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Locuming

A few things about The Performers List first

Every doctor in England needs to be on something called the Performers’ List.  It is PCSE Online that manages this process.   You can sign up online and to do so is every doctor’s responsibility.  The application/registration process is now online and this makes the whole thing easier to do.   Here are a few useful links followed by some FAQs.

Performer Lists provide an extra layer of reassurance for the public that GPs, Dentists and Opticians practising in the NHS are suitably qualified, have up to date training, have appropriate English language skills and have passed other relevant checks such as with the Disclosure and Barring Service and the NHS Litigation Authority.

In accordance with The National Health Service (Performers Lists) (England) Regulations 2013 it is your responsibility to ensure that you update your status and circumstances on the Performers List

PCSE Online is a web-based system for submitting and approving Performer List change notifications and Performer List applications.  Practices, Performers, CCGs and NHS England can access the service via the PCSE website with a unique login ID and password. Some users may already have access to PCSE Online for ordering supplies and tracking medical records.

PCSE Online is a web-based system for submitting and approving Performer List change notifications and Performer List applications.  Practices, Performers, CCGs and NHS England can access the service via the PCSE website with a unique login ID and password. Some users may already have access to PCSE Online for ordering supplies and tracking medical records.

Before starting work as a locum

The following needs to be done BEFORE you can independently work as a GP in the UK – irrespective of you being a locum, salaried, partner or other.   Don’t leave it until the last minute.  If you have jobs set up, failure to do this will not only cause you grief but grief to your future employers who then will not be impressed with you!  First impressions count.

You need to be on the GMC’s GP register if you have not already done so.

  • So there are two GMC registers you need to be on.  The General GMC register that every doctor needs to be on.   Then the GP GMC register for GPs.
  • Click here for the GMC GP Register.
  • Ring and tell them that you are now considering locum work and need cover.   
  • They will want to know how many sessions.

Ring your car insurance and tell them that your car is going to be both for personal and business use.

  • DBS in England:  NHS SBS Greenwich, 8th Floor, 6 Mitre Passage, Greenwich Peninsula, London, SE10 0ER;  Tel: 0208 5363000; [email protected]
  • Scotland, Wales and Northern Ireland : usually done as part of the performers list application.
  • Locum agenciess: if you plan to work for several locum agencies, beware – each one might ask you to go through a DBS check.  If this is the case, think about signing up to the annual DBS update service – currently only £13 per year.
  • Occupational Health check certificate.   You will usually have to pay for this.   If you’re working for a locum agency – they should pay.  If a salaried post, hopefully the surgery might offer to pay.   Accredited Occupation Health Services can be found on the SEQOHS website.

Practices will want to see the following documents, so keep them together in a physical AND electronic file.  In this way you can show them in person or email beforehand.

  1. Your identity  (Driving Licence or Passport)
  2. Qualification certificates (Medical Degree, GMC registration, MRCGP CCT certificate)
  3. Indemnity certificate
  4. Performers List certificate  + DBS certificate
  5. Occupational Health docs  (Hep B status in particular)

In order to practice as a GP in the UK you MUST be on the Performers List.  Basically it is a list to say you have been vetted and allowed to perform.   In England, Wales and NI, there is just the one National Performers List.  In Scotland, you have to apply to each Health Board you work in (yes, a pain in the bum!).

How to get on?

  • If employed by a locum agency only, then you will probably be PAYE. Check this with them.  Your locum agency pay will not be pensionable under the NHS scheme.
  • If any of your work is freelance, you can either
    1. Register as self-employed.
          • This type of freelance is pensionable under the NHS scheme.
          • Register as self employed with the HM Revenue and Customs and arrange to pay Class 2 National Insurance contributions. Do this online here via the HMRC’s website (or your accountant can do it for you but they will probably charge you).
          • If you are also employed and paying Class 1 National Insurance, consider obtaining deferment of Class 2 and 4 National Insurance contributions.
    2. Set up a limited company to limit your tax liability.    But take advice from an accountant.  You may lose the benefit of being able to pay into the NHS pension scheme.
  • There are three different definitions of being self-employed or employed, depending on whether you’re interpreting it from NHS pension status, tax status or employment law status. All explained here in our FAQ:

It should be a maximum of 2 sides of A4.  Remember, busy GPs and their Practice Managers don’t have time to read a 6 page thing and they get CVs all the time!

