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Sessional GPs - Take good care of your locums

Dr Judith Harvey reminds practices to treat locums well to ensure their help is available when needed.

There can be a world of difference between how a plumber and a locum are treated by some practices (Photograph: Istock)
There can be a world of difference between how a plumber and a locum are treated by some practices (Photograph: Istock)

A locum is like a toolkit: vital if you are a frantic practice manager with two doctors and three fully booked surgeries, but otherwise largely forgotten.

But locums are human beings too. Although they are often engaged at short notice, this is no excuse for usage that is frequently poor and sometimes exploitative.

Practices often fail to get the best out of locums, putting patients, locums and the practice at risk. The result is patient dissatisfaction, complaints and a gulf of bad feeling between the hiring practice and locums hired.

A locum is not a GP partner in disguise. How many of your partners could consult effectively in their colleagues' consulting rooms, let alone in a practice with a different computer system, patient clientele and ethos? Locums do this all the time.

Today, around 15,000 GP locums will be seeing patients. The profession's representative and educational bodies have an obligation to this crucial element of the workforce. Yet their needs are poorly served.

Doctors receive minimal training in locum work. The GPC struggles to represent both GP principals and salaried and sessional GPs. Good practice for hiring locums is not considered in GPs' or practice managers' training and does not feature in the QOF.

  • Locums are expensive but practices would not employ a plumber as casually as some employ locums.
  • The plumber knows what they have been asked to do. Locums are often asked to 'do a morning surgery' without clarification about visits, extras and administration.
  • The plumber is probably offered coffee. Locums often do not even get a break.
  • The plumber charges the going rate and is paid promptly. Locums may be obliged to accept exploitative rates and wait weeks for payment.

When did the local practice managers' group last invite a locum to talk about their experiences. When did your practice hold a staff training session on helping locums to make the best use of their time?

You cannot rustle up a locum booking form, produce a briefing pack or set up the computer properly in five minutes. Good management of locums should be part of practice culture.

Here are some of the barriers locums encounter to working optimally:

  • 'I'm afraid it's just a locum today'. Hearing this, most patients will promptly rebook with a partner. What a waste of money and goodwill given that the undermined locum will pass on negative impressions to colleagues.
  • Commonsense patient safety precautions are not universal. Some practices do not use individual computer log-ins to provide an audit trail. If a locum prescribes penicillin to a patient with a history of severe penicillin allergy and the practice logs in all locums as 'locum', it would not be able to prove who had written the prescription and would be vicariously liable.
  • Broken equipment, out-of-date test strips and even a grossly untidy consulting room are other ways in which patients could be put at risk.
  • Locum work in unknown territory. A quick verbal sketch of the practice and its dynamics is helpful. Why is the doctor absent? If due to illness, have they broken a leg or gone off with depression? If they have resigned or been suspended, why? The information may be important when the locum is examining patients' medical records.
  • Staff need to understand there are jobs that a locum cannot do - signing passport forms, for example- and there are tasks which locums can rightfully refuse to do - signing repeat prescriptions, for example. Most locums will oblige but they do not know the patients.
  • Locums need time - perhaps quite a lot - to check patients' notes. They can refuse to sign a prescription they consider unsafe. Similarly, it takes locums longer to interpret radiology reports and comment on test results.

If the locum turns up drunk or is rude to staff or mismanages a patient, the practice has an obligation to do more than cross them off their address book. The GMC's Good Medical Practice (www.gmc-uk.org) outlines the action GPs should take if a locum gives cause for concern.

However, a good locum is a great asset. So why not invite regular locums to practice meetings and educational events?

  • Dr Harvey is a locum in central London.

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