Dr Richard Fieldhouse Gives 11 Top Tips on Navigating Life as a Locum GP, Emphasising the Importance of Peer Support
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As data collected about GPs typically exclude locum work, it is difficult to know how many locum GPs there are in the UK.3 Figures from NHS Digital suggest that there are fewer than 2000 regular locum GPs, but this statistic only applies to England, and does not account for ad-hoc work4—based on General Medical Council (GMC) and NHS numbers, the total could actually be more than 17,000.3 Regardless, locum work has become much more popular in recent years: between September 2021 and September 2022, locum GP bookings doubled, and membership of the National Association of Sessional GPs (NASGP)—of which I am the Founder and Chairman—increased by 79%.
In this article, I will discuss the working life of a locum GP, giving 11 top tips for anyone who does locum work, or is considering it as a career option.
1. Demonstrate that You Meet the Requirements of a Locum GP
Keep Documentation Organised and Up to Date
Just like other GPs, locum GPs are fully qualified and must have certain documentation to be able to practise in the UK,1,4–6 outlined in Box 1. However, as locum GPs need to prove their status more regularly than their peers, it is particularly useful for them to keep these documents organised and in one place, with both paper and digital copies available. Other useful documents to keep together and up to date include immunisation cards, an NHS Smartcard, professional references, and a curriculum vitae (CV)—the cornerstone of getting locum work.5
|Box 1: Documentation Required to Practise Independently as a Locum GP1,4–6|
2. Appreciate that Locum GPs are Generally Self-Employed and Practise Independently
Recognise the Differences between GP and Hospital Locums
For the purposes of tax, employment, and NHS pension law, locum GPs are self-employed (unless they work through an agency or their own limited company).1,6 Because all GPs, including locum GPs, are licensed by the GMC to practise independently, practices hire locum GPs to cover sessions rather than shifts, and expect them to perform duties across their agreed competencies without direct supervision, as per their privileged place on the GMC GP Register.1,4,6
This differs from how locums are usually hired in hospitals, in which the process is a little more restrictive and use of locum agencies is more common.1 As hospital locums cover shifts in a specific department and are usually not licensed to do all of the duties therein, the hospital will more explicitly define the locum doctor’s duties and assign them a clinical supervisor, usually a consultant.7 Because hospital locums are not self-employed, and are therefore classed as employees or workers,7 payment is usually through Pay As You Earn, and the locum can accrue holiday privileges, that is, statutory entitlement to annual leave or compensation for it, as well as the entitlement to equal treatment after 12 weeks of service with the same employer.8
Cultivate a New Mindset
In one respect, this difference in employment status is a significant benefit of being a locum GP—being self-employed and able to cover sessions independently equates to greater autonomy and flexibility, and enables a locum GP to negotiate pay more easily.1,9 On the other hand, as locum GPs have less well-defined duties than their hospital counterparts, they must be more careful in defining what work they do, and what rate they charge for their work.
3. Establish Terms and Conditions for Locum Work
Work in the Way that You Choose
When a locum GP sets out clear terms and conditions before agreeing to work, it can protect them from unsafe clinical work and gradual changes in the requirements of, or relationship with, a practice.1,6 It also gives both the GP and the practice a chance to negotiate before a session. When agreeing terms, it is best to be specific and transparent, and practices will generally appreciate the value of having a set of terms and conditions that a locum GP, or the members of a locum chambers, adopt.6 Topics to cover include:1,6,10
- the amount of work that is expected—this is usually based on workload or time, with a session defined by a maximum number of patient contacts (including whether they are 10- or 15-minute consultations), a fixed amount of time (often around 4 hours), or another standardised measurement
- the core work that is expected—including whether it consists of face-to-face, remote, and/or telephone consultations, whether triaged surgeries are involved, and whether supervision of non-GP colleagues is required
- any additional work—including enhanced services that the locum GP can provide and additional workload that they are willing to take on, such as extra patient contacts or on-call duties
- the fee—bearing in mind the anticipated workload, and pension, tax, and other additional costs (such as medical indemnity insurance and GMC registration fees).
