MA(Hons) CIHM FIHM
Independent Consultant in Practice Management
Fiona is an experienced primary care trainer and facilitator. She is the national RCGP QPA Adviser and has advised on both the original and the review of the Quality and Outcomes Framework of the 2004 GP contract
Many practices use locums. Some do so regularly, not wishing or having the need to enter into a regular contract of employment but covering occasional shortfalls in availability of appointments. Most practices will need at some point to use a locum to cover the absence of a GP partner or salaried GP for maternity or sickness absence.
For practices in England, it is likely that experienced GPs in the practice will be drawn into involvement with clinical commissioning groups (CCGs) and managing the delivery of commissioning in the practice. This will, in turn, lead to an increased need for backfill in the practice by a locum.
Developing a policy
Making a decision about how the practice employs locums is better done in advance, as an agenda item, than 'on the hoof' when someone is ill and you need cover for the day after tomorrow. Consider the following:
Defining a pre-employment checklist
Employees can be kept on successive fixed-terms contracts for up to four years. Renewal after that point makes someone a permanent employee.
Be prepared to be flexible; you may have to be, if locums are in short supply! Regardless of this, locums will have varying levels of experience, may have family commitments, may have other posts as well and will have varying tolerances of length of appointment, workload, etc. It is fair to negotiate an agreement that works for both sides. If not, you may be left feeling that the service being supplied does not meet your needs or your locum may disappear fast over the horizon.
Defining what the locum will do
Take care to define this in detail. This is likely to cover: surgeries; house calls; triage; telephone consultations; acute and repeat prescriptions; referrals and investigations (internal, such as Treatment Room, and external); and the Quality and Outcomes Framework (QOF) and other coding.
It is possible that, for longer-term locums, there will be a need to cover a wider range of duties such as terminal care patients, private certification/medicals, clinics, prescribing reviews, etc. These should also be pre-defined and agreed, and payment adjusted accordingly.
This could also include work related to additional and enhanced services such as IUDs/contraceptive implants, minor surgery or covering a nursing home.
Attendance at meetings and participation in learning events, such as a significant event, may also be required. Appropriate payment or time-in-lieu arrangements for this should be made as far in advance as possible and documented in the agreement.
Looking after your locum
Many locums are undertaking this work because they have recently completed their GP training. They may be seeking partnership and 'trying out' local practices to define their preferences in terms of the type of organisation to which they want to belong. They may be uncertain of their longer-term plans, using locum work to fill a career gap or they may be unable to find a suitable salaried post locally.
Whatever the reason, it is important that locums are cared for in the practice. The practice manager can have a significant role here. If you are going to be offering a salaried or partner post in the near future, looking after locums well may pay
Many locums will appreciate a brief orientation visit to the practice before commencing work there. This is an opportunity to go through elements of the Welcome Pack (see Box 1) as well as the agreement and to clarify any queries the locum may have about issues like parking or the availability of community nursing locally.
Establish that you are available to answer any kind of organisational question and how the locum should access you for guidance. Ensure the locum is aware of arrangements around coffee time and lunch so that opportunities are established for interacting with other GPs and the wider team as much as possible. This will increase the practice's knowledge of the locum, as well as enhancing the locum's experience of working in the practice.
Meet with the locum informally to check progress and to have an opportunity to identify and sort out any issues.
For longer-term locums, especially those who are immediately post-MRCGP, the practice may find it useful to have an identified GP who is the clinical buddy of the locum. This does not need to be time-consuming or a formal arrangement. However, it will aid both the practice and the locum.
As suggested above, the practice will want to reassure itself of the locum's quality of clinical decision-making and issues around using the clinical system, referrals and prescribing. This will require an identified individual and is a good opportunity to establish a culture of support and quality.
Additionally, newer locums will appreciate the continuation of a mentoring relationship, even if this is less structured than the trainer/trainee relationship.
British Medical Association. Guidance on Locum Agreements in General Practice. London: BMA; 2011.
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General Medical Council
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"Extensively researched article which is absolutely detailed in its explanations" – Rashid Motala