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Monday 26 September 2016
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Diary of a practice manager: the mystery of the absent locum

Practice diary

Edward Picot has been a practice manager for 16 years. His personal website, edwardpicot.com, features a collection of his writing – including poetry and short stories – as well as animations.

Being essentially a single-handed practice (with two retainer GPs and a registrar), we have to get locums every time Jack, the main GP, goes on holiday. This year he took three weeks in August, but we were lucky enough to get two really good locums who have done lots of work for us in the past: Jane Howell from Sparrowhurst agreed to cover all the mornings, and Richard Skinner from Steepleton was booked for the afternoons.

There's always a nervous moment on the first morning of a holiday, when you wonder if the locum is actually going to turn up.

Then, when he or she does arrive, there's a frantic period of about 20 minutes during which all the usual Monday morning things are happening – telephone ringing, babies wailing, somebody wanting to collect a letter nobody can find, queries and problems bursting on the front desk like bags of flour – but you can't deal with any of it because the locum can't remember how to log onto the computer.

Once this frantic period is over, an eerie calm descends. With Jack away, a lot of the most regular attendees go into suspended animation. Many of the phone calls are from people who just want to check when he's coming back. It's bound to be hell on the morning of his return, but in the meantime it's rather peaceful.

And it has to be said that Jack himself actually generates a lot of the chaos in which we normally work. He's always charging into reception, demanding to know what's wrong with his computer, or why there isn't more money in the practice account, or asking us to ring all the private hospitals to see what they charge for a hip replacement, or insisting that we've got to squeeze an electrocardiogram (ECG) into the nurse's already overbooked morning (which immediately brings her storming down the corridor to complain), or cursing the disappearance of his stethoscope (which usually turns up round the registrar's neck).

Locums, by contrast, are low-maintenance, biddable creatures. All they want to do is get through the day as quickly and simply as possible.
 
As a result of this quietness, I got through my work much more quickly than I expected; and whereas my original plan had been to work the whole day through, it turned out that I was almost finished by the time afternoon surgery started, at four o'clock.

At quarter-past four I came downstairs to find the first three patients sitting in the waiting room and Maureen, who works in reception on a Monday afternoon, getting agitated. "No sign of Dr Skinner!" she hissed as soon as I appeared.

"What? He's never usually late."

"Never! He's always bang on time. You don't suppose he's forgotten, do you?"

Needless to say, the thought had already crossed my mind. It's happened a couple of times in the past. But Dr Skinner, a bald, tweedy gentleman who retired from full-time general practice about five years ago, has normally been completely reliable.

"I'd better ring him," I said. "It's probably just his car or something." His wife, Shirley, answered the phone. "I'm sorry to bother you, Mrs Skinner – but we were expecting Dr Skinner for afternoon surgery."

"Oh," she said. "Were you?"

"Is he on his way?"

"No – I'm afraid he isn't. He's up a ladder, repointing the chimney."

There followed a period of confusion, during which we both spoke at once.

"Well, if he's –"

"I'm sure his diary was –"

"… We can always –"

"… Said to me yesterday –"

"… Only there are three –"

"… Nothing on the calendar. But I'm afraid he is getting rather forgetful" (which is what wives always say about their husbands, of course). "I'll call him," said Shirley.

Fortunately, Dr Skinner lives in one of the nearby villages. He arrived about 20 minutes later, with a blob of what looked like cement on the top of his head, and launched into evening surgery with his usual calm efficiency.

"Was it my fault or yours?" I asked him after the first patient.

"I really don't know," he replied. "I normally write these things down. But there's nothing in my diary or on the calendar."

At first I had an uneasy conviction that the mistake must be mine. I couldn't remember how the arrangements had been made. But I keep a database of all the dates for which we require locums, with details of who we've asked and what they've replied, and I wouldn't normally book Dr Skinner into all those afternoons unless he'd said something.

Then I remembered. We offered the three weeks to Dr Skinner before anybody else, because he covered the summer holiday for us the year before. I wrote the dates on a piece of paper for him. He rubbed the piece of paper between the fingers and thumb of his right hand, thoughtfully, as if it were a bank note that might be counterfeit. Eventually, in his serious way, he said he definitely wouldn't take the whole thing, because full weeks were a bit too much like hard work these days. He'd have a think about it and let me know.

He rang me back a couple of days later and booked the afternoons. That was back in May or June. I should have confirmed the arrangement by letter, but I never got around to it.

After he'd seen a couple more patients, I asked Dr Skinner if he thought he could cover any of the other afternoons during Jack's absence. He said he could do them if we were stuck, but he'd rather not, because he was trying to get his house decorated before he went on his own holidays. Luckily I managed to get Dr Howell on the telephone, and she agreed to take the afternoons.

At the end of the week I received a letter from Dr Skinner:

"Dear Edward,
I have decided to hang up my stethoscope once and for all, so I am afraid I will be unavailable for any locums from now on.

May I say how much I have always enjoyed working at your surgery over the past few years. However, I think it is wise to retire of my own accord, before retirement is forced upon me, especially as my memory seems to be starting to play tricks on me.

Shirley found the piece of paper with the dates on it, in the pocket of my old jacket.

Yours sincerely,
Richard Skinner"