The powers that be in Government have met up and made their thoughts known on what lies ahead for our beloved land of GP. The Health and Social Care Committee, including now chancellor Jeremy Hunt, released their aptly named ‘The Future of General Practice’ report on 20 October.
Some of the recommendations are the more obvious – remove micromanagement eg QoF – and some rather interesting like deploying artificial intelligence to perform read coding and report test results.
In regard to locums, the committee starts off well saying: ‘No NHS employee should be forced to choose to locum or work for an agency to regain control over their working life.’
Of course, this makes sense – working conditions should be favourably whatever the modus operandi. The committee added becoming a locum was, ‘a self-imposed regulation to allow practising in a safe and manageable way'.
Interesting…is it being so bold as to say you can either work as the over-stretched system requires or work safely but not both?
But from there it descends…
‘Urgent work needs to be done to … establish requirements for a minimum fair share of administrative duties.’
I have to say this ruffled my tail feathers. Get rid of QoF *tick*, make working life bearable *tick*, and have a go at micromanaging a group of sole traders undermining their self-employed status *tick*. This idea suggests that locums are part of the problem. We are not!
The report has statements from salaried and GP partners who are spending unpaid sessions outside of work completing extra admin. Not one said, ‘and by the way, you just cannot get locums to help out with any admin these days.’
Mandating locums to do admin – well that will work out poorly for practices. If a practice has a budget to pay a locum for seven hours of work, they should be able to book a locum to complete the tasks they feel meet their needs.
This tends to of course mean getting the patients banging at the door seen. If an outside force comes barging in and says your prevailing need is now admin – well from a locum’s perspective that still counts as work. Going back to the reason for the request, interpreting results, making a decision, and arranging who follows up.
Prescriptions, queries and consultant letters with actions are all taxing, done at a much faster pace than consulting and increase your patient contacts for the day. That is still your precious time and expertise so don’t forget it should afford the correct time allocated and compensation.
A practice has only two viable options to compromise: ask you to see fewer patients to fit in that mandated practice admin or inflate the budget to ask you to do admin work on top. Was the committee expecting locums to do this work for free? I should hope not. And if they did, well they should just expect another mass exodus conflating the overall problem.
Remember, part of what makes you self-employed legally is determining the how, what and when of how you operate, especially if you work at a practice over the long term. Do not allow yourself to be cajoled into seeing more patients than you feel able to, in a shorter paid time than you can.
These are already things locums sometimes lose control over, and make your status no different to an employee – and they could lead to tax ramifications and HMRC converting your status to an employee, should they investigate.
Alicia Barnes is sessional GPs committee representative for the West Midlands and a locum GP in the West Midlands and central London