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Independents' Day

Why would anyone want to be a locum GP?

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The other day I found myself asking, ‘Why would anyone want to be a locum GP?’

In the current climate, this may sound naïve – there’s no doubt a cohort of partners and salaried GPs out there who long for locum-esque liberation.

But before I get a barrage from free-spirited locums waxing lyrical about the ready cash and ‘on my terms’ work ethic, or an aerial bombardment from peeved principals, give me a moment to justify the question.

One of the best things about our job is case follow-up. I see a doctor’s job as being like a detective’s. The patient presents with symptoms, a bit like a witness statement. Then you investigate further and gather clues – blood tests, imaging, trials of treatment. Then you bring it all together to diagnose and manage, or solve, the case.

And surely the most appealing aspect to any job, medical or not, is ‘solving the case’, whether you’re an officer in the Met, or a teacher with a challenging child, or a young parent managing a busy household with a stretched income. There is unquestionable satisfaction derived from catching the criminal, getting Archie to write his name, or ending another tight month in the black.

This morning I got another email from another cutting-edge, ‘by GPs, for GPs’ market-leading online locum agency (who, they point out, are not actually an agency, they just ‘match’ GPs to practices). The Head of GP Engagement had taken the time to write, though we’ve never met.

‘Head of GP Engagement’. Ouch, the irony burns. GPs are being proactively and cynically encouraged to disengage from the profession by this toxic industry that increasingly wants a slice of NHS pie. They are lured with promises of ‘unbeatable rates’ and seduced by insincere emails offering ‘an holistic approach to locuming’.

At my practice, we’ve use several locums to deal with winter pressures. Their abilities were worryingly variable: some have been excellent, many were not. They have their role, of course, and we stumbled through January thankful for their appointments.

But to return to my original question: who would want to be one? No case closure, no follow-up, no team to work with, no home.

It’s not so satisfying catching the criminal if you’ve not been involved with the case. Personally, I’ve had enough of filing pathology and imaging results I didn’t request. Often, I can’t even see how the investigations were justified. Perhaps the locum who ordered them felt more wary of litigation that day. Or perhaps they felt reassured by their cloak of anonymity, knowing a regular GP would follow it up.

And I don’t think politicians or practices help the issue, either. We all need more flexible work and better employment terms to re-patriate a generation of GPs whose needs now are very different to their predecessors’ 20 years ago.

Locum agencies don’t care about locums and their self-pronounced holism is hollow. They exploit a silent stand-off between ageing partners worried about practice profits, and younger or disenchanted GPs for whom agencies seem a flexible friend.

I’ve done a few locums myself (though never through an agency) and I enjoyed doing them (for a month or two) because the money seemed better, and the freedom was a treat.

But it didn’t take long for the gloss to wear off. A tax return in January and eight weeks’ work without solving a single case were two reminders that, as they’d say in Sheffield, ‘the riches offered to a locum are nowt but hokum’.

Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. 

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Readers' comments (45)

  • I don't see continuity of care a problem in locum land, I deal with this by locuming in only few practices and often regularly, by this I manage to follow up and reflect on the interesting cases. By this also the colleagues get to know me and I can't hide behind anonymity.

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  • "I see a doctor’s job as being like a detective’s."

    Well, for some of us, this is what made medicine seem like an interesting career:

    Ambiguous yet plausible symptoms - investigations - postive findings - lightbulb moment - treatment - cure! The excitement!

    But - let's be honest here - how much of our time is really spent following this happy and rewarding sequence?

    In a majority of cases the diagnosis is either obvious within a few minutes of starting the consultation, or eternally mysterious. Or both, when it's evident within a few minutes of starting the consultation that the diagnosis will be eternally mysterious.

    If I had to list the rewards that I get from the job on a regular basis, there are plenty. But "satisfying medical detective work" is definitely one of the rarer pleasures.

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  • Tom Gillham

    Clearly "case-solving" goes well beyond the clinical presentations our patients consult us with, and the medical school interview response to "why do you want to be a doctor."

