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So you want to work as a locum?

Working as a locum can provide you with a variety of clinical experience, but with this work comes specific risks.

First things first – you need to make sure you have the appropriate indemnity in place, either supplied by your employer or arranged by you through MPS.

Working as a locum can be extremely rewarding. You may wish to gain further experience in a particular clinical setting, or you may wish to supplement your income after many years of being a student.

There are benefits for healthcare organisations, too. With the ability to cover shifts at the last minute and provide continuity when permanent staff are absent, locums are an essential resource, particularly in an Emergency Centre setting or at GP practices. Some recruitment agencies are contracted to fill open shifts with locums.

Locums are an essential resource, particularly in an Emergency Centre setting or at GP practices
However, the highly flexible nature of the job as a locum, which usually involves working in an unfamiliar environment and with different people each day, can present you with a number of challenges. So what are the common risks locums face and how can you reduce them?

A lack of information

Any member of staff is likely to perform below their best if they are unfamiliar with their surroundings, so as a locum getting as much information as possible before the shift starts is highly advisable. Not all healthcare establishments have adequate arrangements for inductions of locums. Should a practice or hospital provide you with an information pack, read it as soon as possible. If you are unclear on anything, ask so you have everything you need in preparation for your shift. The information pack should include emergency contacts, intelligence of local services and pathways, as well as detail regarding prescribing, referral protocols, and local clinics. Locums demanding a thorough induction will eventually lead to better common practice, so it’s important that you push for as much detail as possible.

As a locum you will usually be expected to cover short-term absence and are likely to work out of hours
This is particularly important because as a locum you will usually be expected to cover short-term absence and are likely to work out of hours. Without up-to-date information, the chance of putting patients at risk increases, as simple tasks such as blood tests or ultrasound scans can’t be performed. Don’t throw yourself blindly into the shift. If you get into an at-risk situation, determine what caused the situation and how you can prevent it from occurring in the future. Speak to the relevant person and ensure action is taken on both your parts where appropriate.

Miscommunicated expectations

Every team will have different expectations from their locums. To avoid any misunderstanding, you need to understand your expected remit before beginning work. There are tasks and duties that you understandably may not feel comfortable with, such as signing repeat prescriptions and taking action on pathology results. These are particularly risky for locums because of your unfamiliarity with patients. If in doubt, you should carefully explain your reasons for declining to sign prescriptions or, if time permits, you should negotiate an allotment of time to complete the task safely in order to familiarise yourself with the patient’s medical record. A doctor under time pressure is more likely to make mistakes, so it’s important that you protect yourself and try to agree your terms and conditions ahead of your shift.

Different IT systems

Different practices and hospitals work with different medical computer packages, so as a locum you could find yourself using up to three different computer programmes in a single week. This can be risky as it increases the likelihood of making a mistake. For example, giving a prescription to a patient and then entering the details onto someone else’s record could have devastating consequences.

Not being accustomed to the practice’s IT systems can lead to a danger of the information being accessed by unauthorised individuals
Familiarise yourself with the technology and procedures before you start. Any patient information obtained during the shift is confidential and must be treated with due care. Not being accustomed to the practice’s IT systems can lead to a danger of the information being accessed by unauthorised individuals. To ensure that all information stays protected, make sure that you keep any passwords safe and log off immediately after you finish using the computer, even if you are familiar with the system.

Accurate and detailed handovers

Meticulous record-keeping is essential for a safe and effective transfer of information. After all, the next doctor the patient sees will most likely be someone else. Where you aren’t present to check that any urgent actions have been carried out, it’s critical that handover notes are accurate and detailed. For this reason, be wary to consult carefully and efficiently with new patients and document detailed clinical notes. When it comes to handling patient complaints, these records will help guide how well the complaint is processed and managed.

Training and development

If you do not have a professional post elsewhere, you should be mindful of ensuring you are up-to-date with the latest training opportunities. You are also at risk of professional isolation as you spend a lot of time working on your own. Peer groups can provide support for locums and assist in providing evidence for appraisals and CPD.

Many risks that locums face can be prevented if you have good communication channels with practices and hospitals. And remember – it really is worth taking time to ensure that you’re ready for your shift before it starts.

Are you covered?

Interns and community service medical officers are not allowed to undertake locum sessions as they are not appropriately registered and have to work under approved supervision.

If you are a fully-qualified junior doctor wanting to carry out locum work, first check that you are registered and check you are paying the correct subscription for your membership category. If you are in any doubt, contact MPS before embarking on any private or locum work.