  • So, be concise.  Bullet form format (or lecture style).  
  • 2 sides of A4 max
  • Add something exciting about yourself in the “Personal Interests & Hobbies” and “Mission Statement” sections.   Stand out from the crowd.
  • Get two up to date referrees.

STATIONARY

  1. Your own letter headed notepaper.  Nothing expensive. 
  2. Do it yourself via Microsoft Word or something similar like the cloud based office suite Google Drive and Google Docs.  Advantage of the cloud is that it backs everything up, provides all the software you could want (email, calendars, word type software, spreadsheets) and mostly it’s free!
  3. Some business cards.   Something cheap and cheerful.  

THE DOCTOR’S BAG

Work out your system for

  1. The email address you will use (create a new work-specific one if you want, but using your existing one is fine too if you don’t mind work and personal emails together).  Nearly all locum work is organised electronically and it makes life ten times easier than a paper method.    If you’re not good with electronic systems or computers – TIME TO LEARN.  The whole world is based around computers.  Time you moved with the world.  And anyone can learn computing within days!
  2. What calendar will you use for booking surgeries for work.  Beware of physical diaries – if they get lost then you put both yourself and surgeries at risk.   Use something that enables a back up.   Alternatively, join one of these online locum manager type things where you get a dashboard – showing you the calendar, making invoicing easier and checking payments easier too.  They can be invaluable for easy tax return, but come at a cost.
  3. Develop your paperwork for invoicing.   Again, either develop an electronic one, use one a locum friend uses or use something automated and online.  I prefer the last!
  4. Work out a system for checking payments have been recieved.   Again, one of these online things will automate all of that and can remove the headache out of the equation.
  5. What mobile phone will you use for making locum related phone calls – personal or a work one?
  • Google Maps for android and iOS is fine.  Does the job.
  • Download the TomTom app.
  • If using your phone, don’t forget to buy a car mount – look them up on ebay or Amazon.
  • Or buy a specific sat nav device (which is usually unnecessary these days).
  • Of course, you may not need one at all if your car has a good sat nav, but in my opinion, most are a bit clunky and painful to use.

Then start booking!

Now it’s time to get yourself out there!  Get known, get seen, get booked up and start working and earning.  

Don’t confuse local locum group with locum agency.  Most regions in the UK have their own local locum groups – a group of locum GPs in the area who network with each other – physically, electronically, via Whatsapp etc.  Learn from other people’s experiences.   Practice that are good, practices to avoid.   Hints and tips for getting work, collating data for your tax accounts, how to charge, share invoice examples etc.  And of course, make some friends – some of whom will remain friends for the rest of your life!

In some areas, there are locum chambers – small, independent groups of local self-employed locum GPs all working together through a shared management and clinical governance structure.  This collaborativism is seen to be good for both GP practices and local locums. By collectivising administrative work, pastoral care and systems and processes for clinical governance, chambers support and retain flexible GPs, enabling them to become a well-engaged presence in a local health area.

  1. To find your local locum group – just do a google search e.g. “Leeds Locum Group”.
  2. To find your local chambers group – google search again.  “Leeds Chambers”
  3. Alternatively, ask and locums that you come across.  

Send a copy of your CV with a covering letter to…

  • Practices
  • The LMC
  • Locum agencies (if you wish to work for them)

Your covering letter should be brief – about one or two paragraphs summarising who you, key interests, and when you are available for work.  And of course contact numbers/email.

