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Locuming – good, bad or ugly?

Writing competition runner-up Dr Lucy Dolman looks back at her decision to leave partnership for sessional work

It was humongous. With compartments, pockets, wheels and a telescopic handle, my new doctor’s bag was the size of a fridge. Like buying a new pencil case for the start of term, buying the bag was a treat to calm my nerves. And I was going to cram it with kit for every eventuality I might face during life as a locum.

The good

Life on the road was fantastic. No other job affords the same flexibility. I loved that I could choose my working pattern, but it was the variety of the work that I relished most. Bookings catapulted me from the cholesterol-obsessed leafy suburbs, to gritty inner-city surgeries with bars on the windows, and then out to rural remoteness where I had to hitch a lift to a house call by tractor when my car got stuck in a ditch. 

I cast my locum net fairly small, but still illness and health-seeking behaviour varied astonishingly. On my journeys, I saw a gangrenous foot in a routine appointment (‘I didn’t want to bother you, doctor’), emergency consultations for grazed knees, and one unforgettable elderly lady who, when asked how I could help, looked at me worriedly and said: ‘Well, doctor, I’ve got a bat in my kitchen and just didn’t know who else to call.’ 

Accents also varied. There was many an embarrassing consultation when I got the wrong end of the stick. I will always remember a cystitis consultation – when I explained I needed to do a urine test, the patient looked perplexed and retorted that there was no need as her ‘hearing was fine, thank you, and could we get back to the problem in hand’. It turned out that urine and hearing sound very much alike in a strong Welsh accent.

Sometimes I was a tiny cog in a huge, posh new-build factory of a surgery, with flashy LED signs guiding the patient to the correct door.  Other days I played at being a singlehanded GP, in an old terraced house where pressing a doorbell on the desk summons the next patient – sometimes two at once if there was disagreement about who was first in the queue.

The bad

I have heard that being a locum is comparable to being a chef who is expected to cook to professional standards in an unfamiliar kitchen. You’re regularly faced by a new area, surgery, staff, patients, referral protocols and forms. Sometimes even the computer software is alien. I found that a concise locum pack and a quick guide to the important locations – your room, emergency kit, the loo, and the kettle – make for a smoother day.

Then there is the unpredictability of work. There is a temptation to ‘make hay while the sun shines’ and work flat-out for fear of a work drought. But then bills continued to land on my doormat regardless. It’s difficult to get the balance right. And of course, being self-employed means no pay for annual leave or sickness. 

It can also be lonely. As a locum you cast a solitary shadow with little peer support. Patients can sometimes be suspicious of you or disappointed that are spending time explaining their problem to a face they’re likely not to see again.

The not so ugly

Reflecting on the four years of my locum adventure, I conclude that, overall, I loved it. Like any role, it had good and bad points, but no two days were the same, and it was a real privilege to see such breadth of practice. 

Now I’ve entered a partnership and my professional development, knowledge and confidence have blossomed, but I am glad to say that my ugly wheelie bag has been drastically downsized to a natty Gladstone.

Dr Lucy Dolman is a GP in Cardiff.

Pulse asked for talented GP writers to send us stories to inspire and amuse their colleagues, and we were bowled over by the quality of the entries submitted.

Nearly 30 GPs took the time to put pen to paper – or finger to keyboard – and entries varied from amusing tales from consultations to clinical dilemmas or political ideas about general practice or the NHS in general.

Click here to read the winner and all the runners up.

Readers' comments (1)

  • My personal experience and I stand corrected- locums expect a generous reward but usually are clock watching. They( I mean most) do not provide a complete service e.g involved in QOF ,visiting etc. the nature of being a locum means gps in this category becomes de skilled in chronic disease management and tend to ask patients' to return to their usual dr.
    We now have moved away from locums and give our resident partners the 1st refusal to do xtra work. In the present climate it is unsustainable to offer the asking rates to locums when partner income have fallen dramatically with added stress if more work farmed out to primary care.
    This is the perspective from a partner point of view. My colleague who wrote the article made an informed decision to move from a partnership to a locum - one obvious reason must be the stress and the demand placed on partners by the new NHS.
    I apologise in advance if my opinion had deviated from PC but lots of my partner colleagues think likewise but afraid to say openly.

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