Robbie Coull

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Locums deserve to earn more than principals

Pulse Magazine, 28th October 2004

Locum GPs are the only doctors in the NHS able to apply market forces to their pay, terms and conditions. Since locum rates are market based, I fail to see how complaining about locums ''getting paid more than principals'' helps anyone. But I''ll come back to the issue of market forces later.

It is obvious from reading the article that Dr Couch has never been a locum doctor. He seems to be under the illusion that locum work consists of a locum doctor simply teleporting into his surgery, sitting in a room for 2.5hrs and then teleporting home again.

So, first, lets look at what locums do.

1. Work in unfamiliar environments, with unfamiliar patients and unfamiliar staff.

2. Travel to and from different work locations, sometimes to different locations in the same day.

3. Some locums work away from home, with the associated travel, inconvenience, time away from family, accommodation problems etc..

4. Locums run a small business - they need to

- take requests from practices

- maintain an appointments book

- send out quotes

- invoice practices for work done

- chase up late payments etc..

- negotiate pay, terms and conditions of cover

- arrange travel and accommodation for residential locums

- maintain their own equipment and many locums carry their own emergency drugs

- maintain their accounts for tax purposes

- PDPs and unpaid study leave for re-accreditation

5. Locums have no guarantee of income, they get no sickness pay, and they do not get any paid study leave.

Now lets look at the work locums should avoid:

1. Visits - visiting unknown patients, in an area that may be unfamiliar to the locum is more risky medico-legally than for a principal who knows the patient and the area. It takes locums longer to carry out home visits, and while many practices are very helpful as regards leaving more time for visits, supplying maps and directions etc., many are not. As a result, many locums feel that visiting is not an efficient use of their time.

2. Routine paperwork - dealing with routine paperwork on patients that are not known to the locum carries a high medico-legal risk, and should be avoided if at all possible. MDU advice is that the notes should be supplied and checked for every result looked at by a locum. This is time consuming, and again many locums feel this is not an efficient use of their time and are not willing to accept the risks involved.

3. Routine repeat prescribing - is the same as routine paperwork. High risk, time consuming work. MDU again advises that the notes should be checked for every prescription signed no matter what system for repeat prescribing is in use. This makes this very time consuming work, and, again, many locums are not willing to accept the risk and feel it is not efficient for them to do this kind of work.

Single handed practices, of course present special problems for locums because of the above factors.

Finally, lets look again at the market forces aspect. Dr Couch wants principals to be paid more than locums per hour because he thinks the main attraction for GPs to become principals should be financial.

First of all, like many principals, Dr Couch has over-estimated how much locums earn.

So, we can see why market forces have driven locum rates up. It''s a difficult, demanding, chaotic, career with little job security. Partners have their own consulting room that they can personalise, have a team of people for support and camaraderie, have long term job security, have investment in premises and the financial advantages that brings etc..

So, in fact, what should attract GPs to partnership is all the benefits that a stable partnership has over locum work. Locum work should be paid well, because of all the disadvantages of the job.

The real question is not ''why are locums being paid well'', but ''what is putting GPs off partnerships?''. Partnerships should be attractive enough to survive a slight pay differential.

Could it be that partnerships are unpopular because of the lack of control over workload and spiralling paperwork that dominate General Practice, but which are absent from locum work?

For the retention and recruitment crisis to end, partnerships need to become more attractive, not locum work less attractive.

Oh, and principals should remember that a well paid, active, locum workforce, gives principals far more leverage when they negotiate with PCTs and the DoH over the new contract, enhanced services etc..

Robbie Coull

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