 

  • You should be now have a reliable calendar booking system for booking in your future work with surgeries.    Your calendar system should have a back up in case anything goes wrong.  Remember, if your calendar is a paper one and it goes missing, you end up putting a lot of practices and their patients at risk of no doctor cover.   This is professionally unacceptable.
  • Send an email confirmation summarising….
      • the dates of work
      • the rate of pay including pro rata payment for overrunning, payment terms (28 days is usual)
      • what the work includes (surgeries – how many apppointments, what times, visits, bloods) 
      • Any other extra non-core work or special enhanced services
      • terms and conditions, like
          • cancellations (set your own sliding scale from 0-100% of the booked fee for 0-28 days in advance)
          • private fees like HGV medicals
          • cremation fees
  • Of course, if you’re subscribed to an online locum organiser type thing, it should be able to do all of this for you.  
  • So that you can become familiar with  it.   
  • If it is not a system you are familiar with, get learning!  Look at some basic videos either via a Google Videos or YouTube search. 
  • Or ask the PM for some basic electronic training guide for the system and come in an hour early to learn the system and ask if anyone can be there to help you.   This will then help train you up for other practices who use a similar system.

 

On the day...

Here are some things to do when turning up for each job…

Every week look up where you are working on a map.   

  • How will you get there? 
  • What time of day will you be setting off? 
  • How bad will the traffic be then?   In Google Maps – you can enter your home address, the practice address and the time you are thinking of going.  It will then estimate how busy the traffic will be and will visually show you where the traffic blocks are.  That might help you find an easier route. 
  • Do you need to set off earlier?
  • Tip – when booking surgeries for a morning – practices are more bothered about providing cover rather than the exact start time.  So, choosing to start at 930am or 10am can help you avoid rush traffic.   Same for finishing.  Don’t finish at 5pm.  Go for 6pm.  or do 2-4pm.

Practices will want to see the following documents, so keep them together in a physical AND electronic file.  In this way you can show them in person or email beforehand.

  1. Your identity  (Driving Licence or Passport)
  2. Qualification certificates (Medical Degree, GMC registration, MRCGP CCT certificate)
  3. Indemnity certificate
  4. Performers List certificate  + DBS certificate
  5. Occupational Health docs  (Hep B status in particular)

Ask the PM to show you around the building for things like…

  1. The toilet
  2. The kitchen (so you can make yourself a drink)
  3. The common room where the docs and other staff hang out
  4. Your room
  5. Brief introduction to some vital staff (receptions staff more so than docs and nurses – as they will help you to no end)

Also ask the PM for a Locum Induction Pack. 

  • Some GP practices have one, others dont. 
  • It tells you some local stuff, like how to do referrals, where they go, how to do fast-tracks, website info and other practical information like ordering bloods.
  • If the surgery doesnt have one… ask
      1. how to order bloods
      2. how to do referrals – forms, dictation etc
      3. how  to do hospital admissions
  • For practices that don’t have a GP locum pack, once you have developed a good working relationship with them, suggest to the PM or GP that they develop one.   Refer them to this link: CQC’s Dr Nigel’s Surgery advice on developing a GP Locum Induction Pack.
  • Hospital phone numbers with direct lines for admissions, A&E and path labs
  • Ambulance number 
  • Adult Safeguarding and Child safeguarding numbers/protocols
  • Mental Health Crisis team number
  • Social Services number
  • The Police and Corner
  • Department of Public Health – to report Notifiable Diseases;
  • Be nice to everyone – not just the doctors.   And especially the reception staff as they will help you in every way they can if they like you and they can easily get you out of bother.
  • Also, when you pass GPs or other staff in the corridor, smile and acknowledge them.
  • When passing GPs, introduce yourself.   Get chatting.  
  • In your break, or after surgery – go and sit in the common room where the doctors hang out.   Introduce yourself, engage in small talk, have a bit of laughter.
  • If you’re regularly working at a practice for a little while, remember to greet people as you arrive and say goodbye when you leave.   Don’t just turn up, slip into your room, do the work, then troddle off.  Mix with the staff!  Some practices love their regular locums.  Would you like to be one of those  ones that they love?
  • All this networking not only guarantees repeat business, but even the prospect of a permanent future job offer.

