Transitioning into a locum career can be hugely unnerving, whether you are a partner changing the direction of your career, or a newly qualified GP wanting some variety. There are so many reasons why a GP may choose to become a locum. Moving away from the continuity of one practice and regular paid employment has its inherent challenges.
As I approached the end of my GP training, I remember the apprehension well. I felt uncomfortable at the thought of walking away from secure employment. However, I wanted to challenge myself by working in different practices, and understand how they adapted to meeting the needs of their patients. Working with different patient populations and on different portfolio roles was important to me and so I decided to become a locum after I qualified.
Whatever your path into locuming, here are some practical tips and insights to help make the transition a success.
Plan your job search
One of the ways that I succeeded as a locum was by planning ahead. Towards the end of my GP training, I wrote covering letters, and dropped these along with my CV to all the local surgeries. The NHS Choices ‘Find GP services’ website is a great free resource for practices local to you. I followed up with a phone call and email to their practice managers. It wasn’t long before I realised practice managers needed a number of documents before allowing me to come and work with them.
- Documents confirming you’re entitled to work in the UK
- Certificate of completion of training
- Confirmation you are on the Performers List
- GMC certificate
- Medical indemnity certificate
- DBS check
- Immunisation status – Hep B
- Child safeguarding training certificate
- Basic life support training certificate.
I saved all these documents as a pdf document that could be easily emailed to prospective practice managers. You can also create a Dropbox file, or other online storage file, and send this to your local practices.
It was important to me that I built up good relationships with practices and had a continuity of work and patient care.
The alternatives would be to use agencies and third parties to source the work for you. This comes with its own uncertainties, challenges and risks. After the initial introduction to practices you may want to work without a middleman, but beware of the terms and conditions of booking – you will be often be prohibited from working directly with practices if the work is sourced via a third party.
Practice managers as well as practice rota coordinators have locum lists to hand, to whom they send their locum requirements on a regular basis. Once you are added to these lists, you will begin to receive offers of work. Many areas have a WhatsApp group on which they post upcoming sessions. To secure work, respond promptly as sessions are often secured on a first come, first served basis.
Managing locum administration
Make sure you keep a diary with all your booked sessions. While this may sound obvious, double booking does happen and is inconvenient for all parties.
Ensure you secure a good medical accountant and take their advice as to whether you set up as a sole trader or limited company.
Have a system to create invoices, log expenses, track mileage, monitor the number of sessions you are working in line with your indemnity and collect all your work data for your accountant. You may have additional portfolio jobs which contribute to your income. You can do this manually, on Excel, or with one of the online bespoke locum business toolkits.
Set terms beforehand
It is important that both you and the practice understand what work will be undertaken. When I first started working as a locum, I put together a contract setting out my terms, and sent this to practice managers. This had the amount I expected to be paid for my work and included the number of patients I expected to see in a routine surgery, how I wanted my surgery arranged regarding breaks and catch-ups, and the number of telephone calls and home visits included in my fee.
I also included a clause regarding cancelling work and the time frame of notice I would give and expect to be given by practices, should my locum work need to be cancelled. These terms and conditions helped to protect me and the practice and ensure each party was clear with their expectations of one another.
When it comes to agreeing a fee, I often ask practices what rate they usually pay and we negotiate from there. Clarify in advance if your rate is inclusive of your pension contribution.
On the day
Ensure you arrive early to get set up in your room. Introduce yourself to key staff and get their extension numbers so you can access their advice quickly. Ask for the locum pack which will have key information from login details to local prescribing protocols.
To ensure you are well prepared for your first session at a new practice, here is a list of useful questions to ask:
- What is the extension number for reception?
- Where is the panic button?
- How do I call patients in?
- How do I request blood tests and where are these done (on site or local hospital)?
- How do I order X-rays and Ultrasounds?
- How do I refer for physiotherapy and counselling?
- Where are MED3, MATB1 and maternity exemption forms kept?
- Do I dictate or type up referrals?
The patients you see as a locum are your patients and you have a duty of care to them and your colleagues. Do not be tempted to ‘pass the buck’ even if you won’t be working at the practice again. Clear documentation, arranging investigations, reviewing results to assess clinical problems are extremely important from both a clinical and medicolegal point of view.
If you work with a regular group of practices, continuity of care and reviewing patients is often easier. However, if you are changing practices regularly and you won’t have the chance to follow up a patient, it is helpful to hand over to your colleagues and also put a clear plan in the notes so the patients’ regular doctor is able to get all the information they may need. Ensure you document red flags, safety netting advice and follow-up arrangements that you have discussed with your patients.
I often discuss any queries that I have with the practices’ regular doctors. I also make sure I submit any referrals before I leave for the day.
Returning to a practice
The key to being a successful locum is to ensure you are called back to work at practices. Remember to be flexible in helping meet the needs of the surgery, be punctual and organised, and that you always have the necessary equipment. Developing a relationship with the practices you work at will help you access regular work, support and continuity, and become a valued member of each practice’s wider team.
Dr Surina Chibber is a locum GP and co-founder of MyLocumManager.com