Most practices will, from time to time, employ locum GPs to supplement their workforce. This might be on a short-term basis – to cover for sick leave, for example – or longer-term, such as a maternity cover.
Sometimes, a locum agreement can be useful if the practice needs a doctor with a certain set of skills (for example, minor surgery or coil-fitting) to fulfil a specific need on a semi-regular basis.
However, it would be wise to consider the risks associated with long-term locums, which are often centred around tax. For instance, for tax purposes, the locum might be better off as an employee, and if the locum does not pay tax, the practice may be considered responsible.
Additionally, funding regulations are different for locums, such as CCGs’ discretionary funds and NHS sickness schemes in cases where others are off sick.
The newly announced indemnity contract means practices should negotiate more up-to-date deals with locums, and remember that medical mistakes now have to go through the Government, not the locum directly.
Finding a reliable locum can be challenging, and in some parts of the country extremely so. However, as more GPs look for flexibility in working that is rarely offered in traditional partnership or salaried contracts, the locum pool is growing.
Agencies
To find a locum at short notice, and if the practice has never employed locums before, then a commercial agency is often the quickest and most hassle-free way to find someone suitable. There are several national and regional providers of such services.
The price of convenience is that agency rates will usually be higher than employing the doctor directly (with a lower hourly rate going to the doctor themselves).
And, if you find a locum who works well in your practice and you’re tempted to bypass the agency to use them again, agency agreements usually prohibit this.
Locum chambers
Many areas operate locum chambers or similar systems, where a looser collective of locums work together to offer some of the convenience of scale of a locum agency but without such restrictive contracts and with a greater percentage of the fee going to the doctor.
Employing a doctor directly usually makes the most financial sense for both practice and doctor, but obviously you need to do more leg-work initially.
Advertising
For longer-term locums, practices can advertise through NHS jobs or other regional or national advertising spaces, such as the CCG or LMC website, industry titles such as Pulse, or medical journals.
For short-term cover, word of mouth, asking around neighbouring practices and contacting previously used locums – or looking through any CVs that have been dropped off – are all the basic standbys.
Increasingly, locum GPs are more proactive in advertising their services and looking for work online and through social networks such as LinkedIn.
It is important to be clear on what exactly you will need from your locum. Some questions to consider include:
Many surgeries are content that a locum turns up five minutes before the surgery and leaves when they have finished their list. In some cases, you might need them to stay until closing time if they are, for example, the only doctor on site.
You may need your locum to take a share of incoming documents and investigation results, or you may prefer them to undertake their own admin and letter writing, then leave.
It may be more convenient to pay the locum for a session or list completed, or it might be better to pay an hourly rate. You will need to consider:
These thorny issues will usually be ironed out for you by using a locum agency. If you’re planning to manage without, then make sure it has all been given due consideration. The BMA offers online guidance and model contracts to use and adapt on its website.
Once you have found a locum who appears to meet your needs, there are additional considerations, chief among them is whether they are actually allowed to do the work.
If the GP is on a UK performers list – a pre-condition for most practices employing one – then immunisations, bloods, and occupational health and DBS checks will have been carried out at some point when they joined the list. You will need to ensure this is recent enough and decide whether you need to see any additional evidence.
All GPs undergo appraisal and revalidation as a condition of staying on the register. As a bare minimum, this should mean they are up to date with mandatory training, but as the employer, it would be prudent to see evidence of this as well. Most GPs who do regular locum work will be prepared for these requests.
Part of the role of a GP locum agency includes getting this sort of thing in order as a condition for the GP being on their books: again, you may wish to see copies of the relevant paperwork yourself.
Once the locum is on board, you will need to prepare for their arrival, so they are ready to work.
Equipment
Locum pack
Information technology
Hopefully your locum will already know how to use the relevant IT and equipment. However, in some CCG areas, three or four different patient electronic records are used in neighbouring practices.
How your practice requests blood tests and x-rays might differ from their local area if they have travelled across a CCG or hospital boundary to work for you. Think about:
It is now considered best practice for everyone accessing patient information to do so with their own login and password. Someone will need to set one up if the locum is working for you for the first time and, if relevant, arrange to sync their NHS smartcard.
You should have agreed in advance who will meet the locum when they arrive, and if any extra preparation, training or induction is required, who will deliver it, where and when. Notwithstanding, they should, at the very least, know where the toilets and fire exits are located.
During the session it may be prudent – especially if they are working for you for the first time – to designate another permanent staff member as a mentor or supervisor, so the locum knows who to contact for clinical and administrative queries during the session.
You might be happy for the locum to simply pack up and leave, but it is helpful to make sure someone is available for a five-minute debrief. For example:
Advanced preparation
☐ Does the practice have a standard locum contract to use?
☐ Does the practice have a locum pack?
Before hiring a locum
☐ Define the dates and times the locum is required
☐ Define the duties required
☐ Visits
☐ Phone calls
☐ Test results
☐ Number of patients
☐ File a request with the locum agency (if applicable)
☐ Advertise through formal/informal networks
☐ Meet (or call) the locum to agree terms/duties/times/dates in advance
☐ Pre-employment checks (performers list, GMC, indemnity, etc)
☐ Additional checks (immunisations, DBS, etc)
☐ Prepare a room for the locum
☐ Check the room (printer, computer, equipment, etc)
☐ Arrange computer logins for the locum
☐ Make sure the locum’s appointment availability is on the computer system
☐ Send out, or make available, a copy of the locum pack
On the day
☐ Determine who is meeting the locum (when and where)
☐ Is any training/induction required today?
☐ Who is their contact at the surgery during their session?
☐ Start session – see some patients
After the session
☐ Debrief
☐ Anything to hand over (clinical or non-clinical)?
☐ Has payment/invoicing process been agreed?
☐ Pension paperwork
☐ Process payment(s)
☐ Process pension payment(s)
Looking to fill a vacancy at your practice? Contact the Pulse Practice Jobs team on 020 7214 0570 or email [email protected]
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