The work includes

  • Deal with the patients in your surgery
  • Do any necessary paperwork like referrals
  • Fill relevant forms like blood forms and ordering investigations.
  • Arrange  any urgent admissions
  • Do home visits if you have agreed to do them

The results of blood tests and investigations you order should really return to the patient’s usual GP but if you are at any one place for a while, don’t be surprised if they come back to you.   You can challenge the practice to send these back to the regular doctors at the practice.  And of course, just because your in a practice for a few months doesn’t mean that you should then become part of the blood results and letters sharing protocol with the regular doctors at that practice.  Of course, you can agree to do it, but then negotiate more pay OR reduce the number of patients seen during a session and substitute it with admin time. 

Charging fees

The first thing you need to understand is that in the UK there is this very important law for service providers about Anti-Competitive Activity.  PLEASE familiarise your self with it.   If you break it, you can be fined.  Asking around is not option: anti-competition laws are very clear about the illegality of discussing rates with fellow GP locums.

Competition Act 1998 in a Nutshell:
The economy thrives on businesses engaging in healthy competition.   That means you cannot say that you have fixed locum prices – you have to engage in negotiation.  You cannot agree with a set of other locums to charge a particular price for a particular area (bid rigging).  The full definition and range of Anti-Competitive Activity can be found on the UK’s government website here.  Please read through it carefully.

You will be fined if you break this law.  

What makes it particularly difficult is that you are not allowed to discuss locum rates with your fellow locums and you must not discuss the prices you are going to charge practices with other locums.   This will be considered as breaking the Anti-competitive law.  So, how do you work out a rate?

Determine 3 things

  1. What is the MARKET RATE for someone with your experience for the service you will be providing?
      • This can be difficult to work out
      • No one (including the BMA) is allowed to publish suggested rates because it is considered to be anti-competitive.
      • But as well as the market rate, do take into account your SKILLS and LEVEL OF EXPERIENCE.   The more skills or experience you have, the more you may want to charge.
  2. What is a FAIR RATE for your work taking into account your expenses?
      • Remember, your expenses aren’t just the fuel costs.
      • It also includes the fee for membership of professional bodies – BMA, RCGP, defence union
      • Also take bear in mind your accountant fees and tax advice fees
      • And of course anything you pay toward GP Appraisal
      • And of course, you may charge a higher rate if the booking is short notice or urgent.
      • And also you can charge higher during periods of high demand – for example, some locums charge more during the Summer months.  You can vary your charges through out the months based on supply and demand.   
  3. What would you reasonably expected to be paid if you were a SALARIED DOCTOR for the same number of sessions and workload?
      • Can you work out a fair locum rate based around the salaried rate as a starting point?
      • Clearly your rate would be higher than a salaried rate because of professional expenses, and an allowance for annual/sick/study leave.  

In summary, there is NO ONE SIZE THAT FITS ALL.     Try and work out a rate that looks at all three of the above things.    And if you have worked out a reasonable rate, then you will know quite quickly when you try to book practices.  If your price is too high, no one will want you.  If it is too low – everyone will snatch you up!   Do feel free to experiment with rates.   It can be quite fun.  

Search the internet for NASGP LOCUM RATES CALCULATOR – it can help you determinea reasonable rate.

Please note that the advice offered on these pages must not be considered as providing any guide to the level of fees that may be set by GP locums. Competition Law is complex and anyone with a Competition Law enquiry must seek appropriate legal advice.

  • The market rate
  • Your skills and experience – the more skills and experience, the more you can charge
  • The greater your expenses, the more reasonable it is to charge a higher rate.   Expenses like  Fuel costs, Accountancy Fees, Tax Advisor Fees, Subsciption fees to professional medical organisations (BMA, Defence Union, RCGP etc)
  • Higher demand months  you can charge more eg Summer, Christmas, Easter
  • Short notice or urgent cover – reasonable to charge more
  • Supply of locums – if there is a shortage in your area of locums, it is reasonable to charge more.  In busy cities, there may be lots of locums flying around, so you might have to charge less.
  • Doctors are generally apprehensive about negotiation. 
  • But actually, you do negotiation all the time in every day life.  AND it is a skill that can be learnt.  So, look at our BVTS pages on Negotiation and learn some of the basic theory.  And then start practising.   
  • Remember, aim for a deal where everyone is a winner.  It ensure repeat custom.   And it shows that you’re flexible as a person.
  • You can negotiate on the phone, in person or via email.  Essentially it’s all the same.  With email, you have more time to think about and construct what you’re going to say.
  • And of course, you may want to brush up on your assertiveness skills too.   Click here for Assertiveness training.

