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Locums aren’t victims, they’re the future

Medical bodies need to stop trying to turn locums into partners, and learn how to use their skills, says Dr Michael Smith.

I don't exist. I used to exist when I worked in a hospital; I even used to exist when I was a GP registrar. I existed when I was a GP partner, but at the moment I decided to choose a new career path, I ceased to exist.

This is because I belong to a tribe of doctors called ‘portfolio' GPs, or ‘freelance' GPs. You and your patients may know me better as ‘the locum'.

There have been noises recently from all the main GP organisations, led by the Royal Medical Benevolent Fund, on how the profession can do more to help and support this group of doctors. After a day of varied discussions, ideas and usefulness, the group still hadn't decided how on earth you even find out how many freelance GPs are working in the UK.

It appeared that because the various bodies were not doing enough for freelance GPs, they weren't members of those bodies – and therefore according to the official figures for GPs working in the UK, we don't exist.

I read recently that an analysis by the RCGP shows that a ‘disproportionate' number of newly qualified GPs remain as salaried GPs or locums five years after training.

What do we mean by disproportionate? Disproportionate to whom? Is it disproportionate to NHS London or the London Deanery, which both continue to describe freelance doctors as ‘doctors in transition', as if we are travellers in the profession, looking for the promised land of GP partnership? Is it disproportionate to the BMA, whose Dr Peter Holden last week said these GPs were ‘unwilling to commit or make the necessary compromises and put in the hard graft'?

Is it disproportionate to the RCGP, from whom these results emerged via a Council candidate's election manifesto and not in its own journal or press releases? After all, with news like this, some good should come of it.

The truth is that all the stakeholders involved are doing their best to answer the ‘locum question', like a well-meaning auntie who wants to buy you a jumper for Christmas.

At a recent stakeholders' meeting, after the results were presented from the commissioned study from the RMBF, it was suggested that because this group of doctors was feeling isolated and because there were limited funds to invest in embracing these GPs, that there was a quick and easy solution. That maybe sessional GPs should have each other round for a ‘bit of supper' and a ‘bit of learning'. (This would be fine as long as they don't mind my three small children running around the place.)

While I admire the various organisations' attempts to answer the locum question, the problem is they don't know what the question actually is. But they need to find out – and fast.

I have the pleasure of working with 20 or so sessional GPs in an urgent care centre in north London, and the quality of the doctors there is a lesson to the profession. We are involving these GPs in the process of change more and more, and despite occasional opposition from some of the local partnership establishment, we are making inroads to service redesign and redevelopment.

As Dr Richard Fieldhouse, chief executive of the National Association of Sessional GPs, put it: ‘The profession is changing. The partnership fitted into the social, political and economic landscape of the 1950s, but not so much today.'

So my advice to the various organisations trying their best to help my ‘lost tribe' (a term becoming more and more overused in medicine) is:

• Find out who we are

• Find out what we want

• Let us implement the changes.

Because until you do this, I'm afraid that I, and more than 15,000 of my kind, are perfectly happy not to exist.

Dr Michael Smith is medical director of the Haverstock Healthcare Federation and a GP locum in north London

Dr Michael Smith