Why are 15,500 GPs held in poor regard? It is because they are locums.
Every practice needs a locum now and again, and sometimes on a very frequent basis. Locums often step in at a moment's notice. They are a vital part of the GP workforce. But despite the skill and flexibility that it takes to sit down in someone else's consulting room and see someone else's patients, being a locum is not a prestigious job.
Unrealistic expectations contribute to the general air of dissatisfaction. In an emergency, a practice wants a magic wand, and the staff secretly hope a locum will be a replica of the GP into whose shoes they are stepping, minus the annoying habits.
However, the locum is not a replicant, but a different person, perhaps a different gender, a different age, with a different approach to patients. The locum does not know Mrs Bloggs or where Dr Smith keeps his prescription pad. Other things of which the locum will be unaware include where the practice keeps the pulse oximeter, that specimens are collected before 11.30am, or that to get the printer going you need to give it a kick.
Nobody checked in advance whether the locum is qualified to insert IUDs, so Ms Green has to make another appointment and is annoyed. The locum has an afternoon surgery booked 10 miles away, so cannot stay to do the bits and pieces they are presented with at 12.45pm.
The result is that the locum runs late, interrupts staff by asking for help, does not manage to do all the things the absent doctor would have polished off, and departs leaving an impression of having done a second-rate job.
The disappointment is two-way, of course. The locum feels the practice is poorly organised and the staff elusive and unhelpful. The likelihood is, locum colleagues will be advised not to work there.
It does not have to be like this. The first step is for the profession to embrace locums as essential colleagues and value their skills. The second step is ensuring that all GPs - we are all potential locums - receive training in those skills. The third step is realising that locums have no control over their working environment and it is down to practices to address enforced underperformance.
Let us start with the RCGP and the GPC, the organisations that head our profession. How generously do they acknowledge that about 30% of the people they represent work as locums?
When was a question specific to locum work last asked in the MRCGP examinations? The RCGP curriculum barely mentions locums and offers no guidance on the skills, clinical and managerial, that they need. No wonder new locums founder. However, many local deaneries now offer sessional GP support and special study days - that is at least a start.
In addition, the GPC now has an effective sessional GPs subcommittee. The subcommittee is working on locum involvement in clinical commissioning groups and information cascades. The Locums' Handbook is due out this spring.
But sessional GPs are still underrepresented on the GPC, and despite strenuous efforts by some members, it still tends to be the employers' point of view that wins the day.
With notable exceptions, the same is true of LMCs. Locum issues can drop off the end of a busy agenda. So if you feel hard done by, stand for election.
Revalidation is slowly approaching and one obstacle has been deciding how to assess GPs who are not practice based. How do you judge flexibility, for example? And how can you decide whether a locum does better or worse than the average locum, when we do not know what average performance is?
Sadly, GPs do not have a good record as employers of their peers. The idea that all locums roll up to the surgery in their Porsche is hard to dislodge from partners' minds. Just as the idea that GP partners earn £500,000 a year is hard to dislodge from the mind of the Daily Mail.
As times become harder, it is ever more tempting to squeeze the last drop of juice from the lemon. But locums, like partners, should be earning enough to cover time out of the working day for education and to take holidays. Worn-out GPs who are unable to update their knowledge are at increased risk of making mistakes that affect not just their careers, but also practices, patients and reputations.
A bit more moral and contractual pressure on practices that exploit employees, and reminders of their legal obligation as employers, would help.
When did your practice last look at itself from the locum's point of view? Do your locums have a personal computer log-in? Do you have an up-to-date induction pack? Are tools of the trade to hand and fit for purpose? Do you value and support your locum colleagues, or do reception staff tell patients: 'It's just a locum today?'
A 'them and us' attitude is neither helpful nor realistic. Every GP is potentially a locum, an employee or a partner. To give of our best for our patients, we need to support each other.
- Dr Harvey is a GP locum in central London