Nevern ignore the T&Cs – they’re as important as anything else.   It’s the fundamental document that people will refer to in a legal dispute.  So, it is worth formulating it carefully right from the start.

Be clear about 

  • What services you will provide: what the work includes (surgeries – how many apppointments, on-call, triagewhat times, visits, bloods) 
  • Any other extra non-core work or special enhanced services
  • Rate of pay including pro rata payment for overrunning, payment terms (28 days is usual)
  • Pension contributions
  • Cancellations (set your own sliding scale from 0-100% of the booked fee for 0-28 days in advance)
  • Other private fees like HGV medicals and cremation fees
  • Send the invoice – preferably electronic.
 
  • Don’t forget to give the Practice Manager pension form A.      GP Locum Form A (England & Wales Apr ’19) pdf – 298.9 KB
  • NHS Pension as a Locum
    • Members have 10 weeks to pension their locum work. If they do not submit the forms in time then this work cannot be pensioned.   
    • If you’re a GP locum employed by a company, such as a locum agency or your own limited company, your are not eligible to contribute money earned in this way into the NHS superannuation scheme since you are the employee of a private company. 
    • If you’re asked to do a locum in the practice where you’re a partner or are salaried, then this has to be worked as overtime, and not as a self-employed locum. so you’ll have to pension this extra work according to your existing NHS pension arrangements.
    • Learn more about the Pension Forms here
    • NASGP FAQs on Pensions (register to access, it’s free)
 
  • Then it is a matter of chasing the payment.  I would give practices 28days to settle the payment.
  • Try and ask for payments through BACS – it is more headache free than asking for cheques.  There’s nothing wrong with the latter.  It’s just a pain having to go to the bank and paying them in!   All practices these days do electronic banking, so why not use it?   Some of the online locum software has built in accountancy packages that tracks payments and facilitates the electronic banking process.   Explore….  make your life easier!
  • If you do recieve cheques, pay them into your account quickly to avoid cash flow problems.   
  • Also consider putting away 1/3rd of your income into a high-interest immediate-access savings account.   This will ring fence some of the income for the tax bill you will have to pay later on.  It will stop you from going crazy and spending all your income and having little left over for the tax payment!  Remember, there are two tax payments every year.
  • Some of the online locum platforms are really good at helping you to manage the invoices sent, those that have been settled and those that haven’t.
  • Don’t forget to fill out your GP Locum Form B   GP Locum Form B (England & Wales Apr ’19) pdf – 309.5 KB
  • Send your completed GP Locum form B off.  

A few warnings & other bits n bobs

  • This is important.   Best done all electronically.
  • Online GP Locum Organiser software are good at automating this for you.
  • But you can do it yourself if you enjoy being methodical and organised.  
  • Failing to keep records can attract a fine of up to £3,000 (and more if failure continues).
    • NASGP’s LocumDeck includes a comprehensive free locum accounts package called Bookkeeper, completely free with NASGP membership.
    • Records do not need to be elaborate – a simple spreadsheet recording income and expenses, backed up by invoices and receipts may be all you need. Consider a separate bank account and credit card account just for business items, this will make it easier to collate the information.
    • If you intending to be a career locum rather than a temporary one, you may prefer to use bespoke software for your records that will also include your diary, invoicing and your pension forms.

For anyone who wants to leave the UK for a short period (1-2 years), you may be wondering whether or not to come off the performers list.  ANSWER – STAY ON THE PERFORMER’S LIST!!   You will regret coming off it because when you return, it will cost you a lot of time, money and unnecessary head banging.   So, if you’re heading off to Australia or New Zealand for 18m, lots to people may tell you to come off it but think carefully before you do.  Giving up your Licence to Practice with the GMC which automatically take you off the Performers List.   Getting back on will prove difficult and there are various hurdles you will meet.

