- Posted Wednesday July 8, 2015
Do locums offer value for money?
Like most practices, from time to time we have to rely on locum doctors to keep the surgery going. Jeremy Hunt has been discussing their charges in hospitals and the exorbitant rates spent on locums a lot recently. However, the same could be said for primary care, but at times we just do not have any other choice.
Yes, there is a cost implication, but perhaps the problem should be addressed in a different way.
There are no shortages of locum doctors (unlike the situation with salaried) which must mean that doctors prefer it to committing to one surgery. Is it all down to money or is there another reason though? This is a good question, and one that is very hard to answer.
For a start, the money is better and it carries a premium over a partner or salaried GP, on top of this a locum does not have to cope with the ever increasing paperwork and forms to complete, or have to attend as many meetings.
When I have asked some of our locums if they wanted to be salaried or partnered, they reply “why should we?” They get well paid with half the hassle, “but what about patient continuity of care, or having guaranteed work?” I ask. I repeatedly hear the response “I’ve tried that before and it did not work out”, or “I had a bad experience in a partnership... never again”.
I have one locum who (if he times it right) can fit in three sessions a day at £300 per session. You cannot argue with his logic in remaining a locum doctor, can you?
I do have to question whether the patient gets a raw deal on care if seeing a locum though, and I have to express my concern that in some cases this may very well be the case?
After careful consideration, I believe locums have it too easy.
In some cases I question the care they feel towards patients. I wonder how it can be satisfying to come and go and not have long term input into patient care. It’s just like a conveyor belt... next please!
Last week I had a very unfortunate incident that illustrated the patient need for permanent doctors rather than locums too. As a result, I hope that from this month onwards I will not be as reliant on locums.
A regular locum had a fairly busy morning, including time spent doing paperwork and telephone consultations as he has been doing for some time. At twelve o clock he came out of surgery and said he had done all the work he needed to and was going, however, he would not have any time to do a visit that was needed after one of the telephone consultations.
When we asked why he didn’t have the time, he told us he has another booking elsewhere. The 89 year old lady who needed the visit had recently come out of hospital and lives less than 5 minutes from the surgery - a quick visit was possible.
As I overheard him inform a member of staff that he had told the patient he wouldn’t visit till Monday, I had already formed the opinion that a visit to this patient was necessary and had to be done as patient care should not be put at risk.
We told the locum we were disappointed he would not visit and agreed to document this in the records. We had obviously touched a raw nerve with the locum as 20 minutes after leaving he phoned to apologise and offered to reduce his bill by one hour. I think he thought the offer of a reduction was enough for us and we would be happy, but he seemed surprised when we told him that money was not the issue; it was patient care that was the priority here.
As it happens, our salaried GP contacted the patient by telephone and was more than happy to visit this patient before attending afternoon surgery. Maybe it could have waited, but that is not the point. I cannot understand how a locum would be willing to take the risk at all.
Another trend we notice with locums is that they tend to only want to see one problem at a time.
If a patient comes in with a list of problems, they are usually told to come back again for other issues. I can understand their position, but doing so could mean missing the most significant problem on the list if it isn’t the one the patient deems to be the most immediate.
I am told it is down to patient management, but what if the last issue is, for example, chest pains? That is far more a red flag and needs addressed sooner.
So, how can we control this? Other than to rely less on locums and more on regular GPs, I'm not sure.
Unfortunately whilst the pressure on GPs will remain, and less and less want to come in to general practice, I cannot see an end to the problem and patients will in some cases not get the level of care they should expect.