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What type of locum will work best for you?
A GP locum has a range of options to choose from: freelance, via an agency, a web-based booking system or locum chambers. Your decision may depend on what is most important for you: autonomy and control, peer support, income, minimising risk, superannuability etc.
Most GPs opt for locum work to have increased control over their workload and greater flexibility to juggle caring responsibilities and other portfolios. The downsides of locum work include professional isolation, administrative complexity, financial risk associated with uncertain bookings, unpaid sickness and GMC investigations and more recently, the challenges of revalidation and presenting all necessary ‘CQC’ checks (certificates including DBS).
We also know locums are excluded from CCG education, information cascades about education and services and from access to NHS net email accounts. Increasingly, practices like to get their locums via a single point of access which has done all the vetting ie intermediaries (agencies, chambers etc.). So which option will work best for you as a locum?
There is no doubt that the greatest autonomy and control is still offered by the freelance option: terms are defined entirely by you. Location, type of work, rates, dates and hours are your choice. It is superannuable work but you handle all the bookings and invoicing, delayed payments, complaints and have no peer support. You also have to market yourself and should you be subject to a GMC complaint, you may find yourself without work even if the complaint is unfounded. This option appeals to experienced, confident, assertive GPs who understand tax returns, and are confident with booking and invoicing programs.
Working through agencies removes some of the demands of marketing yourself, finding work, and supplying certificates, and also relieves you of the invoicing side. Some agencies also set clear terms of work, which can reduce autonomy but provide some welcome clarity and more control than being a salaried GP or a partner. Only payments directly to you will be superannuable. There is generally no peer, education or appraisal support and no support for complaints.
Web based platforms, which take a fee either from the practice or the locum, allow you to be booked directly by practices accessing your certificates and online calendar of availability. They provide automated systems for invoicing which can also be used to produce summaries for tax returns. In some cases, your terms may be defined by the platform or indeed the platform may be set up to allow the practice to set the terms, something which will appeal less to those for whom autonomy and control is paramount. You will generally get paid directly so work is usually superannuable but late payments are up to you to chase.
Beware of web-based platforms which are free to you and charge practices instead: their primary loyalty is to practices not you, and you may well feel like a commodity to be sold and discarded if any negative experiences are expressed against you, however unfair. As a freelancer you don’t have the right of appeal of an employee against such a platform, and also have no collective bargaining rights, with what may be the dominant supplier in your area. There is generally no peer, education or appraisal support and no support for complaints. This could be the NHS equivalent of exploitative practices playing out in other parts of the gig economy.
Locum chambers are GP locum led groups which provide administrative, peer and educational support. A formal recruitment process, door plates and name badges define a quality standard, and practices are expected to offer proper induction information and individualised logins. Predefined terms of engagement are set, usually by consensus between members, and a pick list of session types provide clarity to both locums and practices. You can choose the type of sessions you wish to work, your fees, when and where (how far) you are prepared to work.
Invoicing, superannuation forms, and late payments are all handled for you as are any awkward disputes over terms. You also get support with complaints, importantly with GMC complaints. A professional culture of peer support and education means regular meetings for CPD, and SEAs and a well-structured system for feeding back SEAS to practices ie advocacy for the locum’s perspective rather than the all too easy conclusion when things go wrong (that it was the locums fault). The work is fully superannuable and there is often support for carrying out appraisal (with PSQ/MSF/SEAS/audit etc.).
Unlike the other intermediaries however, you will be required to commit exclusively to doing all your work through the chambers (exceptions sometimes being made for out of hours and hub work) and will have to pay a percentage of your income to the chambers (between 5% and 18%) with some chambers having punitive clauses if your average working sessions drops below a certain number per month. Indemnity costs can be reduced too. Chambers can help improve retention in an area so in some places CCGs are keen to support their development.
For an overview of the options have a look at my video comparing these options.
The views expressed in this piece are the author’s.
Paula is the north-east representative for the sessional GPs subcommittee
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