Dr Lindsay Moran’s experience will highlight the difficulties…

The General Medical Council

Getting back on to the GMC register was relatively straightforward. However, they insisted on a in person appointment to verify my identity with my passport in order to add me back onto the Licence to Practice register (although the fact that I was still paying to be on their regular register). “But I’m still on your register and still paying your fees!” was my argument? That didn’t matter. They had to see me in person. There was a two-week wait for appointments in both London and Manchester. I had to cancel one appointment, which meant another two-week wait for the next one.

Paperwork

Occupational health took 3 weeks to be approved. Thankfully, I did not need to attend in person; it was simply a review of my paperwork. But still incurred a charge. Level 3 safeguarding training had to be done online – fine. The problem came because the online training does not issue certificates. Even so, the performers list office demanded a certificate. Multiple phone calls to various people eventually resulted in the performers list agreeing to accept a print out of the transcript from the Internet.

For the performers list itself,  you need to fill in a small(!) 27 page document to reapply. And then, you have to go in person with all your original certificates. The fact that I was on their performers list previously and had trained, worked and had appraisals as a GP with them was irrelevant. They needed all the information again, shown in person.

The main problem I had was getting my DBS check.  . As a locum, I could not easily get my DBS done as you need a nominating practice to undertake this. In the end I joined a locum agency who did it for me. They advised me that it could only be completed when I was in the UK (this I now know to be untrue). After sending off my paperwork it took 6 weeks for me to see (online) that I had passed my DBS. However, the paperwork did not arrive. The DBS centre refused to reprint my certificate until two weeks had passed. The performers list office insisted on an original paper DBS certificate before processing my paperwork. More than 8 weeks after I submitted my application my certificate finally arrived, and I was able to take it to my performers list office.

Once my paperwork was satisfactory for the performers list office it then got sent off to be approved by their manager. This I was told could take 2 weeks. Thankfully this was only one additional week.  So after arriving back in the UK in the first week of June, it was not until mid August that I was finally able to start working. More than 2 months later. I was frustrated and demoralised by this process, not to mention significantly out of pocket. I had to cancel locum shifts and let surgeries down too.

So if you are advised to come off the Performer’s List, and you are planning on coming back to the UK – don’t. The system to reinstate you is so flawed that it is not worth the hassle. You will, however, need to work a small amount each year in order to be able to undertake an appraisal (that ‘small’ amount is not defined though). For most performers’ lists if you are out of the country for more than 2 years then you need to undergo a period of retraining or get onto a returner’s scheme. I am heading back to Australia soon, but i plan to return every summer to do the minimum amount of work necessary to stay on the performers list, as eventually I will be coming back here.

