Posts where GPs work moving between locations in one locality rather than one team have existed for over two decades, and there is widespread experience of these, both good and bad. This blog builds on advice from those who have worked in such posts regarding the things to ask and the potential pitfalls.
- Does the post offer the ‘model’ contract including CPD, paid LMC membership, recognition of previous NHS service for the purpose of sickness, redundancy, maternity? These are all features of the model salaried GP contract which is the benchmark negotiated in 2004 for all GMS practices.
- Will you be working to a standardised workload (x appointments, at y intervals) which is manageable for your level of experience? Or will it vary depending on the practice? Will you be expected to be on-call in practices you are unfamiliar with or feel uncomfortable working in? Locums normally define their own workload to match their experience, professional working style and preferences, having often left permanent practice roles to gain control over their workload and avoid burnout. They sacrifice belonging to a team for this autonomy. As a nomadic salaried GP without a fixed practice team, you can potentially be in the worst of both worlds unless your workload is defined centrally rather than site dependent. Are you expected to do any admin work such as tasks, labs, prescriptions or e consults? If so, will this be only in longer term placements after appropriate induction as part of a reasonably adjusted schedule with less appointments than in sites where there is not admin?
- Will the scheme provide a central contact point (manager) to act as your advocate in liaising with practices, to organise logins (to clinical systems, video consulting, lab requesting systems, intranets, etc.), inductions, to ensure your workload in each practice is appropriate to your role and contract and to handle matters when mismatched expectations of role arise? This is especially important as appointment systems have seen significant changes with the move to total triage.
- What flexibility does the post provide for the employed GP? For example, is there a choice of location(s), type of work (in-hours, UTC, consult), and mode of work (remote by telephone or video, or only face-to-face). Is there flexibility to change your working times and days, for example, to fit around activities in your other portfolios or caring responsibilities. E.g. annualised sessions allowing fewer sessions during school holidays, or attendance at meetings, conference, courses. Or does flexibility simply signify a zero hours contract with no obligation to provide regular work, and an expectation to go where you are needed with enforced CPD time or leave where demand from practices or UTCs has dropped?
- Do you get any choice in which practices you work in, and distances travelled? Is mileage paid for commuting? Working flexibly across several practices can offer variety for the doctor, which can be useful, especially when new to an area or newly qualified. For some GPs however, mobility will pose problems with organising childcare due to the varying travelling times and then there are commuting costs. As a locum you may choose to avoid practices where there is lack of support or weak governance processes. What protection do you have from or within these practices if salaried to a federation of PCN? Inexperienced GPs may struggle, particularly in these situations, and for all GPs working in such practices some clear lines of support from your employer is crucial, especially if there is a significant event.
- Will induction to new practices be provided within paid time? When starting at a new practice you will need to be given relevant, organised information, efficiently conveyed to get you up to speed quickly, for example, on both internal processes and external referral pathways and services. This is to ensure that care received by patients meets the same high standard regardless of the clinician they see.
- Are there regular opportunities in paid time to meet your colleagues working in a similar role within the PCN? How is your collective voice heard? Your role will be very different to those of your practice-based peers. We know that peer support and belonging to a network is essential for resilience, retention and professional development.
- Is there access to remote working (laptops/ VPNS/ “use your own device”)? If you have to self-isolate, due to track and trace, or are clinically vulnerable?
- What opportunities are there to be part of the wider GP community such as protected learning events, consultations on service changes, and other meetings within the PCN?
Paula Wright is a member of the BMA sessional GPs committee