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From locuming to leading a chamber

Working as a locum allows Dr Richard Fieldhouse to combine a role at his CCG with running a locum chamber and representing sessional GPs

Richard Fieldhouse


Dr Richard Fieldhouse

Age 48

Location West Sussex

Roles Co-director of Pallant Medical Chambers, locum GP, CEO of the National Association of Sessional GPs and clinical lead for communications and engagement at NHS Coastal West Sussex CCG


What is an average week? 

I work two clinical sessions in surgery and for a day each week at the CCG communications office. For the rest of the time I work from home, on trains or at meetings. This enables me to carry on my CCG role while running the locum chambers where I am co-director and the National Association of Sessional GPs (NASGP). I carry my MacBook Air everywhere. My favourite place to work is the café, at a rate of one americano an hour. Technology and coffee are huge enablers.

What’s the best thing about being a locum GP?

The variety. I’ve worked as a locum in around 100 different practices. I love that I’m helping out practices and patients who would otherwise be struggling. What I lack in terms of providing continuity, 

I make up for in alternative perspective. My career also opens up myriad opportunities, such as commissioning.

What’s the most challenging aspect of your different roles?

The stress when deadlines collide.

What is a locum chamber? 

Each chamber is a co-operative of 10 or so GP locums who combine their resources to work together as one professional unit, alongside other local chambers. We started as one chamber, and now we have around 10, from London to Bristol; more than half of us were partners or salaried GPs before joining the chambers.

How did you get your job?

The NASGP came up with the chambers idea after consulting 30 locum groups on how to enfranchise locum GPs. The idea was to maximise the advantages of working as a team of GPs, without the disadvantages. I tried to sell the idea to PCTs, but ended up setting it up myself with two colleagues. Our PCT agreed to give us 180 sessions to get started and we went from there.

How much remuneration do you get for this work? 

I’m not going to give an exact figure. Instead of a salary, we pay ourselves if there’s any money left over after our costs (such as staff and IT equipment). The chambers has required a substantial amount of risk from its four directors, including me. So when I tell my kids I’ve been working in a café, in terms of getting paid, I might as well have been. Luckily, I’m not doing it for the money. 

What one trait do you most deplore in your colleagues?

I don’t so much deplore as take pity on colleagues who have a fixed mindset. 

The system we work in has led to a sense of learned helplessness. Instead of embracing challenges, creating solutions and finding inspiration in others, they tend to stick with the status quo, complain and feel threatened. We are all the masters of our own destinies.

One living person who inspires you?

At the moment it’s Daniel Kahneman, author of Thinking Fast and Slow. I now realise I know far less than I ever thought I did, and it’s liberating.

What’s the best advice your GP trainer gave you? 

Never underestimate the suffering caused by the death of a pet, and always get a chest X-ray done in a smoker with shoulder pain.

What’s the most common assumption GPs make about your role? 

That I’m a politician. And that the chambers are a way to print money.

How would your patients describe you?

As ‘one of the locums’, ‘Dr Fieldmouse’, or ‘the one with wobbly eyes’. 

What have you given up to have a career as a GP?

Dreams of being a spaceman, detective, architect, scientist, gynaecologist or chef – in that order. I did have a place at university to study brewing, which I was looking forward to, but I took a place at medical school instead.

What makes you angry?

NHS IT. I cannot believe one of the world’s largest employers is still rolling out technology developed in the previous century. It’s hardly surprising the NHS is where it is. In fact, it could be classified as industrial sabotage. 

If you weren’t a medic, what would you like to do for a living? 

If I could get paid to make sourdough bread, I’d do that. Or keep bees and chickens and grow all our own food.

Readers' comments (5)

  • It is unsurprising that Richard is looking so smug and won't divulge a figure for the remuneration that he receives from Pallant Chambers . The agency demands crippling fees for their locums ( 750 pounds per day , excluding employers superannuation ) the effect of which is sucking out partners from General Practice ( 24 partners from the area in the last few years ) This is bankrupting practices , who are forced to use locums , as they cannot get partners , who have left for Pallant ! It is just far too easy to be a Locum with no responsibility for patients , ridiculously overpaid and Superannuation payable by the practices . A Locum recently in our practice admitted that he was embarrassed at how much he was being paid as a Locum for Pallant . Man up and become a partner , with all the responsibility that that entails . Pallant locum agency have a lot to answer for .

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  • 18 patient surgery= £250. Two in a day £500.
    10% management fee paid by the locum, not the practice.
    No sick pay, no annual leave, no paid half day, no study leave, no regular income, no guarantees, no maternity leave.
    Where are they being paid £750 a day? Do I need to move?

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  • I have to make an apology and a correction , having checked with our PM - the rates for a Pallant locum are 600 pound per day including superannuation . My error !

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  • Anon @09:02, I don't think I could be a partner again - too much time spent on non-patient admin. I've got nothing but complete admiration for GPs who are partners, and i'm delighted that we're providing a viable alternative for the growing number who simply don't want increasing responsibility whilst losing control, that at the same time keeps excellent GPs within the NHS.

    The £750 a day rate you quote would be for on-call for 12 hours - £62.50 per hour. You think that's too much? On-call sessions are the exception, not the rule.

    More than happy to man-up - hey, i've even posted using my name. My average hourly gross income as a chambers director over the last 10 years has been £9.80 per hour. In fact, us directors have each paid £2k back into the chambers for ongoing investment.

    And blaming Pallant (we're a chambers, not an agency - there's a huge difference) for "sucking partners out of general practice"?! "Crippling fees"?! Do you by any chance read the Daily Mail?

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  • Anon @ 8:46am, you're a gent - although to be fair, I don't think you were actually too far off the mark in your first post! It *could* cost a practice around £750 (inc employee superann, exc employer superann) if you engaged that locum for a bust oncall that overran. But that would be exceptional.

    But practices don't often ask for on-call sessions, and Pallanteers rarely charge for over-running a surgery since each type of session (2.5-hour, 4-hour and on-call) are finely tuned to prevent this.

    Around 75% of all sessions our members do (they've done over 150,000) are 4-hour sessions, the rest 2-hour, with very few on-call. As with any self-employed locum (that's one of the many differences - chambers locums remain self-employed and so get NHS superannuation, and pay their own management fee, saving the practice doing so), the locum pays their employee contribution out of their fee, but for the last year practices have had to administer the employer's contribution from "central funding". Whether you ever receive that central funding is another issue - would drive me mad if I was a partner; another reason I admire partners so much. How do you stay so sane!

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