  • Take holidays during the quieter months when GPs with families are not usually away.  For example
      • Late January
      • February, March, April
      • October, November, early December
  • Practices are usually desperate for doctors during the usual holiday periods that centre around school holidays.  Like summer time (June – September) and Christmas/New Year.  So try not to take holidays then.   List of School Holidays for your reference (try not to take your holidays during these times)
      • February Half Term – usually last two weeks of feb
      • Easter holidays – first two weeks of April
      • May Half Term – last week of May
      • Summer holidays – 3rd week July – 1st week September
      • October Half Term – last two weeks October
      • Christmas & New Year holidays – Last week Dec and 1st week Jan
  • Most practices will usually start off by employing you for a short period.  But in the UK there is a GP recruitment problem.  Therefore, short-term locums often transform into long-term ones as practices become desperate and urge you to stay on. And it’s difficult to say no once you like a practice and they like you!   And it’s great to feel part of a team doesn’t it?
  • HOWEVER, THERE IS AN IMPORTANT WARNING YOU NEED TO TAKE HEED OF.
      • Tax Benefits: HMRC may start seeing you as EMPLOYED rather than SELF-EMPLOYED and that means you lose all the tax benefits of being self-employed.  If you find that you’re mainly working for one practice on a regular weekly time schedule dictated by them and that you can no long decide when and where you do your work, you are probably no longer self-employed! Click here to read the HMRC’s definition of self-employed.  You can also use the HMRC’s employment indicator tool to give you a better understanding of whether you’re self-employed or verging on the employed!
      • NHS Pension – if you are at any one place doing regular sessions for more than 6 months, then there are two options in how you want to pension your locum work from month 7 onwards.   Either continue via GP Locum forms A and B.   OR as a Type 2 (regular) Practitioner.  Please seek advice from accountants, colleagues and your chambers group when making your decision about what to do.  You will need to liaise with the Practice Manager of the practice to administer it.    You can pension all the work at a regular practice as Type 2 practitioner if you know from the outset that your work will exceed 6 months.  The NASGP site has a wonderful section on this.  You will need to register to view the advice.
      • Employment Rights: if you are verging into the employed territory, then the only good thing is that you have access to certain rights like any other employees – Statutory Sick Pay, Time off for Emergencies, Right to flexible working, Protection against unfair dismissal.  Read about the full rights of employed people here. 
  • There is the problem of what NASGP calls “MISSION CREEP”.  Basically, you decided to work as a locum to simply deal with patients seen in surgery that day and move on.   However, the mission for GPs who are Salaried or Partners is one of building relationships and continuity of care.   If you are at a practice too long, this salaried-partners mission will creep and take over your working style.   You’ll start getting your regulars, and perhaps patients will become dependent on you.  Not only that, being the nice doctor that you are, other staff like reception and nurses might start coming to you more as they find you more approachable.  And then the blood results and letters start coming your way.  All of this will gradually eat more and more of your time making your working day more pressured.   So, be careful of this mission creep that often comes with staying at a practice for too long.  
  • How to avoid mission creep?  ANSWER: Set your boundaries.    As GPs, we like to help out and find it hard to say no, especially with a practice that you like.   But if you start to neglect yourself and fail to set your own boundaries, your workload, pressure and stress starts to go up silently in the background until it reaches breaking point.  And then you become ill – which is unfair on you, other practices that need you, patients, your partner, your family and your life.
  • How to set boundaries by NASGP

Some practices are very well organised.  Others aren’t so good.  So, if a practice fails to pay you on time, it’s probably because there are not so well organised or something acutely has happened throwing their organisation systems slightly off track temporarily.  In the first instance, be kind, compassionate and understanding.   Don’t come over as dictatorial or aggressive.  Practices respond better to an understanding person who is firm about his or her position.   There is a world of difference between being firm and being an aggressive dictator!

  1. Email the Practice Manager
    • Be nice and gentle – request urgent payment within 2 weeks.  Ask for an acknowledgement that they have recieved the email.
    • Give times, dates
    • Remind them of T&Cs
  2. Still no joy? Write!
      • Repeat the above, but send letter.
      • Via recorded delivery.
  3. Still no joy? Speak to PM
    • Speak to the practice manager about the above
    • Explain this is now the 3rd contact and help them to see how frustrating it is for you and not good practice
    • Record of your conversation via mobile phone. Before you start the conversation say “I’m sorry to have to record this conversation but the thing is I have contacted you twice already without a reply and I hope you can see how frustrating it is for me….”
  4. Still no joy? Speak GP Partner/LMC
    • Speak to the senior GP partner at the practice.   Get them to see how frustrating for you it is and how unprofessional and discourteous it is.
    • If that fails, speak to your LMC, who will be able to talk to the practice on your behalf.
  5. Still no joy? Court

Appraisal, Learning & the Future

The concept of appraisals, their value and purpose has been around for a long time within organisations and businesses.  GP appraisal by one’s peers and clinical mentors were introduced in 2002 but in 2012 became a part of the process of revalidation. Initially a formative and supportive process, they now have the dual role of providing evidence required for revalidation as well.  

  • Appraisal is the annual process to ensuring you reflect on and meet your educational and pastoral needs.    NHS England defines medical appraisal as a process of facilitated self-review supported by information gathered from the full scope of a doctor’s work. As part of the revalidation process, appraisals are key for doctors to demonstrate they are fit to practise, as well as being an opportunity to consider professional development needs. GP appraisals are undertaken annually at a meeting between a doctor and an individual (usually, but not invariably, a doctor) who is trained as an appraiser.
  • Revalidation is the 5 yearly process that signs you off as being up to date and fit to practice as a GP for the next 5 years.  

