GPs are increasingly turning to locum working, either as a career choice or because of changes in circumstances, to allow flexibility and control of their working pattern.
How can GP practices and locum GPs work together effectively to benefit both sides? From a practice perspective, having a locum who is engaged, aware of local processes and happy is more likely to lead to effective, reliable patient care, and possible future staffing support. From a locum perspective, having a practice that is supportive and aware of your needs can mean a less stressful working environment, the opportunity for engaging with a future team and potential appraisal and revalidation support.
Here are my top 10 tips for having a productive and mutually rewarding relationship with your locum GPs.
1 Negotiate terms up front
Once you have selected a locum (see box below), having clear terms and conditions is key.1 This will ensure you communicate any changes effectively and avoid misunderstandings. Include the type and number of clinics or appointments booked, any extra responsibilities such as home visits, signing prescriptions or on-call duties and most importantly what to do in situations of cancellation or complete system failures due to, for example, snow or a cyber-attack.
At our practice we negotiated terms for short-term cancellations so that, for example, if a regular locum has to drop
a session on the day for ill-defined reasons or short-term ill health, they agree to provide a session free of charge at a later date.
Terms and conditions for payment are particularly important. Never assume what work has been agreed, for what cost and over what time frame. If a payment is late, a clear line of communication will often prevent frustration turning into animosity and costly legal processes.
2 Request documents in advance
It is important to check a potential locum’s documentation well in advance. Key items are a valid registration on the performers list, indemnity cover, registration with the GMC, an up-to-date disclosure and barring service (DBS) certificate and appropriate system registration details, such as their Smartcard for electronic health record (EHR) access. The practice manager is best placed to arrange this. Well-organised locums will keep all the details in email format for rapid delivery and confirmation.
3 Provide a virtual tour
It is vital to give a new locum an induction session before they start, so they can hit the ground running on their first day. The induction allows you to check documents and make sure new locums know where the amenities such as toilets and the kitchen are, and that they are aware of safety procedures including fire evacuation.
You can also allow them to try out your system on a session of dummy patients.
Another option is to send them instructional videos. Our practice emails new locums a ‘virtual’ tour that shows how to use our clinical system and local referral processes, and signposts them to automatic protocols for things like documenting the presence of an interpreter or chaperone, or arranging investigations.2 Such videos can be created easily with simple online screen recorder software, for example Loom.3
4 Include login details in your locum pack
Locum induction packs are an invaluable resource. They should include simple reference material for how your practice runs, referral routes and other support services. This includes any in-house dermatology or minor surgery services to help your practice maintain an efficient service to patients and comply with commissioning objectives. You should also include relevant login information for computers or interface systems.
The CQC has guidelines on use of locum packs.4 They should be easily updated, searchable and accessible. A simple method is to have a document on a shared drive with all the pertinent information. Another option is to use software that offers this function, such as the National Association of Sessional GPs standard practice information portal (SPIP).5
5 Prepare locums for phone consulting
With the variation in access models and increased use of phone-based or even Skype video consultations, it is important to be clear how you expect the locum to function. Our surgery uses telephone assessments with locum staff for acute problems, to help the regular clinicians offer continuity when needed. Check when booking a locum that they are happy to offer telephone or other alternatives to face-to-face appointments if needed, to ensure they have competence and confidence.
6 Provide easy access to kit
It is sensible to confirm what equipment, if any, locums need to bring. Most locums will have their own examination kit, but you should provide consumables such as otoscopy heads and urine dipsticks, and make it clear where they are kept. Some practices may have rooms set aside for locums. If not, make sure you have a locum pack, as above. Also make sure locums know where tea, coffee and other refreshments are kept.
7 Offer a link clinician
In bigger practices especially, it is a good idea to team locums with a link clinician for back-up. At our practice, regular locums are offered a catch-up with the same partner, while ad-hoc locum clinicians are signposted to the on-call partner for any complicated matters. This also fosters a more inclusive and supportive working environment, and helps ensure complicated patient handovers are completed effectively. For branch site working, or for singlehanded practices, phone support may suffice.
