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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)

  • Four observations from my perspective as a f/t locum:
    1. I am clinically independent, something I cannot say of all those in salaried roles (like Farah, in a salaried role I experienced pressure from partners to prescribe poorly or give Med3s inappropriately in order to avert complaints); as a locum, I am quite content to not work again for a practice that does not accept this and work more for those that do.
    2. As a locum who works regularly for a few practices, I have a degree of continuity.
    3. When locumming, it is not unusual to see more patients in a day than partners and yet to still leave for home earlier, and happier.
    4. If the GP partners of 2004 had not cashed-in by employing salaried underlings en masse, the current generation of GPs may be inclined to feel a little more solidarity and possibly even aspire to partnership in due course - a model, incidentally, which I think provides excellent patient care and value for the taxpayer. As it is, that generation of partners are now either comfortably retired or paying the price of chasing the short-term cash.

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  • Thomas Gillham the following highlights of your job are exactly what I think ruin beinga regular GP and make it a duller career:

    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.

    I am stunned that maximizing QOF and getting your head round a new DES are exciting tasks for you when there are masses of patients waiting to be seen . Your surgery muct be quitet. These things just always seemed like unpaid work to me and a sign of hinderance and micro management but I guess we all enjoy different aspects of work and hence the option to work in different ways.

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  • Comment about personality and economics hit the nail on the head.

    People who talk about this article trying to get locums to move back in to partnerships of dying practices - listen to yourself and realise what is going on is everyone's problem and when those practices die you won't have a practice to Locum at.

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  • As with everything life (including your job) it's what you make it. I've been a Locum for the last 2 years and wouldn't have it any other way. I work in a group of practices and frequently see the same patients time and again. The autor of this article has a poor understanding of what working as a Locum can be like ...and as has already been said there's plenty of variation in the quality of salaried GPs and Partners too not just Locums ...this guy isn't locum...just because someone is doing somthing you can't get your head round doesn't mean you've got to come up with reasons why it must somehow be inferior...it's a similar approach to misguided hospital Drs thinking 'why would anyone want to be a Partner or salaried GP?' ...as a Locum....I could happily write an article along the same lines questioning being a regular GP....the difference would be...I've actually been one for many years and I know...this guy hasn't and doesn't. His article is classic 'them and us' and lacking.

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  • To all the happy locums out there- is there a threat to job security as a locum ? If the practice partners retire and practice is taken over by private provider, will locum usage be curtailed?
    (F1, interested in GPVTS)

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  • Being a partner for few years and now a portfolio GP seen both sides. still waiting for money from partnership after over 1 year while locum money in quickly allowing financial planning. Now can go to my children's school meeting( virtually never as partner) and do not share diary with anybody so take time off every holiday( was dream before). Without work in these days- I just wonder if you missed something with many rotas and shifts being unfilled. Fulfilling variety of work-surgery,WIC,UCC etc and do loads of other bits in GP practice . Yes it has element on enterpreneurship ( not for faint hearted ) and work has to be negotiated, do not miss parts of partnership. Yes few downside but have chosen to live with it.

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  • Most partner GP's are either not available to see patients because they too have other interests, e.g private work or as os many are today, tied up with CCG activities.
    It is amazing to hear so many GP's complain about the constant demand on their time and not having enough time to see patients, but attend any CCG meetings and there are all the GP's supping tea and telling other GP's how the job should be done.
    As a locum you choose where you work and many do stick to just a couple of practices, there is as much continuity of care as there can be found with the 'absent' GP's, minus all the 'tick box' tasks and paperwork.
    I believe you get better care seeing a locum, seeing him / her more often than an absent partner GP and get continuity of care.

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  • This is a very simplistic article and these views just widen the gulf between partners,salaried GPs and locums.
    We are all GPs and the sooner the respect accorded to every category is firmly in place,the better for us all.

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  • I am a GP partner but I would gladly give it up if I could to become a locum or salaried Gp . I could then actually do what I went to medical school for, what I desired to do when I decided to be a doctor and a Gp --to deal with patients Not to be an administrator nor an economist nor spend my time doing a myriad of stuff which has no bearing on my patients welfare but only serve to satisfy the nhs England so I can have a reasonable income.
    I start work at 7am to satisfy extended hours and often leave work around 8-9 pm and go in Sunday's.
    There were times in the 90s when it was great being a partner but not any more.
    There are gd and bad doctors amongst partners/ locums./salaried GPS .
    There are partner GPS who are adept at passing the bulk of the clinical work to others.
    There is even no continuity of care for patients where there are only partners in large practices especially if you are on several sites so that is not only a problem faced by locums.
    The problem with doctors is that we are our own worst enemies because each grp think they are better than the other. We all have different roles to play in patient care and should learn to work cohesively and respect each other .

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  • I'd rather not add a comment in case Gillham is revelling in the response he has generated. However I should like to ask, what was the purpose of this article and does the writer regret his actions any way?

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