All doctors need to engage in Appraisal and Revalidation.  The same applies to GP Locums.    GP appraisal every year and GP Revalidation every 5 years.    Your Revalidation date is most likely to be 5 years from your CCT date (but check with your appraiser).     So, remember – it is the appraisal BEFORE that 5th year date that you will need to make sure is fit for signing you off.  There will be some essential requirements – like Child and Adult Protection training, PREVENT etc.

  • It’s easier for GPs in more permanent roles (Salarieds & Partners) to show things like Quality Improvement Activity.  But how do you show this when you’re a locum moving from practice practice.      There are in fact plenty of ways in which you can collect and build a portfolio of evidence for your Appraisal.
  • Please try and belong to a locum group or locum chambers – network and ask locum colleagues how they do it.
  • There is some great advice on the NASGP site  – Click AppraisalAid.
  • And finally, FourteenFish is a great app and tool for keeping all your appraisal stuff together and seeing what is essential at a glance.   Another great thing – if you do more work at a practice than another and if most of them are on FourteenFish, you can ask to join their FourteenFish e-group and share learning activities and notes. 

Click here to acccess the Bradford VTS pages on GP appraisal

You can’t just be a locum by doing your job and then going home and putting your feet up.     Medical knowledge is changing at a phenomenal rate and there are always new skills a doctor can learn so that he or she can adapt themselves to a forever changing society.   So, think about how you plan to update your knowledge, learn new skills and get some pastoral support.

KNOWLEDGE & SKILLS

  • Evening courses, seminars, lectures and workshops. 
      • Many are free.   Many are hosted by your local CCG.    Contact them and find out where you can get an up to date programme of educational events.  
      • If you are staying in your training area, ask your GP Trainer and TPDs – they’ll have some idea.
  • How about creating a Whats App group or something similar with some of your colleagues? 
      • Former peer GP Trainees
      • A locum What’s App group
      • Discuss clinical knowledge (remember to respect patient confidentiality)
  • GP Clinical Knowledge Update Courses
      • These are usually fantastic.  One whole day focusing on a topic or a group of topics.
      • There are currently two main players – Red Whale and NB Medical
  • Go on advertised workshops e.g. communication skills course for handling conflict
      • Usually have to pay for these
      • But they’re often amazing at skilling you up
  • E-modules

PASTORAL SUPPORT

  • Evening meetings with colleagues for support and fun
  • Stay in touch – with GP Trainer and TPDs
  • What’s app group of GP trainee friends
  • Local locum group / Locum Chambers

REMEMBER

Never post anything confidential on social forums.  You are responsible for what you post.  Keep things totally anonymous; protect the patient.   Remember, a patient can be identified without their name, address and date of birth.     For instance, if I wrote “Can someone help me with a young lady in Bradford who has this rare genetic disorder called Diddly-Squat syndrome” – I will be breaking confidentiality as someone on the net will probably know who you are talking about!   The rarity in this case makes it an identifying feature, especially if say there are only 4 cases in the UK.   Stay away from posting on permanent social platforms.  Instead, use colleagues you know or groups that you belong to or chat groups which are closed off from the public and are totally private and confidential.

  • Remember to be nice to all staff during the course of your daily work.
  • When passing colleagues in the corridor, say hi.   Don’t look down at the floor.   Look up, smile and introduce yourself.    Engage if small talk if it happens naturally.
  • During your breaks and certainly after surgery, grab a drink and sit down in the common room or common area with other docs and nurses hang out.   Mingle.  Chat.  Laugh.   Show them your personality.
  • All of this will help build your professional network and raise your profile.   And when you do this, don’t be surprised at more job permanent and exciting job offers being thrown your way.
  • But remember, YOU HAVE TO GO OUT THERE AND MINGLE.   They won’t come to you.
  • At some point, you will want to settle a bit more.  
  • But don’t hurry to try and find something more permanent.
  • Let it naturally happen. 
  • As you go through locuming life, and from experiencing the life of many practices, you will get a better idea of what you want to do next.
  • And if your relax, be courteous, approachable and nice, the right job will fall into your lap.

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

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