Don’t blame locums for their ‘enforced underperformance’

GP locums seem to be being blamed, yet again, for crippling general practice with high fees and lack of commitment. Doctors are an easy target, especially if there’s an attention grabbing headline about obscene rates of pay, and totally ignore the multiple systemic factors behind the headline. 

Over my 23 years of heading The National Association of Sessional GPs, I’ve dealt with hundreds, if not thousands, of GPs who locum – either temporarily, long-term or alongside other roles. As a group they are as heterogeneous as partners in their attitude to money and patient care.

Gently scratching the service of the stories of ‘lazy and greedy’ locums however, usually reveals the reason. Do these practices invite their locums to educational events, or provide an up-to-date locum induction pack?

Have they ever cancelled a locum at short notice, or paid them late? Have they ever invited any of their locums to any practice team events, or asked a locum for feedback?

Have they asked them to join their practice as a salaried GP or partner, or passed on news of a local clinical leadership role that they might be interested in?

Do these practices invite their locums to educational events, or provide an up-to-date locum induction pack? 

These locums are no more likely to be lazy, with any perceived shortcomings often due to poor engagement; like anyone, they prefer to work in a place where they’re respected and appreciated, and will do this for a lot less than you’d expect.

Another criticism often levelled at locums is that we’re ‘frighteningly risk averse’, which simply reflects an ignorance of how all GPs are.

GP locums are continually placed into a position of ‘enforced underperformance’: every practice has its own unique way of working, with a staggering 500 different practice-specific variables – different pathways, policies and procedures, nearly all decentralised, with no easy way to access them.

And so, in an almost completely alien situation, faced with partial or even no information, the best management option invariably involves a belt and braces approach. Or, should we knowingly or unknowingly make an assumption that turns out to be wrong, and a complaint follows, history tells us that it will be us who gets the blame. 

The NASGP provides a completely free, simple, online locum induction pack for all practices in the UK for precisely this reason, but until practices adopt these universally, we’re going to continue to waste approximately one hour every day hunting this information down, and continue to practise safely.

Locum chambers

In all this ignorance, those blaming the locums also completely ignore all the incredible work that’s being done in the form of developing local not-for-profit collectives of GP locums – locum chambers – to completely revolutionise the way in which we as GP locums work, supporting practices and stabilising the GP workforce.

These GP locum chambers are the obvious antidote. Where they currently exist, GPs move to the area to join them, or stay in the area for longer. Their members report a strong sense of belonging, pooling their professional resources and provide holistic support to both the locums and practices, all paid for by the locums themselves.

Across the country, forward-thinking clinical commissioning groups and GP federations have been actively supporting the formation of locum chambers.

For example, as part of the new GP Retention Programme in Buckinghamshire, Oxfordshire and Berkshire West, BOB Locum Chambers is an initiative developed with the BOB Integrated Training Hub, and North East Essex Locum Chambers has just launched with support from North East Essex CCG.

So transformative are these chambers, and so fundamental to local clinical quality, that practices in the process of recruiting a non-chamber locum to be their new partner or salaried GP have asked locums to first work within the chambers

Rather than disrupting the local health economy, they bring workforce stability and improve quality. Each chamber’s manager is responsible for signposting local information resources, so that its locums are better informed of referral pathways and processes.

Long cancellation notice periods reduce the resource-intensive cancellation culture, and all locums meet together on a monthly basis for co-mentoring and clinical governance.

Where those locums have collective concerns about local services or systems, and having unique access to these, they provide invaluable constructive feedback to further support the practices in which they work.

So transformative are these chambers, and so fundamental to local clinical quality, that practices in the process of recruiting a non-chamber locum to be their new partner or salaried GP have asked locums to first work within the chambers.

With such a support framework that actively promotes system-wide quality, the chambers soon become a local bastion of good practice, a ‘virtual practice’ in its own right, there to bring stability to a disrupted system, to the benefit of practices and patients alike.