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Locum dilemma: A practice is assigning me the most difficult patients

A practice is clearly assigning the most difficult and time-consuming visits to me, causing me to over-run. What should I do?

Dr Sara Chambers

Dr Sara Chambers: Let the practice know this is a problem

First off, talk to them. Find out their reasons, see what the facts are, and see if there’s been a misunderstanding on your part. In this sort of situation I tend to apply Occam’s razor – the simplest answer is usually the right one, and in this case it’s probably less conspiracy and more a misunderstanding.

It could be a reflection of their faith in your ability to manage complex cases; perhaps your fresh approach, being able to take each of these chronic cases at face value? Perhaps you’ve made some breakthroughs with some of their other complex patients? Perhaps they expected you would have said something if you weren’t happy? Or maybe they don’t appreciate that you have to be elsewhere at the end of your agreed sessions, and think you’d welcome the extra money you’d be expected to charge for going above and beyond. Working in different practices, you know as well as anyone else just how under pressure practices are, and it’s probable that they’re singing your praises, although maybe not to your face.

If finishing on time is critical to you, then I suggest that that’s the parameter you base any negotiations on. You simply need to finish on time. So maybe, since they’re clearly keen for your skills in managing complexity, they instead reduce the number of patients in your surgery list by three or four, giving you more capacity for your post-surgery visit. Or if time isn’t a factor, but being fairly rewarded for your skills is, either repeat the above, or simply give them notice (if it isn’t already in your T&Cs) that you’ll start charging them for the extra time taken.

Dr Sara Chambers is a GP in Chichester

Dr Mohammed Saqib Anwar

Dr Mohammed Saqib Anwar: Speak to the senior partner or manager

The first thing I will say with this is there is no single or indeed correct way to handle this potential conflict. That said, one thing that is for is certain is if you don’t tackle and address this issue head on it will amongst other things foster extreme negativity and that is not helpful to you, the practice or indeed your collective patients. Often, it is not the situation itself but the perspective on the situation that causes anger and so it is imperative that you sit down with the practice early on to raise your concern. I would suggest you speak to the senior partner and/or manager to discuss this issue and most importantly discuss and agree a way forward. The GMC in its Good Medical Practice states that ‘you must treat colleagues fairly and with respect’ and ‘work collaboratively with colleagues to maintain and improve patient care’. The GMC also expects doctors to ‘treat colleagues fairly and without discrimination’ and together with this and your terms of engagement there may also be other contractual levers that you can apply to help seek a resolution. Try not to finger point and steer the conversation more towards ways of the resolving the issue.

Despite that, if for any reason you find that you are unable to agree then I would strongly recommend you seek the advice and support of your local LMC and or the BMA who will undoubtedly be able to help in this situation.

Dr Mohammed Saqib Anwar is Chair of RCGP Leicester and a GP in Oadby, Leicestershire