For those of us working in primary care, our fundamental objective is that, after a contact with the practice, patients are safe and clear about their management plan and confident in the care they have received.
Preparing for a locum session is about focusing on what is going to enable that doctor, who could be working in anything up to 40 different practices, to come into an unfamiliar practice and deliver those vital features of a successful, safe patient contact.
Here is a common scenario GP locums are faced with. You may reflect on how the locum and patients were feeling and what their subsequent behaviour may have been:
On arrival for a locum session at a new practice, I presented myself to the front desk. The receptionist looked puzzled and there was a staff discussion lasting several minutes as to which consulting room I would use.
‘You’re in Dr B’s room,’ she finally announced.
I had no idea where Dr B’s room was. The (by now flustered) receptionist took me to the room. The next problem was logging onto the computer. Despite arriving 30 minutes early to set up, time was ticking as the staff worked out how to get me logged on. During the comings and goings, I asked for the practice induction pack, to provide me with a guide on how to organise referrals and investigations.
There was no induction pack and the answer to all of my enquiries was to ‘ask Julie the secretary upstairs’.
The surgery was all uphill: trying to print the first prescription with an empty printer; having to leave the room during consultations to find urine dipsticks, then again for gloves; discovering I was not authorised to use the electronic pathology request system so having to find paper forms.
'It turned out that ‘Julie upstairs’ was not at work, so I had no access to timely information on how to make referrals during the consultation, leaving myself and the patient unsure of what to expect next.
Working in such an unsupported, isolated environment, I question how safely I would have been able to manage a patient with an urgent, serious problem.
This is an unsatisfactory scenario for all concerned. The practice has paid good money for a locum and has not used them effectively. The practice staff were exasperated that the surgery overran and by what they saw as repeated interruptions to their work. The locum had been placed into a position of enforced underperformance. They will not have enjoyed feeling undermined and inept in front of patients. They may well not want to return to your practice.
Most importantly, how would patients have felt faced with a doctor who is running late, cannot even seem to organise a blood test properly and has to keep rushing off to ask other people questions? They will probably be re-booking an appointment with their ‘real’ doctor as soon as possible, duplicating appointments.
A safer, more productive locum session is possible with some basic preparation. The Pre-arrival checklist below is designed to help with this. This has been borrowed with permission from the NASGP from their work on a Standardised Practice Induction Pack.
Directions to your practice and parking arrangements
- Any helpful directions for a first time visitor?
- sometimes postcode on satnav does not match real location
- Parking arrangements
- Is a parking permit needed?
- Has the GP got access to the building if arriving out-of-hours?
- Does the locum need training on your clinical IT system? (see box 2)
- Before the session is due to start
- Computer switched on
- Already logged in to
- the computer’s operating system e.g. Microsoft Windows
- any document management systems
- any electronic dictation equipment
- A secure, unique password and username to access the practice’s clinical system
- Access to any electronic pathology or other investigation system
- Practice Induction Pack
- printer topped up with plain A4 and prescription paper
- prescription pad if doing visits
- dictation equipment and relevant instructions
- pathology and microbiology forms (if no access to these electronically)
- radiology request forms (if no access to these electronically)
- Internal phone numbers for useful contacts
- Panic button
- location and use of panic button
- blood pressure measuring device
- sample pots for urine, stool and sputum
- urinalysis dipsticks
- peak flow meter and mouthpieces
- tongue depressors
- swabs for microbiology
- lubricating jelly
- vaginal speculae
- pregnancy tests for urgent assessment of abdominal pain in women of childbearing age
On the day of arrival, it is also helpful if there is a nominated member of staff to welcome the locum and give them a brief induction tour of the building and take them to their allocated consulting room. This staff member could also be a point of contact for the locum should problems or queries arise during the session.
The induction tour
- any door codes?
- where to get a drink
- treatment room
- location of defibrillator
The consultation room
- location and use of panic button
- check that Box 1 is in place
- how to call patients in
Key staff members on duty and how to contact them
- On call GP
- practice nurses
In an emergency
- panic button
- location of defibrillator and emergency drugs
- At the time of making the booking and as part of agreeing terms and conditions, determine whether your locum is familiar with your clinical IT system.
- You may need to arrange some training before their session begins.
- It is most helpful if the training is with a member of staff who is familiar with how clinicians use the system (how to prescribe, call patients in etc) and if the locum can practice on a test patient with support for a few minutes.
- Most locums are versatile and very used to switching between systems but it is in the interests of all concerned that they feel confident on your system and 15 minutes before their session starts with a suitable member of staff is time well-spent.
When properly equipped, a locum GP is freed to concentrate on the patient and the clinical work. They may even have more time and inclination to fill in that QOF smoking template or give that opportunistic flu jab.
This article deals with how you can smoothly get your locum set up and ready to start their session in a way that will minimise stress to your practice staff and improve your patients’ experience. Next in the series will focus on the important information that a locum will need to work safely during their session.
- Dr Sara Chambers is a sessional GP in West Sussex, appraisal lead partner for Pallant Medical Chambers and the quality lead for the National Association of Sessional GPs.