Using locums can be unavoidable even for the most well-prepared practices, but taking time to identify suitable locums in advance can take the pressure off later
Your salaried GP has just phoned and said that he has broken his leg skiing and won’t be in today, and one of your partners’ wives has gone into labour prematurely. Both have fully-booked surgeries starting in an hour’s time. Panic! You phone, text and email all the locums that have worked recently in your practice and in desperation contact the locum agency that has helped you in the past. An hour later, both surgeries are covered with locums. Is this a scenario that has confronted you? Under more relaxed circumstances, you will have been able to contact those GP locums in a more timely manner, having established the need for a locum. But why might you need a locum? Possible reasons include:
- Acute emergencies, such as those detailed above.
- Maternity or paternity leave cover.
- Long-term sickness.
- Dealing with capacity/workload issues.
It is prudent to think about the processes involved in establishing an up-to-date locum base and the necessary checks that need to be carried out as a minimum to ensure that bona fide doctors are engaged in providing medical services to your patients. You should ask for:
- An up-to-date CV.
- Recent references.
- General Medical Council check (this can be done online).
- Evidence of medical indemnity cover.
- Evidence of registration on a medical performers list (remember that there are currently separate Welsh and Scottish lists).
So how best to go about finding a GP locum? There are a number of ways that GP locums can be procured, some of which will have cost implications over and above the pay to the locum:
- GP locums contacting you directly.
- Local postgraduate centre/deanery.
- Sessional GP lists that includes GP chambers.
- Advertising in journals or online.
Locum agencies can be a cost-effective measure saving you time searching fruitlessly when your time would be better spent on practice matters.
Assuming that you have secured a locum for the work that you require, you will need to try and ensure that you put your practice in the best possible light, so that should the need arise to recruit a GP locum in the future, word-of-mouth among locums does not put you in a less favourable position than another practice in town. There are a few key areas to think about:
- Name a contact at the surgery for your locum to refer to should problems arise.
- A brief induction to the practice and software used (remember to allocate a unique log-in for your locum).
- Doctor’s name on door.
- Location of an up-to-date help file, online if possible, with links to relevant forms.
- A clean and well-organised consulting room with basic diagnostic equipment.
- Tea, coffee, refreshments and other facilities.
- Clear guidance on what is expected of your GP locum (this needs to be negotiated before the doctor arrives) and also expected remuneration.
- Prompt payment and completion of necessary paperwork (eg. superannuation forms).
The negotiation of a few other key areas needs to be sensitively managed, and among these there will need to be discussions surrounding locum pay rates, either on a sessional or hourly basis. Also, travel costs, private fees, duties (will they be on call, issuing repeat prescriptions, etc) as well as reports for insurance companies.
Keep in mind that GP locums are now more frequently presenting their own terms and conditions that will encompass the points noted above. So, what happens when a problem arises and who is responsible? Regulation and performance issues now form a larger part of doctors’ working lives since the introduction of appraisals and revalidation. This area may already have been encompassed with the establishment of the locum contract or terms of engagement. If a locum is supplied by an agency then this should be explicit in the terms and conditions. By making the locum feel welcome and part of the team, from anecdotal experience, it is less likely that problems will arise.
Feedback, positive or negative, is often actively sought; complaints and significant events, less so. However, the locum should be part of the clinical governance system within the practice and support offered in dealing with these areas, as it is in all parties’ best interests that these events are dealt with swiftly and effectively to achieve a local resolution that the complainant is happy with. We are all encouraged to reflect and learn from our clinical encounters.
In conclusion, you may be the lucky practice that rarely uses locums, whereas there are some practices that rely heavily for support from this group of doctors. The provision and supply of this particular workforce has increased dramatically over the years, coupled with acceptance that this is now an established career pathway that doctors follow after completing their GP training. Your locum of today could be your partner of tomorrow. Treat them well and they may return, help you and perhaps even stay on, solving your longer-term recruitment needs.