8 Connect with local prescribing networks
A key challenge for locums is the variation in prescribing policies. This can mean they inadvertently transgress local formulary guidelines.
Most electronic health records now support formulary options that prioritise the selection of specific medications or offer alternatives, for example if a medication is out of national supply. Several groups exist to share these formularies, such as the unofficial SystmOne and EMIS Facebook user groups.6,7 Alternatively, the local area prescribing team may have a similar system. Make sure locum GPs are set up to engage with these systems.
Antibiotic prescribing is a key area where guidance is needed. Include a link to local prescribing team guidance in your locum pack or on the desktop.
Remember locums also bring different skills, expertise and perspectives on prescribing that can be helpful. They have the opportunity to see different systems and can share useful tips.
9 Create robust referral protocols
Supporting locum colleagues with referrals will benefit both patients and the practice. At our surgery, locums are asked to complete a referral sheet, which the on-call GP partner will review. This serves multiple functions. For example, an accurate log of referrals allows you to keep an audit trail and ensure no referrals are lost, and partners can check the referral is in line with local guidance and add relevant information.
Requests for investigations such as an echo or MRI may require system access. It is vital you highlight this in your locum pack, or create protocols or workflows to ensure locums collect all necessary information so a patient does not need to be contacted or brought back, for example, to confirm recent weight, or check for history of claustrophobia.
A simple click-through, shown in our introduction video and in our locum pack, guides both regular staff and locums through the process of requesting investigations to ensure pertinent information is documented for our administration team.
10 Invite locums to practice meetings
Offering support to locums can act as an ongoing interview for future work, both for the practice and the locum. Locums are more likely to consider a permanent role at a practice that has supported them, and practices are more likely to hire locums who engage with their structure. It is important to invite regular locums to practice meetings to facilitate inclusion and bring in an outside perspective.
Regular locums may ask for support with completing patient survey questionnaires or multi-source feedback. This may use admin time, but it can reap benefits in providing engaged future staff.
Providing feedback for locums should be routine both as a practice policy and for the benefit of a peer. This includes support for complaints or adverse event analysis, particularly as part of appraisal and revalidation.
Finding the right locum
To recruit new locums, you may consider former staff, word of mouth, advertising, approaching sessional groups or chambers, locum networking agencies or locum agencies. Each route has its benefits and potential implications.
GPs who have previously been part of the practice will know your processes and the area, but their relationship with you may be complicated after leaving, and their former patients’ expectations may be unrealistic.
A locum who is recommended by a colleague will be a reassuring choice in terms of reliability and clinical judgment. However, well-known and trusted locums will often be in high demand.
It is therefore likely that you will need to seek locums by advertising, or by evaluating those who approach you. In this case, look for signs of initiative, such as using online shared calendars or websites to facilitate bookings, as well as relevant experience, such as any specialties, triage abilities, minor surgery or gynaecology skills.
We have a well-developed mailing list that shares sessional work available at local practices with a list of regionally based locums. LMCs are also a good point of contact for networking.
Sessional GP groups will often provide contacts for locums with local experience. These may be informal groups that share contacts, or more structured groups like locum chambers. In a chambers model, a group of GPs offer services at set rates. While this may not guarantee a specific locum works at the practice, it may connect you with a locum who works to the chambers’ standard. The terms and conditions may also guarantee cover, so if the planned locum is unable to attend the chambers can source an alternative. For locums, chambers offer increased administration support (at a cost), and opportunities such as clinical or administrative leadership development in the chambers’ organisation.
You may choose a business to find locums. Traditional locum agencies
provide locums at higher cost than the above options. Also, there are newer, online locum agency services that partner practices with locums, such as Watdoc and Lantum.
Dr Hussain Gandhi is a GP partner and trainer in Nottingham
This article was originally published in Pulse magazine in September 2018; last reviewed: August 2019
2 Wellspring Instructional video. tinyurl.com/yadprrt8
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