Issue 1 - October 2009

Editor's letter

Sessional GPs regularly tell MPS about the unique hurdles that salaried and locum doctors face in daily practice, which GP partners do not

As a medicolegal adviser at MPS and a doctor who previously worked as a GP, I am pleased to have been given the role of editor-in-chief of Sessional GP, a new annual magazine for all sessional GPs. We hope that this magazine will provide you with useful and practical advice on how to avoid the problems commonly encountered by sessional GPs.

Having worked with sessional GPs, we understand how important it is that you understand your legal responsibilities from day one, whether you’re salaried or working as a locum. Being familiar with the red flags that co-exist in day-to-day practice is an essential safeguard against possible legal actions.

First impressions

Locum GPs are in a unique position that could possibly expose them to more medicolegal risk than partners. Unlike permanent GPs, locums often only have one opportunity to make a good first impression, and a bad impression can provoke some patients to seek redress, when, in most cases, there has been no human error.

MPS’s experience is that a breakdown in communication and patients’ dissatisfaction with a doctor’s manner and attitude frequently give rise to complaints and claims. Most incidents leading to medicolegal problems fall into one of the following categories: 

• Failure to appreciate legal and professional responsibilities 
• Problems in clinical management 
• Medication errors 
• Administration errors 
• Failure of communication, including inadequate medical records.

Vital legal concepts

Although doctors are not expected to be infallible, the law requires that they exercise a reasonable standard of skill and care at all times. It is vital to remember to never undertake a task that is beyond your competence nor without the right equipment; when in doubt, seek help from a more experienced colleague.

In most MPS cases where doctors have unwittingly fallen foul of the law, they were not aware of the legal principles that underpin their practice, or they did not understand the inter-relationship between medical practice and considerations such as consent, confidentiality, record keeping and communication.

Using Sessional GP, we’ve honed in on several of these important medicolegal principles to illustrate what salaried and locum GPs should be familiar with, in order to avoid sticky situations. The magazine is divided into medicolegal features, case studies and practical problems.

The medicolegal features begin with an article on how essential good communication is, especially for locum GPs. Sara Williams explores how your body language could impact on your clinical practice. Other essential principles are tackled in the following articles on consent and medical records.

Cases form the heart of MPS’s signature publication Casebook, but we’ve selected three cases that illustrate the interplay between practices and locums and how things can go wrong.

Practical problems

The last part of the magazine is devoted to tackling the practical reality in which sessional GPs work. Dr Richard Fieldhouse, founder of the NASGP, investigates whether it is a myth that locum GPs are becoming more mobilised and working in organised groups.

Sarah Whitehouse and Sara Williams acknowledge that locums can feel excluded from the complaints process, and ask whether the new complaints system will encourage practices to better involve locums.

Locum GP Dr Judith Harvey identifies the top risks for locums in what she describes as the “risk sink” that is the NHS. Sara Williams builds on Dr Harvey’s points, and explores the difficulties of treating non-English speakers in the cultural melting pot that is UK general practice.

Working as a GP your skills may be called upon when you least expect it. I look at medicolegal dilemmas that you may encounter during routine activities like taking the children to school. Sessional GP ends on the musings of Cumbrian portfolio GP Dr Euan Lawson, who describes locums as the Ray Mears of the GP world, and tackles the peculiarities that this presents.

As this is a new publication, we welcome feedback. If you would like to comment on our choice of articles, or suggest an article for the next issue, please contact: sara.williams@mps.org.uk.

Dr Richard Stacey
Editor-in-chief