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Evidence still supports DRE

Most practices use a locum sometimes, but do make sure you check their credentials first, says Dr Paul Colbrook

It is difficult to relax and enjoy your summer break ­ or indeed any break ­ if you are not confident your surgery is in the best possible hands.

As some GPs have found, arranging cover for a holiday or other extended period of absence is not a simple as just contacting an agency and booking the locum.

When you are off duty the GMC says you must be satisfied that suitable arrangements are made for your patients' care. It continues: 'If you arrange cover for your own practice, you must satisfy yourself that doctors who stand in for you have the qualifications, experience, knowledge and skills to perform the duties for which they will be responsible. Deputising doctors and locums are directly accountable to the GMC for the care of patients while on duty.'

To employ a locum you need to take a few precautions to ensure the continued smooth running of the practice and also to ensure continuity of care and good record keeping for patients while you are away.

There are a number of checks that it is good practice to carry out before employing a locum and some of these are also contractual requirements under GMS and PMS regulations. These are:

·Performers lists PCTs are required by law to maintain medical performers lists of all doctors who perform primary care services for NHS patients in their areas and have the power to remove or apply conditions to a doctor where there is cause for concern. GPs should check with the relevant PCT that the locum is on a medical performers list and permitted to provide primary medical services in the area, and that he has not been suspended from the list.

All GPs have to give undertakings to provide a PCT with an enhanced criminal records certificate ­ the practice may wish to ask to see a copy before employing a locum.

·GMC register The practice would also need to be satisfied that the locum was on the GMC register and had not been suspended. GPs can check the GMC's online register to see if the locum GP is registered. If a locum is not listed, it may not mean he or she is not on the register and the GP can contact the GMC to check their registration further.

In an urgent situation the locum GP could be employed for a single period of up to seven days while these two checks were carried out.

·References Practices are also advised to check a locum's references. Under contractual requirements it is necessary to check and be satisfied with two clinical references, relating to two recent posts lasting for three months or longer (which may include any current post). Where this is not possible, the locum should be able to provide a full explanation and alternative referees.

In an urgent situation, the practice has 14 days to carry this out ­ and up to 21 days (in total) if the referee is temporarily unavailable. Where a practice employs or engages the same locum on more than one occasion within a period of three months, it may rely on the references provided on the first occasion, provided those references are not more than 12 months old.

·Competency All GPs including locums are expected to take part in an appropriate appraisal process, and in addition to taking up references, GPs will want to ensure the locum is qualified and competent to carry out the role. The GP contract states that practices should consider: (a) the locum's academic and vocational qualifications; (b) his education and training; and (c) his previous employment or work experience.

·Indemnity The locum GP should also have adequate indemnity insurance in the form of membership of a medical defence organisation or indemnity provider.

Locum GP's responsibilities

The GMC's Good Medical Practice also makes it clear that it is not acceptable for locums to leave a practice in the lurch once they have agreed to provide cover. It states: 'You must take up any post, including a locum post, you have formally accepted, unless the employer has adequate time to make other arrangements.'

Good handover procedures

In order to ensure continuity of care, the GMC says cover arrangements should include 'effective handover procedures and clear communication between doctors'.

Some surgeries provide locums with a 'welcome pack'. An example has been produced by the National Association of Sessional GPs and endorsed by the RCGP. It summarises the association's Code of Good Practice, which draws on ethical guidance provided by the GMC ( spip/index.htm)

It is also advisable to issue a specific login name to the locum for the practice's IT systems. This will ensure that it is easy to identify exactly which doctor has provided care to a patient.

Paul Colbrook is an MDU medicolegal adviser

Case study

A practice that frequently used locums received a claim from a patient treated two years previously whom the GPs believed had been seen by a locum. But it was impossible to work out whether this was the case as the practice's standard procedure was for locums to log in to the computer system under the name of the doctor they were covering for. As a result the patient records only showed the various partners' details. Fortunately, in this instance, the practice was able to look back at its appointment books and identify the locum who treated the patient.

The cases mentioned are fictitious, but based on cases from MDU files ­ doctors with specific concerns are advised to contact their medical defence organisation for advice

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