Dilemma: Locum cancels at last minute
Your locum cancels with hours to go before surgery. Can you charge a cancellation fee and what are the options for managing the day?
Dr Richard Fieldhouse: Complain about repeat offenders
Once you have managed the crisis, find out the reason for the cancellation and determine how sympathetic you feel.
Some reasons for cancellation may be more difficult to accept, such as a broken-down car, or a sick child. But perhaps the locum is a single parent or carer and has no one else to turn to for help.
And if the reason turns out not to be urgent – for instance if the locum found a better offer elsewhere – don’t use them again. If a builder, plumber, architect or accountant cancelled at the last minute, none of us would expect financial compensation, but we would not approach them again unless desperate.
Charging the locum a cancellation fee should only be considered under exceptional circumstances and only be attempted if this was agreed with the locum beforehand. In the absence of a contract, I would not advise this.
If the locum is a repeat offender, consider a complaint to the LMC or even the GMC.
If locums have cancelled at late notice and want to restore a good relationship, they should follow up immediately with a written explanation via email, a letter or both. Visiting the practice at the earliest possible time will help too.
Dr Richard Fieldhouse is CEO of the National Association of Sessional GPs and a locum in Chichester, West Sussex
Dr Richard Stokell: Ask the agency for recompense
Workload for the partners will be affected both on the day and on the following day. So to manage the situation you would need to see if a doctor can be found to fill the shift. If not, the patients will have to be contacted so that as many appointments as possible can be rearranged, while the remainder are redistributed.
Management of the locum would depend on their reasons for cancellation and also on your previous relationship with them, if any. Initially, I would ask the practice manager to find out what had caused the cancellation and establish why the practice had been notified so late.
If the cancellation was caused by poor diary-keeping, for example double-booking, I would expect the locum to offer flexibility, such as a short lunchtime session if they were unable to make morning surgery. But if the cancellation was due to illness or other unexpected circumstances, I would feel more sympathetic.
If the locum has worked for you before – and previously been reliable and efficient – I would ensure they were aware of the disruption and the consequences of further late cancellations, but I would suggest you continue to use them. However, if this was your first experience of this locum, I would not use them again.
I don’t think any financial recompense is likely for the practice as there is inconvenience, but no financial loss. However, if the locum has been employed through an agency, I would negotiate a waiver of the agency’s booking fee the next time you use a locum from them and make it clear that you would not want this doctor again. I would expect them to investigate and consider writing a letter of complaint.
Appraisal for the doctor is usually organised through the locum agency and putting your concerns on paper may ensure a discussion if this problem arises again.
Dr Richard Stokell is a GP in Birkenhead and associate director of the Mersey Deanery
Steven Edwards: Check your written agreement
Once you know the reason for the cancellation, there are various factors to consider.
First, do you have a written agreement with the locum with a cancellation clause? I suggest that all locum bookings are made under such an agreement. The NASGP website has a very good agreement with cancellation clauses although there is no reference to compensation if the locum cancels. If you have a written contract, and an audit trail (or an email trail) that shows when they agreed to attend, it should be fairly easy to show that they are in breach. It is more difficult if you don’t have a contract and are relying on oral arrangements.
Second, you may need to consider whether the cost of claiming a breach of contract is worth the effort. You can recover the added cost of getting someone else at the last minute, but the disruption is the main problem – and hard to compensate. Is enforcing the contract really worth it, for the (presumably fairly small) amount of money you have lost? In any case, do you have the appetite to take the locum to the small claims court?
Third, while the majority of locums are very professional and diligent, there is the occasional one that abuses the trust inherent in the system. Is the cancellation reasonable? If not, is it disruptive and unprofessional enough to put patients at risk? You could consider a referral to the GMC if the locum was aware of the need for them, and had no good reason to avoid work.
The least time-consuming option is simply to put it down to experience and if their reason for skipping work was poor, never use that person again. Locums should be made aware that practices view this behaviour poorly and local partners may share information on which locums are flaky.
In order to manage the crisis on the day, call patients first and triage their appointments or re-arrange. Ask the remaining GPs to take a couple of extra patients each and ensure they pick up the extra urgent appointments and home visits assigned to the locum. Also if you can, get an extra GP for later that day or the next day and create an extra session to make up for the lost appointments.
Steven Edwards is practice manager at the Long Ashton Surgery in Bristol.