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A ban on referrals insults and patronises GP locums and leaves partners in the lurch

Dr Diana Smallwood wonders, if you’re going to tell locums they can’t refer, what’s the point of using them at all?

Dr Diana Smallwood wonders, if you're going to tell locums they can't refer, what's the point of using them at all?

When I first read of the plan by the Southwark Clinical Commissioning Committee to ‘ban' GP locum referrals, my reaction was one of incredulity, then anger. How insulting and patronising to suggest such a thing.

I then read a reply from a GP partner on Pulse's website which said: ‘I do not doubt that locums in the main are clinically competent to make correct clinical judgments'. 

‘In the main'? Surely this applies to all doctors, whatever their practising status?

If locums are not familiar with your local guidelines then include them in your helpful locum pack, which I am sure you provide.

We don't attend PCT or clinical commissioning group meetings as we are not included in the decision making.

What is the evidence that supports the thinking that locums over-refer?

I wonder how this would work in a single-handed practice. I also wonder who would take the legal responsibility if anything went wrong. What if, for example, a locum puts in a patient's notes that a referral is appropriate but there is a delay in referring or no referral is made by the partner? What would the defence body say?

Many locums have wide clinical experience, often having worked in surgeries with differing populations and needs. We often work across different PCT areas with different referral pathways so we are aware there are likely to be differences between areas. I have found not infrequently that as a locum I have ‘a fresh eye' and have picked up diagnoses that have been missed by a GP who is familiar with the patient.

If there is to be any checking of locums' referrals, this should in theory require all locums' consultations to be assessed – to ensure not only that inappropriate referrals aren't made, but that referrals that should have been made were made. This is a lot of extra work for partners, can delay referrals and is dubious ethically. It also raises the question, why use locums at all?

The decision to refer is informed by several, often complex, inter-related factors. These factors cannot easily be appreciated by someone who hasn't seen the patient.

What concerns me most is the impact the ban will have on patients. They are certainly going to ask why we are unable to refer. They will wonder if we are less competent or if there has been a mishap in the past.

How are we to answer patients who ask us why we can't refer? The situation won't inspire confidence and may lead to patients being unwilling to see locums – which won't help anyone.

Dr Diana Smallwood is a GP locum in Barnsley, South Yorkshire

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