    Getting your head round the new DES, up-skilling nurses, maximising QOF achievements, managing staff quibbles, managing a new triage system, delivery of new services: these all require GP input from start to finish, and "case-solving." They are not part of a locum's remit and I can only think their absence make for a duller career.

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  • The new generation of GPs do not like the old school GP concept; of continuity, advocate, gate keeper, carry the patient home in your portfolio. They have a point. Being a GP is no more rewarding.
    The active locum GPs, tend to call the hospital and do their follow ups of diagnosis. Those interested can always find a way around it.

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  • Having been a locum for 7 years and now a GP Partner, I have to disagree with the over simplistic views about locums.

    As a locum a wide variety of work is available, from one off sessions to longer term posts where experience and the rewards of continuity of care can be achieved.

    There may be a varying quality of locum GPs, but I can say pretty much the same about salaried or partners.

    In fact I would say there are numerous locums that are more able than GP Partners, it is annoying that some colleagues think of locums as being inadequate in some way just because they are locums.

    Also banding all agencies together as exploitative is unhelpful. We should be smart enough to engage them when it suits us not the other way round.

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  • Whilst continuity of care is key in general practice, as a locum I think one of the things we do can be very valuable, and that is to provide a second pair of eyes every so often.
    One of the pitfalls of having "regulars" that you know well is that one can occasionally miss things because one makes assumptions based on previous consultations/behaviours etc. Having another clinician review things occasionally can give a different perspective and maybe spot something else that could be done. As locums we have no preconceived ideas about the patient so can be a little more objective.

    Posted by a (very happy) career locum.

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  • Sorry, all this based on eight weeks of locuming and not solving a case in that time? And this makes you some sort of expert on the livelihood of up to 17,000 locum GPs?

    And reducing the role of a GP down to it being about the personal satisfaction of solving cases? If that is the case, why don't we just all stay at home and do crosswords?

    I think you need to think of your role as being less about you, and more about your patients. Problem solving, sure, but It's also about helping that poor lady out about which pills she needs to take; supporting a distressed mother after her marriage breakup; making sure that bricklayer you saw get the right treatment for his back.

    Many of us work in dozens of different practices, from the excellent to the severely dysfunctional, clearing up messes made by our colleagues (I'm sure not you!) as well as supporting our colleagues with their ongoing excellent management when they are not there. It is a difficult job with all sorts of risk associated with it, just in as much as your job is.

    On continuity, you might find this interesting

    So let's all please just respect each other a bit more and support all those in our profession rather than trying to find cheap spurious ways to undermine significant aspects of its workforce.

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  • Secure environments GP

    Well said Richard.

    I'm just about to leave a partnership to do locuming again full-time. I work in prisons, walk-in-centres, every type of practice out there, secure psych hospitals, the list of possibilities is endless. I am much happier doing that until stability of the National & Local changes to General Practice.

    As for continuity, when locuming for 18 month, I had regular work at 5 practices, patient thought I was a regular GP at these and some would wait until I was back for non-urgent follow-up. It was extremely satisfying when a number of times I "cracked a case" that the partners at a practice had "hit brick wall" with years ago.

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  • I have been a partner and salaried. I now locum full time with a Chambers type set up run by doctors. I can follow up patients if I want to, both through my Chambers or individually. I don't miss the continuity of heart sinks, or the lack of support from partners when I was salaried, or the work dumping from fellow partners who didn't contribute. I do miss the nurses, admin and receptionists who used to put a smile on my face. But now I see my kids and get home on time. And I have the energy to face patients and do a good job. Totally agree there are rubbish locums, rubbish salaried and rubbish partners. The days are gone when those who couldn't get a job, locum. It's increasingly popular and rightly so. Unless general practice starts to engage with those of us in this group, it will be to the detriment of the profession.

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  • i think the article presents an archaic view of my area many practices have long term locums..which has its benefits for both the locum and the practice...what is a fact is that the tide has turned..when a qualified a few years back partnerships were akin to Gold you can't give them away with droves looking to retire my view the generation of GPs that enjoyed the financial gain of 2004 contract are now reaping what was sowed.

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