In the current climate practices are becoming increasingly reliant on locums in order to cover sessions. Recent research by GPonline suggested that on average around one in six sessions in a practice is filled by a locum.
But how do you source a suitable, available locum? There are various options open to practices, each with pros and cons.
When it comes to thinking about how locums are booked, the National Association of Sessional GPs’ (NASGP’s) favoured approach is to think of it in terms of either reactive or proactive bookings.
Booking methods: Reactive vs proactive
Reactive booking is the traditional mode of finding and booking a locum that, to date, will be most familiar to practices and locums. It usually involves the following phases:
- Enquiry phase - the practice sends out their booking requirement o individual freelance GP locums and/or to multiple GP locums possibly via a single portal such as an agency, online platform or social media group messaging app
- Screening phase - the practice awaits responses to their enquiry and screens applicants for suitability
- Negotiation phase - terms are agreed, ideally including the duties and fees
- Confirmation phase – commitment is made on the basis of the agreed terms and the booking is finalised
Reactive booking allows locums to be responsive to practices’ needs, but each phase can take varying amounts of time and practice booking managers can therefore find the process labour-intensive and time-consuming.
Proactive booking is a much more modern approach championed by the NASGP, and involves GP locums proactively publishing their real-time bookable availability.
At its most basic level, locums can share their general availability with certain chosen practices, saving both practice and locum time by reducing unnecessary enquiries for periods when a locum is unavailable.The locum needs to commit to keeping their availability continually updated, often requiring a suitable web platform and there are still the all-important negotiation and confirmation phases to ensure that everyone understands the work agreed.
Some GP locums allow practices to go straight to confirmation phase. They do this with the help of online platforms like NASGP’s LocumDeck, or a single booking portal provided by a locum chamber. These platofrms accurately show a locum's real-time availability and define the sessions, terms and fees they are prepared to offer, along with their professional credentials, which allows the practice to move straight to making a booking if they accept the terms.
It may mean that a practice may not get precisely what they were looking for, but this is balanced by saving hours of time, and potentially money, in sourcing a locum with clearly agreed terms.
However practices and locums decide to make their bookings, there are different ways that you can source a locum – these are outlined below.
Local networks of independent locums
If you are fortunate, you may have an informal network of contacts with trusted local GPs who can step in: the retired ex-partner; the part-time, practice-based GP who wants to take on occasional extra hours; the established local locum; or the ex-GP trainee.
Nurture these contacts if you have them; these networks can be an excellent source of high-quality locum GPs. However, if you are using the traditional reactive mode of booking, you will need to work at maintaining an up-to-date list of contacts and be prepared to make many phone calls/send out lots of emails when making bookings.
If the locum is reactively managing their own bookings they will be juggling this with their clinical work, which can mean booking is not instant and you are left waiting for responses and confirmation. You will also be responsible for checking these locums’ credentials and will need to negotiate individually with them regarding rates, terms and conditions.
Proactive booking, as used in LocumDeck’s Instant Book, can reduce the burden of making bookings with freelance, non-agency locums. The publication in one place of detailed, real-time bookable availability of locums, can support your ongoing direct relationship with your regular GP locums. Or it can help you find new locum colleagues, but it is a relatively new concept and will need a critical mass of freelance GP locums and practices to tranform booking in an area.
- Often a known entity who comes with a ‘word of mouth’ recommendation.
- May have experience of working locally.
- Flexibility in agreeing terms.
- If booking reactively, it may be difficult to make contact quickly for bookings
- Variable rates, terms and conditions; you will need to negotiate, individually, with each locum.
- Less likely to provide cross-cover if unable to attend through illness.
- You will be responsible for checking their credentials.
Other points to consider
- Independent locums can be isolated, professionally-speaking.
- What is the clinical governance framework for raising concerns?
Locum agencies and online booking platforms
It is no surprise that practices short on time, or lacking independent locum GP contacts, turn to locum agencies and online booking platforms to source freelance GPs. Theses are commercial organisations which seek to build large databases of locum doctors, all accessible through one point of contact.
Doctors have to present credentials to sign up to reputable agencies and online platforms which operate in a similar way to agencies; often GMC registration, performers list inclusion, CV, references, evidence of completed GP training and occupational health checks. Advertisements in the medical press hoping to attract doctors usually focus on the agency’s nationwide coverage, great rates of pay and speed of placements.
No doubt there are many high-quality locums who work through these agencies and platforms as they are high profile and have access to many practices and GP work placements. These locums are unlikely to spend time out of work. But bear in mind that you are dealing with an organisation whose primary motive is profit, not necessarily the professional support of their doctor workforce or the longer term sustainability of general practice..
