The Jubilee Street Story: how locums are not always the answer
In the second part of our interview with practice manager, Virginia Patania, we look at how goodwill from locums is supporting the Jubilee Street Practice in Tower Hamlets– and the impact of when that goodwill isn’t there.
"It is so alien to me to be equating money by the minute or the hour. To healthcare. It feels incredibly disheartening.”
Jubilee Street Surgery is a practice in the heart of Tower Hamlets in London’s East End, one of the most deprived areas in the UK. Well known for its part in the high profile Save Our Surgeries campaign to save the practice from closure due to funding cuts, partners are working 12 hours a day or longer.
Right now the surgery are making savings on stationary and cannot afford to replace staff on maternity leave. The surgery is also short of 4 full time equivalent GPs. Right now, they rely partly on locums to meet demand.
But practice manager, Virginia Patania, describes how she struggles with the structure of GP employment.
“If you are a partner or a salaried in a practice to which you feel loyalty, it is almost implied that your session ends when your day’s work ends. So yesterday, one of my partners started the day at 8.20 and finished at ten past night. It’s excessive."
"But I think something that doesn’t help if you hire locums. So Limehouse Surgery next door just came out public with its drawings at £50K pre-pension. And then they employ a locum who will charge them for an hour’s overtime. I just find that difficult to balance in the overall sustainability of the system.”
“We have many dedicated locums,” Virginia continues, “Whose 3 hour payment is a 4 or 5 hour session. Without discussion. I’ve never seen them come and debate that with me, that they think that’s unfair.”
“There’s a general recognition in this borough, that it is the goodwill that’s keeping the system going. It’s completely the goodwill,’ Virginia says.
“We have one patient,” she continues, “who was pushed by his 75 year old carer in a wheelchair for four and a half miles fighting the Save Our Surgeries campaign. That’s the sort of personal effort that people are willing to go to in this part of London to maintain the stability of primary care. And that’s where I come from.”
“And then I get a bill for an extra hour. It is so alien to me to be equating money by the minute or the hour. To healthcare. It feels incredibly disheartening.”
In spite of the hours, the practice has no problem recruiting locums. Many of their doctors have long term relationships with the practice, or did their training there.
“We definitely build relationships with these people. We invite them to our parties, we call them to ask them if they’re ok, we send screen messages throughout the day. We check that everyone is coping, that no-one feels like they’re in a place where they can’t find support. I would never dream of asking my staff to do what they do if they weren’t willing to go an extra mile for them. It’s a two way deal, I guess.”
“I think terms and conditions are there to protect but they can’t be there to prevent goodwill and relationships. And there has to be a wise balance between the two.”
Virginia feels that everyone needs to contribute if there is a chance to save primary care as we know it in the NHS. “Everyone working in the NHS has an ownership that goes well beyond their contracted ownership to give back to the system. And that to me is fundamental.”
“This battle for more resource, for the benefit of the patient…can be won more easily if we speak with one, joined up voice putting the patient at the heart of this….I suspect we’d start driving change more quickly than we’ve been able to do so far. “
Read just what it took to save Jubilee Street in part one of the interview here