offer a special service - sports medicine perhaps, or long-acting contraception. And should you be considering appointing a new partner or employing a salaried GP, you know whether there is a GP among the locums you use who would adapt well to a long-term role in the practice.

  • Dr Judith Harvey is a locum GP in London

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Is your briefing information for locums up to date? Ask your locums what they would like added, review the material and ask the practice manager to correct/add information about practice systems and local services. Read the revised information.
  • The next time a locum new to the practice spends a few days with you, ask them to provide some constructive feedback about how the practice operates.
  • At a partners' meeting discuss aspects/processes identified by the locum as possibly needing attention. Draw up an action plan and implement within a set timescale (eg three months).

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