COVID-19 GP diary: Locums are integral to primary care – we must support them

Our co-founder Dr Ishani Patel is a GP based in north-west London and the eHub lead for four primary care networks. In this series of weekly posts, she explains how she and her colleagues are managing in the face of the coronavirus pandemic.

I’ll skate hastily past the goings-on in the wider political world this week, as there doesn’t need to be another voice added to the maelstrom. Instead, I want to focus on what I believe is a growing issue in primary care – locums. 

I’ve touched on the fact that locums are struggling in this crisis already. But I believe the issue is so serious it more than warrants further discussion.

We’re now in a climate where some locums have been driven to apply for Universal Credit because practices are not advertising for locum support – mainly due to their own financial constraints.

As one locum who spoke to us this week said: “If you'd have told me even a couple of years ago that locums would be out of work during a huge pandemic then I would have laughed in your face.” 

I think it’s fair to say that none of us in primary care saw this situation coming. But now it’s here – and we all need to do something about it.

Locums feel undervalued – and that’s a risk for all of primary care

During the early weeks of the COVID-19 crisis, many locums told the Lantum team they were being asked to do some of the most high-risk face-to-face work without adequate protection. 

This is one of many factors that have added to a growing sense from locums we’ve spoken to that they’re seen as the underclass, that they’re not valued for the work they do. 

But the truth is primary care couldn’t survive without them. In London, 25% of the workforce is made up of locums. How have we allowed such an important part of our system to feel this undervalued?

A sense of desperation is clear among locums. Many have told us they’re now seeking out roles in the private sector – which goes against the reasons they became GPs in the first place. Without exception, they’re all incredibly passionate about working for the NHS. But with no support and limited in-hours work, it’s no wonder they feel the need to look for roles elsewhere. Our whole ecosystem needs to be better at integrating locums.

Newly qualified GPs are uniquely vulnerable

On Sunday, I did my weekly shift at the Harrow hot hub and got talking to a recently qualified GP. She was one year out of her training and she had been hoping to ‘shop around’. She told me she wants to see what different places are like to work in. 

This isn’t unusual for newly qualified GPs. We’ve heard from other locums that many of them wanted to see if they had a good fit with different practices, or wanted to try out extended access hubs and working in walk-in centres. This varied experience gives newly qualified GPs a unique opportunity to understand what types of work and which practices are best for them. 

The doctor I spoke to told me that as a newly qualified GP, she feels particularly at risk of not having enough work or support during this crisis. Newly qualified locum GPs haven’t had the time and opportunity to build relationships with practices and hubs, or become part of staff banks. While all locums are struggling, this newly qualified cohort are uniquely vulnerable to potential financial difficulty. 

I believe we need to be looking at how to support this group. For example, through programme directors and RCGP First5 groups continuing to extend pastoral support to people in their first year post-qualifying.

To contribute my own support, over previous weeks, I’ve been looking at how to revive my #21stCenturyGP workshops. These are delivered to GPs who are just about to qualify and the key challenge was to see whether we could make them work as a virtual session. 

This week, I was invited by Dr Kunal Khotari, Programme Director for Luton GP specialty training scheme, to deliver the new virtual version of the workshop. It was truly heartwarming to hear the ambition and enthusiasm from the GPs about to qualify – and reassuring to see that COVID-19 hasn’t dampened their spirits. We covered a whole spectrum of topics during the session, including portfolio working, digital primary care and social determinants of health.

Having done this trial run of the new virtual setup, I’m all set to do more of these sessions again, and looking forward to lending my support to more new GPs.

What can we do to better support locums?

The financial difficulties practices are facing may make them feel helpless in the face of this problem – after all, the main thing locums need is work. However, I think we need to consider how we can make sure locums feel more included – and encourage them to remain in (or come back to) the NHS as work begins to pick up again.

The work we’re doing in Primary Care Network development, the work we’re doing in integrated care – it has to include locums. We can’t set a vision and a mission to improve population health if we don't include the people who will be seeing patients. Locums need to be key stakeholders in any engagement plan around these changes.

At Lantum, we’ve also been doing everything we can to support locums through this difficult period. Our team is speaking to locums every day, providing reassurance and getting updates from practices on when more sessions will be posted. 

We’ve also introduced practical changes to our platform, including more required information about posted sessions – such as whether PPE will be provided and whether any face-to-face COVID-19 patient work is required.

On top of this, all COVID-19 response sessions posted on Lantum also include free Rocketpay, our next-day payment service. With this, GPs can be paid just 24 hours after they invoice for a session --  helping them access their earnings as soon as possible.

We’ve been on quite the journey – now it’s time for a change

Writing this diary every week over the last nine weeks has given me a record of what has been a tumultuous time for me personally – and for all of us in primary care. I can now see that the pace of change has slowed enough for us to reconsider how often I write updates. After all, we’re now adjusting to the ‘new normal’ – and I think this blog series should too.

With that in mind, after this post, I’ll be moving to fortnightly updates. I hope you’ll continue to follow along with me as we begin to settle into “post-covid” primary care.