Top ten risks for locum GPs
The risks locum GPs meet day-to-day are different from the risk sink of the NHS – Dr Judith Harvey identifies the top ten
Practices have to provide safe working environments for all their staff, but the structures they create are designed with their permanent staff in mind. Locums need to be aware of this and manage their own risks from day one. The top ten risks to be wary of are:
1) Misplaced assumptions
Practices often have unrealistic expectations of locum GPs, and locums can be over-optimistic about how practices will treat them. False assumptions about hours, duties and payment frequently taint the relationship. Practices expect different things from locum GPs, and likewise locum GPs expect certain things from practices.
Solution – Both parties need to work together to foster realistic expectations and develop a shared understanding of how to work together effectively. Realistically, it is up to locums to demonstrate what being professional means. This will require the locum GP in particular to be proactive in ensuring that a professional approach is followed.
For instance, submitting a NASGP booking form outlining the job to be done, insisting on signed contracts with practices and ensuring that the practice has adequate protection to cover your own liabilities.
2) Lack of information
It’s amazing how many practices think a locum is born knowing that they hold a venesection session between 2pm and 4pm on alternate Thursdays. Not knowing how to get even simple things done is not just frustrating, it affects the quality of care a locum can deliver. Information about practice-based services and secondary care and support services outside the surgery is essential to deliver the best care.
Solution – a locum information pack. But someone has to create it and keep it up to date. Insist that practices recognise their responsibility to reduce enforced underperformance. Draw their attention to the Standardised Induction Pack developed by MPS and the NASGP. And encourage locum colleagues to help each other by sharing information.
3) Time pressure
Practices want a job done, and rarely allow locums the extra time they need to practise safely in a strange environment. A doctor under time pressure is more likely to make mistakes.
Solution – explain the realities of being a locum to the practice manager: a safe locum may need longer to consult than the partners.
4) Professional isolation
Locums spend a lot of time on their own. It is easy to let continued professional development slip. It can be hard to stay in touch with important information, eg, how many locums received the swine flu cascades? Locums can become paranoid about the way colleagues treat them, and have no idea what to do about it.
Solution – there are more than 90 sessional GP support groups, so there should be one near you. Join. Share clinical and practical problems, and gain from the wisdom and backup of doctors who understand what being a locum is all about. And lobby your PCO about their role in supporting locums.
5) Transfers of information and handovers
The next doctor the patient sees will be someone else. And a locum isn’t there to check that urgent action has been carried out.
Solution – good clinical notes are essential for safe handovers and information transfer between GPs. To ensure that urgent cases are reviewed, worrying results followed up, and referrals made, develop a checklist and hand over, not just by word of mouth, but by paper and electronic means. You may take longer to consult new patients than the partners and you may find that you write longer notes, but this will safeguard your practice. Develop your own systems and safety checklist to follow before each handover.
6) New patient, new doctors
To you, every patient is likely to be a new patient, especially when you’re called at short notice, eg, when a partner is sick. Receptionists don’t know locums either: this could create a situation that does not engender confidence.
Solution – send, or take a written profile with a picture, containing information on your training, experience and background, to the practice – to introduce yourself.
7) Fitting a square peg into a round hole
Locum GPs do not fit into the traditional partner model. Few practices know how to make the most of them and deliver a good continuity of care. Most practices are not akin to their particular needs.
Solution – develop realistic expectations by explaining what your job as a locum entails and what you need to do your job well. Cultivating good communication with other GPs and practices will make this easier to achieve.
8) Risky tasks
Practices often expect locum GPs to perform tasks, such as signing repeat prescriptions, which are risky if you don’t know the patient.
Solution – speak to the practice manager. If he or she thinks you are being difficult, explain that repeat prescribing is a common source of medical error, and it’s a risk for the patients and the practice. Explain that if you are going to do it, you need more time because you have to check each patient’s notes.
The practice has to understand this and pay for it. It’s in their interest. Before you agree to sign repeats, make sure you know how the practice reviews repeat prescriptions. If the system is unsafe, say no. And consider who needs to know that there is a problem.
9) A clash of beliefs
A locum may hold a conscientious objection to a particular treatment or procedure, eg, abortion. It is important that patients do not get stuck in the middle of a moral debate. Nor should everyone’s time be wasted because patients are booked for procedures you aren’t qualified to perform.
Solution – Make clear before you start what you will and won’t do, and what you can and can’t do. Use a NASGP booking form so the practice knows in advance that you don’t refer for termination or that you are skilled at injecting joints.
10) Limited practice feedback
“Am I any good?” Every locum wonders this now and again, and appraisal requires an answer.
Solution – performance feedback is essential for good risk management, and locums should demand it. Working in chambers or through a locum support team makes this easier. Appraisers must take account of a locum GP’s working life, and locums’ personal development plans (PDP) should reflect this.