Check the small print of the agency/platform’s terms for any future exclusivity or introduction fees these agencies and platforms may charge if you later want to work with the GP off-platform or outside of the agency. It is not unusual to see clauses charging 15% of a GP’s first 12 months of earnings if a GP introduced carries out work in your practice within an 18 month period after being introduced by the agency/platform
- Relative ease of access and arranging bookings.
- Preliminary check of locums’ credentials carried out by the agency.
- Usually reactive booking method so still have to go through the reactive booking phases to some degree e.g. awaiting responses, screening applicants, negotiation of terms before getting a confirmed booking.
- Cost: unless they are simply charging a finder's fee and acting as a recruitment company, agencies and platforms will take a cut of the fee they charge to practices, ranging from 15% (+VAT) upwards.
- Locums sourced from large agencies may lack local experience and you may not benefit from ‘word of mouth’ recommendation.
- Restriction charges may inhibit your ability to recruit a promising locum a permanent job
Other points to consider
- Locums working through agencies may be professionally isolated
- What is the clinical governance and quality assurance framework?
- How would you raise concerns about a doctor’s performance?
Social media or informal online locum networks
Some areas benefit from a single online portal providing access to a pool of local GPs whose availability can be ascertained and who can be contacted and booked either online or via phone or email These ‘match-making’ services enable practices to circulate their requirements and seek out a locum who meets their needs.
These systems give ease-of-access to non-agency locums, but lack the peer and management support of the more evolved GP locum chambers.
- Potential for ease of access.
- Usually supply local locums relying on good local reputation.
- Locums using these portals may be charged a fee to do so, which is likely to be reflected in a higher locum rate.
- Online locum networks are not available in every locality.
- Usually reactive booking method so still have to await responses, undergo screening of applicants and negotiation before confirming a booking.
Other points to consider
- What is the clinical governance and quality assurance framework?
- Does posting a job to source a skilled professional through a group messaging app like WhatsApp stand up to scrutiny? You need to have robust system for checking credentials and clarity about terms of engagement if sourcing a new, unfamiliar GP locum by this method.
GP locum chambers
GP locum chambers are groups of local locum GPs who undertake to work as a team in a ‘virtual practice’ and pool a slice of their income to pay for administrative staff and infrastructure to handle all non-clinical aspects of their work such as booking and invoicing. The GPs meet regularly in ‘practice meetings’ for peer support, sharing information and organising educational events.
GP locum chambers tend to be set up by locum GPs keen to form a supportive network of peers to avoid professional isolation and thereby improve patient care and build a good reputation with local practices.
To join chambers, a GP has to present references, evidence of training and is interviewed by fellow GP chamber members, rather like joining a practice. It is in the interests of all the GPs in the chamber to build a good reputation so the process is selective.
Practices in areas with a locum chamber tend to value them highly as they offer ease of access and booking to high-quality locums at reasonable rates.
- Ease of access and bookings: chambers vary in their booking systems but usually a practice sends their booking enquiry. Then, as chambers use online calendars populated with their locums’ availability and pre-agreed terms, they can quickly book and confirm sessions.
- Chambers will provide cross-cover if your booked locum is unable to attend at short notice.
- Terms and conditions are agreed in advance between the chamber and practice.
- Preliminary checks and interviews are carried out by the chamber as an entry requirement.
- Locums will be local and relying on their local reputation.
- They are members of a professionally-supportive peer group and have access to ongoing education, appraisal and revalidation.
- Clinical governance systems within the chambers provide opportunities to learn from feedback and significant events.
- The cost may be higher than freelance, non-agency GP locums as pay rates of chamber locums may factor in administrative costs of running the chamber.
- Not all areas have locum chambers available.
Top tips for finding a suitable locum
There are many high-quality GPs out therebut it can be a challenge to reach them, especially at short notice or at times of high demand. These tips can help:
- Maintain and nurture a network of independent, freelance GPs, including part-time practice-based GPs; trainees due to qualify; and established local locums with good reputations.
- Find out if there is an online portal giving access to local locums or a local locum chamber. If there is no chamber, suggest to locums they may benefit from setting one up.
- Sign up to NASGP’s LocumDeck - it’s free to practices and can facilitate clear, easy bookings with your regular GP locums and and help you find new locum colleagues.
- If you are using a locum agency or online platform, do your research to ensure it is cost-effective; reliable; and can provide quality assurances.
- Gain feedback on the locums you use, from staff and patients, to ensure you only employ those that add value. But bear in mind that the quality of a locum session is also determined by how well the locum was equipped to work in your practice: perceived failings in a locum’s performance often stem from inadequate induction into practice-specific procedures.
Dr Sara Chambers is a sessional GP in West Sussex and the quality lead for the National Association of Sessional GPs