How the NHS can make better use of GP locums
It’s 8 am and I’m standing outside a locked GP surgery in the rain. Water runs off my cycle helmet and onto my glasses. I shift my heavy briefcase, full of medical equipment, from hand to hand, wondering if someone will remember to come and let me in.
This is my way of life as a locum GP. I’m often portrayed as a high earning, dodgy, fly-by-night doctor who can’t get a real job.
But increasing numbers of GPs are now choosing locuming as a career. No-one knows for sure how many of us are locums right now but some estimate this is up to a quarter of the workforce.
I started locuming as a means of treading water for a while, wanting space for a career rethink. But eighteen months later, I’m still here, skimming the surface like a pond skater. Although there are good practices offering permanent posts, I see their working day lengthening inexorably, soaring demand for appointments against dwindling funds while paperwork and government directives keep piling in.
My colleagues give a variety of reasons why they chose this way of life: usually it’s a shield against unsustainable workload. Locuming provides a degree of control, a better work-life balance and the possibility to be more family friendly when many permanent GPs are at their desks until 10 o’clock at night. All in all, it’s not tempting to dive back in and take up a permanent job.
Although the surge in locuming definitely has its downsides for patients, there are plenty of upsides as well. While some patients are not happy to see a locum, in these days of rocketing demand and scarce appointments, plenty of people just want to see a doctor – any doctor – quickly. Engaging locums allows practices the flexibility to respond to periods of increased demand such as winter time or else locums cover the gaps while the regular GPs are away.
As a locum, I’m often a fresh pair of eyes to a problem – there is evidence we are better at spotting cancers, for example. Working across a variety of practices also makes me more versatile as a GP. And I’ve known more than one locum who has acted as whistleblower when they’ve stumbled across a practice unwilling to address a serious safety issue.
Love us or loathe us, the NHS will always need locums, so what can be done to engage with us?
Locums need to be viewed as a resource, rather than the blood-sapping vampires driven by their hourly rate. As locum, I see a lot of how practices run things differently. Take two practices in close proximity: one of which is firefighting demand on the telephones, the other with phone appointments with the doctor and a system of sending test results via text. Guess who has happier patients?
Practices could tap locums as an intelligence source - if the NHS was ready to use our knowledge.
Better use of technology could also engage locums more efficiently. Online platforms such as Network Locum (now Lantum) - where practices advertise sessions and negotiate directly with GPs are a third of the cost of agencies and can achieve a sessional fill-rate of 100%.
Ultimately, until we see better working conditions in permanent posts, there will be a lot of locums around. Locums aren’t always a good thing. Some patients with complex problems should not be seeing a locum.
It won’t help patients or the long term survival of general practice if we all become locums. But until working conditions improve, you are more and more likely to be seeing me, the locum doctor today.
Claire Davies, GP