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CAMHS won't see you now

What are criteria for approval of doctors for section 12 work?

When Dr John Couch took a swipe at sessional GPs in these pages, he was wise to wear protective headgear.

Dr Robbie Coull jabs back on behalf of locums

Locum GPs are the only doctors in the NHS able to apply market forces to their pay, terms and conditions. Since locum rates are market based, I fail to see how complaining about locums 'getting paid more than principals' helps anyone.

It is obvious Dr Couch has never been a locum. He seems to be under the illusion that locum work consists of a locum doctor simply teleporting into his surgery, sitting in a room for two-and-a-half hours and then teleporting home again. So let's look at what locums do.

They work in unfamiliar environments, with unfamiliar patients and unfamiliar staff.

They travel to and from different work locations, sometimes to different locations in the same day.

Some locums work away from home, with the associated travel, inconvenience, time away from family, accommodation problems and so on.

Locums run a small business – they need to:

– take requests from practices

– maintain an appointments book

– send out quotes

– invoice practices for work done

– chase up late payments

– negotiate pay, terms and conditions of cover

– arrange travel and accommodation for residential locums

– maintain their own equipment (many carry their own emergency drugs

– maintain their accounts for tax purposes

– PDPs and unpaid study leave for reaccreditation.

Locums have no guarantee of income, they get no sickness pay and they do not get any paid study leave.

Now let's look at the work locums should avoid.


Visiting unknown patients, in an area that may be unfamiliar to the locum, is more risky medicolegally than for a principal who knows the patient and the area. It takes locums longer to carry out home visits, and while many practices are very helpful as regards leaving more time for visits, supplying maps and directions etc, many are not. As a result, many locums feel visiting is not an efficient use of their time.

Routine paperwork

Dealing with routine paperwork on patients who are not known to the locum carries a high medicolegal risk and should be avoided if at all possible. MDU advice is that the notes should be supplied and checked for every result looked at by a locum. This is time-consuming, and again many locums feel this is not an efficient use of their time and are not willing to accept the risks involved.

Routine repeat prescribing

The same as routine paperwork – high-risk and time-consuming. The MDU again advises that the notes should be checked for every prescription signed no matter what system for repeat prescribing is in use. This makes it very time-consuming work and, again, many locums are not willing to accept the risk and feel it is not efficient for them to do this kind of work.

Singlehanded practices, of course, present special problems for locums because of the above factors.

Finally, let's return to the market forces aspect. Dr Couch wants principals to be paid more than locums per hour because he thinks the main attraction for GPs to become principals should be financial.

First of all, like many principals, Dr Couch has overestimated how much locums earn. (See box).

At £50 an hour, the annual income is equivalent to the current average GP income in England. So, we can see why market forces have driven locum rates up. It's a difficult, demanding, chaotic, career with little job security. Partners have their own consulting room that they can personalise, have a team of people for support and camaraderie, have long-term job security, have investment in premises and the financial advantages that brings.

So, in fact, what should attract GPs to partnership is all the benefits that a stable partnership has over locum work. Locum work should be paid well, because of all the disadvantages.

The real question is not 'why are locums being paid well?' but 'what is putting GPs off partnerships?'. Partnerships should be attractive enough to survive a slight pay differential.

Are partnerships unpopular because of the lack of control over workload and spiralling paperwork that dominate general practice but which are absent from locum work?

For the retention and recruitment crisis to end, partnerships need to become more attractive, not locum work less attractive.

Oh, and principals should remember that a well-paid, active, locum workforce gives principals far more leverage when they negotiate with PCTs and the Department of Health over the new contract, enhanced services and so on.

Locum income

Working flat out at 8 clinical sessions of 3hrs plus

2 unpaid admin/study sessions per week,

46 weeks a year

Minimal £10k per year of expenses

(mainly vehicle, computer equipment, and MDU costs)

Hourly rate=£35/hr Income = £67k/yr

Hourly rate=£40/hr Income= £78k/year

Hourly rate=£50/hr Income = £100k/year

Dr Robbie Coull is a locum in Inverness and runs the agency

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