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Will every little thing soon need consent?

If you can't get around using

a locum at least keep the costs down – Dr John Couch shows how

The cost of locums is now a major expense for many practices. With some locum agencies charging £70 an hour and more, we often pay locums at rates higher than our own! It is therefore clearly in our interests to ensure we only use locums when there is no alternative.

Review working patterns and workforce first

It is unlikely that many of us are working as efficiently as possible. If we can reduce patient demand without affecting quality, then there will be a reduction in locum needs. Look carefully at areas such as triage, need for follow-up, review frequency and increasing nurse and health care professional input. This should be a constant process.

If you use locums regularly, the most obvious question to ask is whether it is time to look at increasing your workforce on a permanent basis (obviously the situation is different if you are using locums due to recruitment problems). Changes in partner attitudes to extra work and areas such as advanced access have meant that occasional use of locums often turns into more permanent use.

There do now seem to be more GPs moving away from the locum circuit into the more secure position of a partnership or salaried post. Even with employer's superannuation, national insurance and paid holidays, the total cost to a practice is still less than using locum cover. Added to this is the greater stability afforded by a permanent team member and reduced administration chasing the next locum.

Look at last year's locum costs in your accounts. How much would this have cost if you had used a salaried partner?

Better planning reduces

locum requirements

Many periods of poor GP cover can be foreseen and reduced with better planning. If you have no rules about partner and salaried GP holidays then there will be inevitable problems. All practices should have fair rules that cater for reasonable holiday needs, but ensure that staffing levels remain at a reasonable level. Popular dates such as school holidays and Christmas can be shared equitably via a rota.

Have agreed contingency plans for unexpected problems such as sickness. These should include how much (if any) extra work each remaining GP will do. If there is no choice but to call in a locum, keep a list of willing doctors who may be available at short notice. This can reduce the need for an SOS call to an expensive agency. The same applies to maternity cover. As locums like to have a guaranteed block of work this can be popular cover if planned ahead.

Consider an internal

locum system

This system can work really well, especially in larger practices. Basically any locums required are offered internally to partners and salaried GPs first, before looking externally.

The important element here is choice. A GP can choose whether to do the locum or not. On completing the locum, the GP submits an invoice to the practice for an agreed hourly rate and is paid outside the normal profit share or salary. GPs who do internal locums get paid more. This is all carrot and no stick, an excellent formula, especially for GPs now doing little or no out-of-hours work.

Smaller practices can try to set up the same system by getting other local practices to join in.

Use effective locums

When there is no other choice but to use an external locum, it is important to ensure quality, availability and reasonable cost as far as possible. Our own experience with agency locums has been mixed. It ranges from very good to appalling. One locum made no computer notes and most of the patients who saw him came back the next day!

We have a list of freelance locums, built up over several years. We try to give them plenty of notice, reasonable pay and a fair, clear and agreed work schedule. This seems to meet with their approval as they are nearly always happy to return. This is also a good way to allow uncertain doctors to get used to your practice and apply for the next permanent vacancy!

John Couch is GP in Ashford, Middlesex

Seniority payment for a salaried GP?

I am a salaried GP – under GMS2 will I be eligible for seniority payments?

Section 13 of the SFE sets out the details of seniority payments under GMS2 and identifies those posts that may be eligible:

a) in the case of posts held before April 1, 2004, if the post-holder provided unrestricted general medical services and was eligible for a basic practice allowance under the Red Book or

b) in the case of posts held on or after April 1, 2004, if the post-holder performs primary medical services and is:

i) himself a GMS contractor (that is, a sole practitioner)

ii) a partner in a partnership that is a GMS contractor, or

iii) a shareholder in a company limited by shares that is a GMS contractor.

Unfortunately, therefore, as a salaried employee you will not be eligible for seniority payments.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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