4. Nurture Professional Relationships to Prevent Isolation
Make a Date
Working as a locum GP can be exceptionally challenging, exhausting, and professionally isolating; locums have no fixed workplace, and are often working in rapidly changing, high-pressure environments over which they have little control, and this can lead to burnout.1,6,9 Peer support can help to counteract this, and can make an active difference to a locum’s professional and social lives. Locum GPs will naturally meet other local locums in the course of their work, and it may be a good idea to set a date for meeting up with one another on these occasions.
Join a Locum Chambers
Being part of a formal group of GPs who work in the same way, such as a locum chambers, is another great way for locum GPs to get support and reduce isolation and stress.1,13 Involvement in a locum chambers offers GPs a peer network, and allows them to share some of the additional burdens of their role—including finding work, negotiating terms with practices, handling administration, and organising things like training, revalidation, and invoices.1,13,14 The NASGP can help locum GPs to reach out to others in their area and set up a first meeting, or to find a nearby chambers that they can join.13
Network, Network, Network
Locum GPs may also benefit from developing relationships with people in the practices in which they work, not just with other locum colleagues. As I often say: surgeons operate, GPs communicate—and communication skills are not just for patients. Every day, a locum GP can spend a little time getting to know the people in the practices in which they are working: finding out what they do, what motivates them, and any tricks they have developed to deal with their workload. When locum GPs nurture these new professional relationships, they may discover unexpected opportunities.
5. Rely on Peer-to-Peer Support in Challenging Times
Share Complaints with Colleagues
There will be times when any locum feels vulnerable and isolated, particularly when on the receiving end of a vexatious complaint. Receiving a complaint as a locum GP comes with the territory—patients do not have the same existing professional relationship with locum GPs that they have with their usual GP, so they may be less forgiving with them.1
When they receive a complaint, locum GPs can only benefit from calling on peer-to-peer support enabled by fostering professional relationships, knowing that their colleagues will listen and empathise having likely experienced similar situations. After all, a key aspect of being a GP is listening to others and giving support, so doing this with colleagues is second nature. This peer support network is one of the perks of the job.
6. Be an Agent for Change at the Practices in Which You Work
Pass on Your Concerns to Practices
At some point in their career, every locum GP will come across a practice that struggles in the way it engages with locums or has systemic issues that can be resolved; in speaking to locum colleagues, they may find that they have shared concerns about that practice. Passing these concerns on to the practice can be challenging when done as an individual, but as a group—particularly when organised into a locum chambers—it can be powerful. This can be especially effective if simple, anonymised, structured feedback is collected and shared with the practice in a collective voice.
In my experience, this kind of action nearly always leads to positive change for both parties. Locum GPs benefit from the practice becoming a better place to work, and the practice is able to continue to hire locums to cover its clinics.
7. Help Practices to Develop Accessible Practice-Specific Information
One particular challenge of working as a locum GP is the wide variety of methods, procedures, and protocols used by different practices for the same purposes.1 Blood tests, referrals, and safeguarding measures, for example, are regularly required, but practices organise them in many different ways.1 Locum GPs are often not party to this kind of practice-specific information, and although many practices attempt to bring this together as part of a ‘locum induction pack’, these packs are rarely kept up to date.1 Box 2 contains some examples of questions that a good locum induction pack will answer, although it is worth noting that the NASGP has identified as many as 500 different events that occur in a typical GP practice that are managed in practice-specific ways.
|Box 2: Questions a Good Locum Induction Pack Will Answer|
How do GPs in this practice typically arrange:
Crowdsource Useful Details
A central, easily accessible and updatable electronic pack can work better; hence, the NASGP has built the functionality for practices and locums to share practice-specific information into LocumDeck.11 Locum GPs can encourage practices to make sure that they have all the necessary information at their fingertips—be it online or in a useful information pack of some kind—and may achieve more success in prompting them to do this when doing so as a collective.
