Locum loving GP

“You know what’s the problem with you, young GPs? You’re spoilt and fussy. You move from one surgery to another doing a half-hearted job.”

A senior GP once said this when we were discussing the junior doctor strikes. She was especially irritated by the fact a large proportion of my GP colleagues didn’t want to take up fixed GP positions once they finished training and instead preferred to locum.

Now, here I am at the end of my GP training, pondering the arguments for and against becoming a “career locum”. 

Permit me to put my “fussy” hat on for a moment.

1) I want to be paid as much as possible for the work I do. (Is that a bad thing to say?) What is it about being a doctor that means you cannot talk about the fact empathy does not pay the bills, GMC fees or extortionate indemnity. Hold on to your stethoscopes everyone, here comes a shocking statement…I work because I need money. Locuming gives me more money.

2) I worry about being trapped in one place. We’ve spent years at medical school and throughout training being moved around against our control from one place to another. I’m used to it. In fact the thought of being fixed in one place somewhat frightens me. What if I get bored?  What if the other doctors/staff are weird? What if my priorities change and I need some time out?  Locuming gives me more choice and freedom.

3) I want to be able to work flexibly so that I can see my children more than my parents ever could when they were young doctors. I chose this career knowing full well I’d spend many years studying, long hours and weekends working and certainly don’t expect it to be a walk in the park.  But I also have a personal life. If I didn’t have one or don’t take the time to nurture it properly, I wouldn’t be able to work at all. My parents (like many) took early retirement from the NHS because of decades being overworked and exhausted. I won’t have the luxury to do the same. I want to pace myself. Locuming gives me that flexibility.

A colleague of mine once said “How can we be expected to take up fixed positions when we know the work volume and responsibility is higher, yet pay and flexibility are lower? We are not martyrs.”

Increasingly I find myself wondering whether this mentality, including my own, is damaging a wonderful profession. All this undoubtedly affects patient continuity of care, puts further financial/staffing pressures on already struggling GP surgeries and is detrimental to the team spirit/camaraderie that can actually increase our own satisfaction at work.

The other side of the coin

Locuming is unpredictable, it can be hard moving around when you have a family and I’m certainly going to miss being able to follow up that referral I made or seeing that pregnant mum from the last appointment proudly bringing her newborn in for its first checkup.  I suppose the grass is not all that much greener…but then some might argue at least I can afford to buy better fertiliser.

Are First5’s a bunch of spoilt, fussy, money grabbing professionals or is the locum-loving trend just another result of the current low morale in a cash strapped healthcare system which is slowly failing its patients and staff?

  • Mark Newbold
    Posted at 11:01h, 05 December Reply

    “Are First5’s a bunch of spoilt, fussy, money grabbing professionals or is the locum-loving trend just another result of the current low morale in a cash strapped healthcare system which is slowly failing its patients and staff?”

    Or, is this an expression of how young GPs wish to work – more flexibility over work schedules, a sense of being in control of one’s own destiny, and an unwillingness to put down deep roots in one workplace and lose the feeling of being able to move and develop?

    Perhaps we should take this as a challenge to conventional work practices, and think about whether non-locum GP jobs can offer some or all of these features, so that young doctors are attracted to the specialty? Something to consider before the new contract lands? Do let us know your views!

  • Anita shah
    Posted at 22:25h, 09 December Reply

    Locum work is great especially as it gives such autonomy which is a refreshing change in the medical profession. I would really recommend toolkits like MyLocumManager to help any new Locum get started

  • Mark Newbold
    Posted at 11:05h, 10 December Reply

    Thanks for posting Anita. Do you feel the autonomy outweighs the disadvantage of not being able to provide continuity of care? Is this a consideration at all do you think? It’s an interesting debate because hospital doctors, who are employed of course, tend to feel that GP partners do have much greater autonomy?

  • Pauline Jones
    Posted at 10:50h, 27 December Reply

    As a retired nurse & also a patient, having been seen by locums, I find that lack of continuity of care, lack of knowledge of the patient history, & a mechanical work ethic of getting the hours in, doesn’t add to,patient faith or feeling of support.

  • Mark Purvis
    Posted at 11:00h, 06 July Reply

    I remember similar criticism when I started 30+ years ago. My first senior partner told me that there was no medical leadership since doctors stopped doing their national service in the forces.

    I lived through a time when we placed GPs with the least preparation into our most hard pressed communities with inadequate resource and support …..then often blamed them from doing a bad job.

    Times change. Most locums I know are not fussy or spoilt. They are not even trying to earn more. Rather, they are trying to boundary their work and tackle an unsustainable decision density in the typical GP working day..

    I would not blame locums for loss of personal continuity. Blurring of role boundary (skill mix), blurring of organisational boundary (e.g. federation), blurring of sector boundary (integration) all reduce personal continuity. Personal continuity is something that is equally valued by patient and professional.

    I worry that we might be in the foothills of “the gig economy”. That failure to recognise and invest in the vital role of general practice will lead the workforce to increasingly sell their skills/expertise by the minute. Perhaps even bypassing organisations and selling their time directly to patients outside the NHS. That would be a very difficult domino to untip and would have disasterous consequences for widening health inequalities.. Those who can afford it will have their continuity back, but we will have lost comprehensive coverage based on need.

    We need to value what we have, including our agency and locum staff. We certainly need to treasure our future workforce and first fives. They are far more important than crusty old docs like me. They are our future. I am proud of them and confident in their abilities, as long as they are looked after.

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