Life in the locum lane

Dr Robin Chesters had been a partner in a practice for six years before he bit the bullet and decided to launch his career as a locum GP. Sara Williams asks: What’s so great about locuming?

How long have you worked as a locum GP?

About three years. I joined a practice six years before that as a partner. I did all my basic medical training in Holland.

"Locum work opens up the opportunity for a more balanced and flexible way of working and is more family-friendly"

When do you work?

I do locum work Monday, Tuesday and Wednesday. Then I do some out-of-hours work once a week. I pursue academic work on top of that.

Describe the job in three words.

Challenging, fulfilling, creative.

What feedback have you received?

The older generation prefers to see the same doctor, but that is not specific for locum GPs. Other patients are very happy to see a doctor – be it a locum GP or a GP reg.

Some patients even prefer locums; they think that a fresh pair of eyes can open up a new diagnosis.

Why did you give up your partnership?

It was a combination of factors. I wanted to further my faith: both my wife and I are members of the Bahá'í faith. Locum work opens up the opportunity for a more balanced and flexible way of working and is more family-friendly.

What are the perks?

You see a lot of parallel universes, and you can pick up gems from some practices and share them with others. For example, I circulate the findings of patient participation groups with other practices. They are patient-led groups that GP practices work with to enhance patient provision.

The other plus point is that you get to know more practices and they get to know you. In the event that you’re asked to join as a partner in a practice, you will have worked there as a locum so you know what you would be getting yourself into. Locuming opens your eyes to a broader sense of learning of how practices work.

What challenges have you faced in locuming?

The computer system can be a challenge, as each practice can use a different system. Another challenge is the idiosyncrasies that are unique to each practice. You press a bell to call patients in one practice and call them in from the waiting room in another. It takes time to tune into the needs of patients from varying socio-economic backgrounds, but good communication can overcome this.

Before you start at a new practice, what do you do?

"I believe that the division between the different types of doctors is not as strong as we are led to believe"

Speak to the practice manager; find out about the computer system. I try to arrive early to introduce myself and get a tour. I then find out the basic prescribing habits and protocols of the practice: are blood tests carried out in surgery; do they have an antenatal clinic? I make sure I have access to the prescription note pad, and find out the use of the local hospitals, the referrals procedure and the procedure for organising an ambulance.

How do the media treat locums?

Locums as a group do not feel the wrath of the media as much as salaried or principal GPs, but I believe that the division between the different types of doctors is not as strong as we are led to believe.

GP vs locum: which is better?

There are pros and cons for working as a GP or as a locum. It ultimately depends on whose eyes you’re looking through. Some GPs prefer partnerships; they believe the job offers more security, responsibility and fosters a deeper sense of belonging.

As a locum, you don't have the same level of support and it can be a challenge getting work. If you don’t work you don’t have an income. However, if you are motivated and can rely on your own initiative and education structure, then you will succeed.

What is the pension and pay like?

Thanks to the NHS I get a good pension, as long as I fill in the right forms. There is no fixed salary; it depends on how many sessions you do and what the practice will pay.

Any advice for other locums?

Most people like to work with someone who is cheerful, arrives on time, is communicative in a friendly way, and who tries to sort things out without causing more work for others.

Where will you be in five years?

At the moment, there are fewer partnerships than applicants, so that’s a worry for a lot of GP locums who fear they won’t become a partner. I don’t worry; I look at working as a marriage. If I were to meet and fall in love with Princess Charming (my perfect practice), then yes I would marry them, as long as the circumstances were reasonable. But at the moment I’m enjoying the right balance of work, education and reflection offered by locuming.

Why I prefer to hire locums

Vivian Baker is practice manager at Heyward Road surgery.

How long have you worked at Heyward?

Ten years, but I have been practice manager for the last seven. I am actually retiring next year; after 21 years with the NHS I feel I’m entitled to.

Why do you hire locums?

We are a training practice, so the doctors are often on courses and two of our doctors are appraisers, so we need locums to cover their sessions. All our partners are female with children, so we can have childcare issues.

Is it difficult to book a locum?

I booked Robin through an agency called Pallant Medical. They source doctors to cover inconvenient times like holidays and late sessions. However, most agencies are in London. If I didn’t use Pallant and needed a locum, I would ring all the practices in the area and source a local one. I’m already booking locums for September; I worry about booking them so far in advance – what if they forget?

Have you ever experienced that?

Yes, it was a nightmare. Our only doctor had to see double the patients, and they were very irate.

Do you prefer using locums?

Yes, because we don’t have enough sessions to employ a salaried GP.

How many do you use?

We are a three-partner practice. Over the next week we only have one doctor, so we will need a lot of locum cover – two in the morning and one in the afternoon.

Is there a quota of patients locums have to see?

Most locums will quote you on just a four hours’ surgery, or a surgery plus visits, or they will quote you four hours. We booked Robin for a B2 session, so he will see 15 patients.

Do you deliver good quality care?

Some patients moan about not getting the same doctor twice but that is not unique to locums. We deliver a good continuity of care with the locums we have.

How do you know?

We use locums that are up-to-date on the clinical information we collect. If you use many different locums, you can miss information necessary for the practice’s quality and outcomes framework. When a locum starts, we give them a locum pack, which contains all the information about the surgery (numbers for hospitals, PCTs, pharmacies, etc), so they have everything they need. Pallant also provide laminated biographies of the locums, which we leave at reception.

Patients understand that doctors can’t be there 24/7. That said, locums should start looking to work Saturday mornings

Are salaried GPs paid better?

The pay is quite good, but they are self-employed so they have to pay their own tax and insurance.

What is the future for locums?

Patients understand that doctors can’t be there 24/7. That said, locums should start looking to work Saturday mornings. If we want to extend our hours, we’d hire locums, as we only have three doctors so they’d have to work every third Saturday, which is a lot – especially when you have young kids.

Do you have the budget for it?

No, not really, as the money would have to come from another service; if you don’t take up the extended hours you lose £18k a year. If one of our doctors wanted to use a locum once a month, then it would have to come out of their income.

What advice would you give about hiring locums?

We have to get two references from past practices that they have worked at. Hire a locum that is clinically sound and chat to colleagues who have employed them before.

Last updated: March 2008

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