Dr Ishani Patel at Network Locum discusses how to mitigate the everyday risks that locum GPs face.
With the ability to cover shifts at the last minute and provide continuity when permanent staff are absent, locums are an essential resource.
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. It exposes you to risks which you need to manage with each assignment in order to get the best possible result for yourself, your patients and the practice.
Risk management is all about thinking ahead, expecting the worst and having a plan. So what are the common risks GP locums face and how can you reduce them?
The 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 practices and hospitals have adequate arrangements for inductions of locums and due to the nature of the job and where they are available, they are likely to differ from one practice to another.
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 ahead in preparation for your shift. The information pack should include emergency contacts, intelligence of local services and pathways as well as detail regarding practice formularies, prescribing incentives, referral protocols, primary care investigations and local community 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.
"To avoid any misunderstanding, you need to understand your expected remit before beginning work"
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.
Every practice 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.
There is always a risk factor with home visits in a new practice. If you haven’t properly negotiated the session structure with the practice, home visits may be a surprise factor in a shift. If you are aware of the visit, especially in advance, you should find out as much as possible before attending the patient, in order to avoid mistakes. Personal safety is also important, so if you are travelling by foot after dark, think about the steps you would take to remain safe.
Different IT systems
Different practices and hospitals work with different medical computer packages, so as a locum you can 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. Familiarise yourself with the technology and procedures before you start.
"Not being accustomed to the practice’s IT systems can lead to a danger of the information being accessed by unauthorised individuals"
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. Wherever you work and no matter for how long, you need to adhere to the requirements of the Data Protection Act 1998.
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.
You should Read code rather than text to ensure that ‘problems’ remain active and feature on the problem list and summary pages. Read codes for referrals adheres to best practice recommendations. The more detailed the documentation, the easier it is to look back and recall events, making the whole process easier and safer for all parties involved, including when handling complaints.
Training and development
The majority of locum GPs do not hold permanent posts anywhere else. As a result, you need to 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. There are various GP peer groups that invite locums to share clinical and practical problems. Educational or CPD events such as child safeguarding, vulnerable adult safeguarding and clinical topics relevant to primary care, also provide support for locums and assist in providing evidence for appraisals and for revalidation.
It’s worth bearing in mind that there are various online forums where locums can network with other GPs and locums. By making the most of the online community and adhering to the RCGP Social Media Highway Code, you can ensure that you have an appropriate support system, can swap experiences and share best practice. By taking these steps, you will be in a better position to avoid risk and ensure a positive experience for yourself, your patients and your practices.
"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"
Free high quality CPD sessions and resources can vary from webinars, such as Simon Wade’s Webinars, to the traditional lecture-based meetings. Network Locum’s calendar feature is an example of a great tool for finding essential CPD events in your area.
Working as a locum can bring great variety to your career, but with it come challenges and responsibilities, especially when dealing with people’s lives. However, 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.