8. Tap into the Knowledge of Fellow Locum GPs
Educational opportunities for locum GPs can be few and far between, in part because they are not regularly employed in the same way as salaried GPs and partners, and this can make appraisal and revalidation more challenging.1,6 Often, the first that a locum GP hears about training opportunities is when they are covering for a colleague who is away on study leave. However, locum GPs will quickly learn that among their local numbers are some real experts in various clinical fields. Some will be newly qualified GPs with special interests, and others will be ex-partners who have run specific services.
Set Up a Study Group
One way to capitalise on this collective knowledge is to form a simple, informal study group—like a journal club or Balint group15—which may emerge from a locum chambers. For those with the motivation, it can also be rewarding, and beneficial for a CV, to create a local programme of fulfilling learning events for GPs.6
9. Ensure That You Get Paid on Time
Synchronise Invoicing with a Practice’s Routines
Practices usually work to a monthly payroll schedule, and the time they set aside to pay invoices is often precious. Therefore, if a locum GP’s invoice is not submitted correctly the first time, it could potentially create a 30-day delay. Submitting an invoice early, as soon as the month ends if possible, can really help a locum GP to get paid on time.4 However, invoicing weekly may, counterintuitively, lead to locum GPs getting paid later—it causes extra work for the practice, takes more time, and increases the chance of mistakes.
Invoices are an example of where being part of a locum chambers can make the process easier for everyone involved, as a chambers’ invoices are often arranged and sent at the same time.14 This coordination helps the practice to organise its payments more easily and plan its payment run in advance, and also allows the locum GPs to be paid more efficiently.1 Even if not as part of a chambers, it is definitely worth scheduling a regular date for getting invoices organised and sent off. To reduce the administrative hassle that comes with being self-employed, it is always helpful to keep clear, accurate records of invoices, taxes, pensions, and any other financial information.4,6
Avoid Pension-Related Complications
Since 1997, when the NASGP started lobbying for locum GPs to have access to the NHS pension scheme, locum GPs have had the option to pension all locum work carried out in a practice each month. However, this process is not particularly easy or intuitive, and is fraught with complications. All invoices require an accompanying form with multiple computations (locum form A), which must then be collated every month and incorporated into a separate form (locum form B).5,6,16 Pensions can be a source of stress for locum GPs and practice managers; hence, the integration of NHS pension forms is one of LocumDeck’s most popular features.
10. Embrace the Variety Involved in Being a Locum GP
Put Your Skills and Experience to Work
Working as a locum GP is an exciting opportunity to use the skills and experience gained from being a GP in a different way. Locum GPs need to develop an instant rapport with patients they have never met, providing a different clinical perspective—sometimes at odds with the practice’s other clinicians, who they have also never met—in practices they have never worked for, in places they know little about, navigating unfamiliar clinical pathways.1,9
This way of working may be considered a disadvantage of locum work, but it enables the locum GP to provide care and support for patients and practices that otherwise would have found it difficult without them.1,9 Locum GPs are a fresh pair of eyes for both a practice and individual patients, potentially picking up on problems that regular staff may miss, and they provide practices with workforce flexibility and variety.9 A lot of locum work occurs in understaffed, struggling practices serving disadvantaged communities, as regional deprivation has been linked to greater reliance on locum GPs,17 and helping patients in these areas to access healthcare can be difficult but especially rewarding.9 Being a locum can therefore be an exciting and fulfilling career choice for many GPs and, over time, it can create all sorts of career opportunities.
11. Access and Utilise Useful Resources for Locum GPs
Being a locum GP may feel daunting at times, but there are many invaluable online resources providing information and assistance. Box 3 contains a few examples.
|Box 3: Useful Resources|
NASGP=National Association of Sessional GPs; BMA=British Medical Association; PCSE=Primary Care Support England
Working as a locum GP, whether it is on occasion or full time, can be a valuable part of a GP’s portfolio career—at the beginning to gain experience of numerous practices, during the middle to get some variety, or towards the end to gain more flexibility. Locum work can be very fulfilling as well, allowing any GP to provide their skills across a wide area, to different communities (some of which would otherwise not have seen a GP), with a fresh perspective that adds to the rich and unique tapestry of care that GPs provide.