The agreement should include a definition of the work that the locum will be expected to carry out. The agreement could include a general definition of the locum’s core work as well as a more specific list of the work that might be undertaken in addition to basic duties (for example, telephone consultations or repeat prescribing).
Core work includes good clinical care as set out in GMC guidelines, encompassing the ordering of investigations, and referral where clinically appropriate.
It may also include telephone consultations and repeat prescribing, although this is not necessarily always included in core work.
It is essential that the practice makes clear what is expected and that the locum is aware of this and has agreed to it.
Practices need to ensure that locums are given the tools to undertake this work and it should be recognised that organising such referrals and investigations is usually done after consultation time and this additional time needs to be included in the overall contracted time or work.
What should be specified
It may be helpful to specify 'referrals and investigations arising directly from own caseload'. The procedure used for referrals should be detailed, for example, whether a dictaphone is available and whether there is assistance for Choose and Book referrals.
These factors should be considered when estimating the time required to complete the work.
There are some areas that frequently prove contentious and should be addressed explicitly (either inclusion or exclusion):
- Dealing with nurse queries.
- Telephone triage outside of agreed surgeries.
- Signing repeat and non-repeat prescriptions.
- Signing prescriptions on behalf of other practitioners such as nurses.
- Defining what the on-call duties are.
- Whether any private work etc will be undertaken and what proportion of payment will be retained.
- What happens to fees incidental to seeing patients eg MHA sectioning fees.
For longer-term placements, there may be an expectation that the locum will deal with incoming results and correspondence and this may need to be explicitly stated.
If necessary, an adjustment should be made to the normal workload to reflect the additional time required and/or the fee should be adjusted accordingly.
It may also be useful to specify whether the paperwork share is only that linked to the locum’s own caseload and that of the doctor the locum is replacing, or whether it is done on the basis of a set share of the overall workload of the practice.
It is also important to state whether fees arising from any reports will be payable to the locum in whole or in part or whether the fee is in lieu of appointments or visits.
It is important to specify whether the locum will sign prescriptions and whether this will be just repeat prescriptions (for patients who have been reviewed within their required review date, subject to seeing the repeat prescribing policy) or also non-repeat requests.