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Locums – All You Need To Know
What is a locum?
Locums offer a temporary solution to staffing shortages. They provide practices with a flexible short term solution, but they can be costly. They usually have the same level of training as their peers (GPs, Nurses, Healthcare Assistants Dispensers, etc.) and are either self employed or employed by a locum agency. Many locums enjoy the freedom of undertaking their job, without being responsible for any other duties or roles within the Practice. However, this can make them isolated and inclined not to be involved in day to day Practice matters which would normally be beneficial for both parties.
There is an estimated 17,000 GPs working as locums, that’s about 1 in 4 GPs, in the UK. They carry out about 80 million NHS consultations a year, so they are a fairly vital part of the GP workforce. They can work at many practices, hospitals and for other providers. Whilst this may limit local knowledge of care provided in geographical areas, it means there can be a lot of variation in practice and a good sharing of knowledge and skills.
Due to staffing shortages, and subsequent recruitment difficulties, there has been an increase in the recruitment of other Primary Care clinical staff such as Practice Nurses. From personal experience Nurses required for temporary cover are difficult to come by, so using an agency is a good option. However, Practice Nursing is a specialised role and it can sometimes prove difficult to find a Nurse who has current skills and experience in chronic disease management, cervical cytology, child health (including immunisations and vaccinations), travel health and wound care. One thing to remember is that, if the nurse is self employed, you must check they have their own sufficient insurance cover, and keep your own medical insurance company informed as a matter of courtesy.
There is the concern that locums can miss out on educational events, local policies such as prescribing and referrals, or any other information that a Practice employed locum would receive regularly. Few of them are on the correct distribution lists and don’t get included in information from the local CCG or NHS teams. So the safest assumption to make is that if you inform a locum of a recent change to any local clinical service, it’ll be the first they’ve heard of it. Locums can feel isolated and this makes it difficult for them to obtain the information they require for their appraisal, such as colleague feedback and participation in significant events. Wherever possible, include locum GPs if there are opportunities to learn and reflect on their performance because this will undoubtedly help them to improve their effectiveness and safety.
Induction and Documentation
When recruiting any locum, whether it’s directly or through a locum agency, you must check that they have the documentation required to carry out their job, and for employment purposes. On the first day, it’s advisable to set some time aside to go through a brief induction, as you would a permanently employed member of staff. Documentation such as proof of ID, proof of eligibility to work in the UK, proof of professional qualification and registration, proof of recent DBS check, and proof of indemnity cover, should be checked and copies taken. Other documentation such as immunisation history and any relevant medical history should also be asked for, if the locum doesn’t offer it, so that you can ensure they are suitably protected and their health is not at risk.
Having a locum pack is a useful way to outline their responsibilities and what is required of them in that particular practice, because many practices work very differently. In that pack you could include local contacts (internal and external), brief protocols for day to day processes including referrals, prescribing and communication.
Pros and Cons
The advantages of being a locum include:
- Flexibility – control over when and where they work, and how often, and regularly required as a means of juggling work and family responsibilities.
- Self employed – in charge of themselves.
- Financial benefits – they can set their own pay rates and can claim many more expenses against their tax bill.
- Increased knowledge – working at various locations can increase knowledge and understanding of different working practices to learn from.
"You really only have to go in and do the job," says Dr. Manisha Shah, comparing the convenience of locum work to the obligations of running a practice. "Running your own practice is a lot of responsibility ... but with locums, everything's taken care of for you."
The disadvantages of being a locum include:
- Insecurity – there is no guarantee of work, where it will be or how much they will be paid.
- Isolation – it can be lonely being a locum without continuity of familiar peer support.
- No employment rights – no automatic entitlement to holiday or sick pay, no paid study leave and no guarantee of an increase in pay.
- Difficult to revalidate – lack of regular CPD time with peers and to complete audit cycles.
- Increased travelling – time and cost of getting to and from places of work can build up.
For Dr. Shrimant Ayaram, working brief engagements at a wide variety of facilities means missing opportunities to connect on a deeper level with the team. "They don't get really to invest in you," he says. "But you don't really have a boss. You're your own boss, really."
Did You Know?
NHSE propose setting a maximum indicative locum GP rate. If this goes ahead NHSE will amend the electronic declaration system to include recording the number of instances where a practice pays a locum doctor more than the maximum indicative rate.
Alison Lowerson – QCS GP Practice Specialist