Locum GPs – the skills we need and how to achieve them

We’re very pleased to announce the publication of our ‘core competencies’ document Locum GPs – the skills we need and how to achieve them. So, who should read it?

• Locum GPs
  • This paper celebrates the importance and skills of locum GPs. Reading it may make you feel better about the job you’re already doing and may even give you some ideas on how to further develop your hugely valuable role.
• Salaried GPs
  • Hats off to salaried GPs who take on significantly more practice responsibility than locums, yet have no where near the same level of control as partners. Reading this document may make you see locuming in a different light and give you more confidence to seriously consider it should your current post not be all it was cracked up to be.
• Partners
  • There’s a lot to locuming that our partner colleagues are often too busy to realise. As a partner reading this document, we hope you’ll gain even more insight into what’s involved in being a GP locum and hope you’ll be able to instigate changes to your practice that will enable locums to work safely and effectively to the full benefit of your patients and their skills.
• Registrars, AiTs, ST1/2/3 – you know who you are.
  • Er, incoming news, guys. You know all that stuff you’re being taught about general practice and being a partner and all? Well, the reality is that you’re very likely to be locuming for longer than you thought, and actually working as a locum can be pretty tough. Your interface with patients will be quite different too, and if you’re serious about being a good GP there’s a lot that this document can tell you about working as a GP locum. Even in the very unlikely event that you locum for just a few months, there’s no excuse not to be prepared.
• Leaders of Sessional GP Groups
  • You are the unsung heroes of general practice, providing a leadership role for GPs who otherwise may completely be without any support or structure to their professional lives. We hope this document will help you to distil what you already know about working as a GP locum and pass on to your group.
• GP tutors, trainers, course organisers etc
  • Just because it’s not on the curriculum, it doesn’t mean it doesn’t exist. Read this document. Make your own decision. 
• RCGP & BMA
  • 25% of all GPs work as locums, loads of us are  your members yet there has been very little investment by our profession in the development of anything to make a tangible difference to the daily lives of busy locums trying to provide excellent care to our patients. Please read this document, accept that your respective AiT committee and Sessional GP Committees both made excellent and supportive contributions to the document, endorse the document and work with NASGP to ensure that working as a GP locum becomes as palatable and as acceptable as working as a GP principal.

New consultation document on the Core Competencies of Locum GPs

This document addresses the problems of training, support and governance of non-practice-based GPs. It focuses on locums but is also relevant to GPs in Out Of Hours organisations (OOH).

Locum doctors keep the show on the road. They provide a crucial flexibility in the workforce. At any one time around 25% of GPs are working as locums. These 15,000 doctors consult with around 36 million patients every year. Many GPs spend time working as a locum, especially at the beginning of their careers, and for some it is a long-term career choice. Yet GP training does little to prepare doctors for locum work. Trainers are practice-based and any experience they have of as locums is unlikely to be recent. Vocational training schemes give it little attention. The RCGP curriculum does not mention locums. The profession’s governance systems are geared to practice-based GPs.

One locum’s experience illustrates the challenges. In three months he worked in 40 rooms and in 20 practices varying from the well-equipped to the chaotic and even dangerous, in seven primary care organizations (PCO) areas. Six clinical software systems were used differently in every practice. He struggled with 20 different models of printer. He referred patients to six different district general hospitals as well as dozens of other secondary care facilities, using six different referral pathway systems, and saw around 2,600 patients, almost all for the first and only time. In three months most partners will not have stepped out of their own consulting room.

Good locums need to be flexible and adaptable, able to get rapidly to grips with each working environment, quick to evaluate and decide how to manage their patients, able to interpret poor patient notes and write good ones, and assiduous about hand-over at the end of each session. Since they work without the cushion of a practice structure they must be resourceful, organised and independent, but able to slot quickly into any team. They need good negotiating and business skills. Since they can only work as well as their working environment permits, they must be able to bear the risks contingent on enforced underperformance. They are particularly vulnerable to complaints, especially as many are newly qualified. Yet they are not being trained for the job or assessed by criteria which test these skills.

NASGP recognises the problems that locum and OOH work presents to those who do it, those who employ them, and those who educate and revalidate them. We offer an analysis of the needs and obligations of all parties, with the aim of benefiting the GPs, practices, the profession and most of all the patients. Locums are a substantial, vital and highly skilled, yet poorly served sector of the GP workforce. NASGP asks the profession’s leaders to acknowledge the crucial contribution of the locum in patient care by providing training and support that recognises their special role. Please become part of this consultaion by reading our full document.

Time to define and refine OOH skills for GPs

We’ve absolutely no idea what the stats are on this, but it doesn’t take a rocket scientist to work out that a significant number of GPs working Out of Hours are Freelance GPs. Exactly how many isn’t the issue (but it would help to know), it’s the quality of care they’re able to provide within the context of the support thay’re able to receive to practice as GPs in as risk-free way as possible.

To help us understand more about this, the NASGP has set up a working group of 3 Out of Hours Freelance GPs to construct a ‘core competencies’ document to first deconstruct, then define, the skills required to work as an OOH GP. On the basis of this we then hope to be able to look at any necesssary training and development needs for OOH GPs.

And we’d love your help! We’re looking for any OOH GPs to help us with this so if you’re interested then please leave your comments on this Blog, or email us at info@nasgp.org.uk, and we’ll get back to you.