Dr Richard Fieldhouse, Chairman of the National Association of Sessional GPs (NASGP), explores the practicalities – and the pros and cons – of working as a locum GP
Q: In your experience what are the main advantages of being a locum GP?
A: Perhaps the greatest advantage to being a GP locum is that you can commit as much as possible of your time to seeing patients. Rather than forming ongoing long-term relationships with patients, seeing the same people on many occasions, our caseload is much broader and less specific. In one year, a full-time partner will see around 1,600 different patients. Most patients a locum sees are for the first time, so they could see up to 10,000 different patients a year if they’re working in lots of different practices, as many are.
Because of this, our approach often has to be quite different. As well as not knowing the patients so well, we also might be working in unfamiliar practices that could be struggling or even underperforming.
And it’s the variety of those practices that can make the work very exciting. It’s great to be able to help out and support struggling practices, and offer patients alternative opinions; to be a fresh pair of eyes, and work with patients to support our colleagues’ ongoing management.
Q: What are the financial implications?
A: On the whole, the financial implications for the practice are cost neutral. Yes, some practices can spend what they feel is a fortune on locum GPs, but they would have otherwise have had to spend it on a salaried GP or partner income. At least this way it can be a tax-deductible expense.
In my 20 years as NASGP chairman I’ve never met a GP locum who was just doing it for the money. Granted, if one extrapolates up what a locum agency could potentially charge a practice for a locum, it could come to an eye-watering amount. But generally what a locum actually receives in income, factoring in a reasonable daily rate, periods of unemployment, unpaid holiday, study and sick leave, and medical indemnity, it’s pretty similar to what a partner would be earning. And bear in mind that for agency locums, the agency can take a cut of around 30% of the fee the practice pays.
Q: Is there anything about the way locums work that might be seen as a disadvantage?
A: To me, the biggest problem faced by GP locums is professional isolation. Back in 2010, the RMBF produced an excellent report on this, and found locum GPs to be some of the most isolated professionals working in the UK.
Professional isolation can have a big knock-on effect in a lot of what we do, and how we are able to support practices.
Every practice does things differently: referrals, policies, guidelines, preferred specialists, how they organise care, etc. Although a GP locum may be a brilliant clinician, what can often let them down is access to those 200 or so different bits of non-clinical information. At the very best, some practices will provide a ‘locum folder’, but these are invariably out-of-date, and it’s still usually very hard to find the information one needs when one needs it.
And when it comes to learning, sharing experiences, supporting colleagues or being supported, and working through significant events, these are all very difficult to do if you don’t actually have any colleagues.
Q: Are there any ways of reducing the possible disadvantages?
A: Yes! When we established the NASGP 20 years ago, our first job was to develop the Standardised Practice Induction Pack (Spip). We produced over 3,000 copies for practices, and have just released a vastly improved online version. Using Spip, practices can centralise all their core information about services, policies, guidelines, etc that any GP unfamiliar with that practice can access, rather than (as often as not) having to painstakingly find out this essential information from staff on a very time-consuming and disruptive ad-hoc basis.
Another thing we set out to achieve is to increase the number of locum groups from a then total of five, to over 100 sessional GP groups today. However, these groups often didn’t have the infrastructure to provide the high level of logistical support needed to support GPs working in lots of practices. For this reason, in 2002 NASGP developed the locum chambers concept, in which locums pay a small percentage of their income to provide all of that support. These chambers function very much as ‘virtual practices’, with members meeting up on a regular basis, sharing experiences and disseminating best practice amongst their locum colleagues and local practices.
Q: If I want to become a locum GP, what can I do to find work?
A: It depends. If there’s a locum chambers near you, then we would very much recommend you check them out first and see if it’s for you; they’ll book all your work for you, and will generally be the first port of call for local practice managers. Failing that, join a local locum group who may have a local practice mailing list. At the end of the day, even if you’re new to a chambers, nothing beats putting a CV together and visiting local practices to introduce yourself and to find out a bit more about the practices.
There are a growing number of websites that can help put you in touch with practices, but make sure you’re with one that allows you to set your own rates.
Q: What about agencies?
A: Since agencies employ their locums, you won’t be entitled to contribute to the NHS pension scheme (unlike chambers, where you remain self-employed). But they can take a lot of the legwork out of finding work, and are often very efficient at making sure you get paid on time. You can register with multiple agencies, and some have better reputations than others, so do ask other local locums what their experiences are. And make sure you read the small print, as they can often have restrictive clauses that mean you can’t work independently at a practice once you’ve worked there through the agency. The real strength of agencies is their tenacity, with staff who are trained to do all they can to fulfil practices’ requests.
Q: Who do I need to be registered with or inform?
A: To be a locum GP, you need to first and foremost be a fully qualified GP. Depending where in the UK you live, you’ll need to be on a specific performers list, pay self-employed National Insurance contributions, be GMC registered, do annual NHS appraisals, have had a recent DBS check, and have a smart card. I also strongly advise getting an accountant!
We’ve put together a lot of this information on the NASGP website, and you can always have a word with your chambers, agency or locum group if you get stuck.
Q: How good a financial manager do you need to be as a locum?
A: Very! If you’re a self-employed locum, you’re running your own private business. So as well as a financial manager, you’re also your own sales, marketing, accounts, bookkeeping, human resources and complaints department too. It’s one of the reasons why chambers are so popular.
Q: How can I keep up to date professionally?
A: Getting access to CPD can be tricky as a locum, because you’re often left off local mailing lists from your CCG or postgraduate centre. Locum chambers usually have their own CPD programme provided for members as well as all other local GPs, or again you can ask at your local locum group to see what they provide or know about.
Q: What equipment would you suggest a locum takes with them?
A: I use a professional rugged camera bag, in which I have my stethoscope, diagnostic set, sphygmomanometer, BNF, Oxford Handbook of Clinical Medicine and Oxford Handbook of Specialities, thermometer, adult pulse oximeter, tendon hammer, tuning fork, pens, and always a bottle of water and some roasted nuts or a banana as a mid-morning snack. Never rely on being offered a cup of tea or coffee.
Q: What would your top three tips be for someone starting out as a locum GP?
A: Enjoy the challenge of working in lots of different practices. Adopt the mindset that you are providing an invaluable service to local practices and offering patients an opportunity to see a different GP. Never say to anyone that you’re ‘just a locum’.
Dr Richard Fieldhouse is the Chairman of the National Association of Sessional GPs (NASGP)