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The world of locum doctors: a practical self-help guide

1 December 2006

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Stuart Harrison
Primary Care Consultant

Stuart is an independent primary care consultant working in North London, Middlesex and Hertfordshire. He specialises in finance, HR and IT issues

E [email protected]

In the past, GP registrars who have completed their vocational training would normally apply to join partnerships. Today, the picture is less clearcut, and many choose to become locums while contemplating their next step. This also applies to those who have taken career breaks and are returning to the world of general practice.

Practice managers should be familiar with the various regulations regarding locum GPs so that their practices are not disadvantaged by lack of knowledge or protocol. Managers who work in training practices will know that this already forms part of the nonmedical education of the GP registrar’s training.

Registration/professional indemnity insurance
Locums must be registered on the approved medical performers’ list with a host primary care organisation (PCO). Without this, they are not licensed to obtain any work. They must also update their medical insurance cover by advising of new circumstances.

Personal profiles
Newly qualified doctors should have updated CVs and references. The CV should be summarised on one sheet. Information must include:

  • Contact details: home telephone, mobile and email address.
  • Registration numbers: medical performers list, GMC (General Medical Council), MDU (Medical Defence Union)/MPS (Medical Protection Society).

Locum profiles might be circulated to PCOs and then forwarded to local practices. Other useful contacts include:

  • Local practice managers’ group officers.
  • Established locum groups.
  • Out-of-hours cooperatives.
  • Commercial locum agencies.

Pam Batchelor, practice manager at the East Finchley Medical Practice, said: “We subscribe to the North London locum group list for a small annual fee, which is updated every few months. We find this very useful.”

Types of work
Most work will involve providing cover for weekday sessions within the traditional general practice setting, although evening and weekend sessions under out-of-hours arrangements are possible.

Rates of pay
Previously, the British Medical Association (BMA) has suggested pay rates. Currently, there is no set pay rate for locum work, since the Office of Fair Trading (OFT) outlawed these arrangements, and it is up to individuals to negotiate themselves.

Informal guidelines may exist, and it is advisable to contact local practice managers and colleagues.

Request in writing or email
Many commissions will be carried out over the telephone. It is essential that everything that is agreed be confirmed in writing by letter or email. This will include: dates; starting and finishing times; the sessions involved; and additional work such as telephone advice, prescriptions or home visits. This provides the basis of a contract between the two parties.

Pam Batchelor adds: “We always define what the work will entail, such as length of sessions, including any paperwork expected, so as to avoid misunderstandings.”

Practices are required to “vet” any locums in advance as part of their clinical governance procedures. Locums should submit evidence of their fitness to practise professionally with adequate insurance cover (ie, copies of their registration with the GMC [see Resources] with a professional indemnity body and with a medical performers list) in advance of the commencement of sessional work.

Cancellation fee
Sometimes commissions are agreed but for varying circumstances are not required. In these cases, the locum would be entitled to a cancellation fee from the practice on the basis that a contract has been made and broken by one of the parties unilaterally. The locum can rightly claim that a cancellation has prevented acceptance of another appointment and that the fee represents loss of earnings on their behalf.

Settlement terms
Invoices will normally be submitted promptly. Each invoice should be numbered with a reference, including the length of the session. It is also a good idea for the practice manager to annotate the start and finish times on the invoice so there are less likely to be any disputes over the number of hours worked in the future, especially if the locum is unfamiliar with the surgery. A copy should also be retained for record-keeping purposes. Invoices should always include settlement on normal commercial terms (ie, payable within 30 days). Interest can be levied on late payment.

Sickness and pension arrangements
Locums have no entitlement to NHS sick pay. Since 1 April 2004, payments made to locums can be classified as pensionable earnings under the NHS Pension Scheme. This is administered by the NHS Pensions Agency, who can be contacted via their website (see Resources). Laura Rogers, practice administrator in Mill Hill, London, said: “We normally sign the GP Locum A form (GP locums’ monthly certificate of earnings) when we pay the locum invoice, so we can check that both figures are the same and take a copy for our records.”

It is then up to the locum to submit the completed forms and pay the 6% superannuation deduction to the host primary care trust (PCT) within seven days of the end of the month to which the work relates.

However, work undertaken on behalf of commercial locum agencies is not included in this arrangement, because the contract is between the practice and the third party and the locum is fulfilling the contract on the agency’s behalf.

Regular locums – employment?
The principal criteria that define whether a locum is self-employed hinges on whether the contract with the practice is a contract for services or a contract of service. A contract for services is one where a specific task is carried out using the locum’s expertise; the contracted worker makes all the decisions about how the work is done and does not act on instructions. Conversely, a contract of service is much more of a traditional working relationship, with the person undertaking the work agreeing to work to the instructions of the employer.

Normally regular locum work is classified as self-employment where the duration is temporary (eg, maternity or sickness cover) and under six months. Sometimes, the position starts with a locum taking a regular session on the same days, week in and week out, and the position then takes on a degree of permanency. This is a grey area that could be classified as employed, even without a written contract of employment, especially where the locum doctor works for only one practice and does not work elsewhere in a locum capacity.

The advantage of this for locums – besides being paid a regular salary and having their income tax, national insurance contributions (NIC) and pension contributions dealt with by the employer – is that they acquire holiday and sickness rights. However, the change in status will be more expensive to the practice in terms of additional employer national insurance and superannuation costs and is likely to be resisted.

Doctors who obtain regular locum posts through commercial agencies may be assessed slightly differently. The BMA employment advisers can provide guidance on the specific criteria of self-employment/employment applied in individual circumstances.

Salaried doctors
Sometimes, salaried doctors employed by practices are asked to provide additional sessions for holiday/sickness cover. They cannot be employed and self-employed for the same practice, so the locum sessions will be classed as employment.

Maternity/sickness reimbursement
Locums are often used by practices to provide maternity or long-term sickness cover. Reimbursement may not necessarily be obtainable from PCOs, some of which are no longer paying out these monies due to current financial predicaments within the NHS, and they are not necessarily obliged to reimburse personal medical services (PMS) practices, depending on the wording in the local PMS contract with the practice.

Laura Rogers adds: “I have started to ask the locums to sign the relevant LOC6 reimbursement forms before their final session; otherwise it is a nightmare to get them to do it after they have left.”
Salaried doctors cannot qualify for reimbursement, only locums.

Good locums are hard to find, and practices that help and assist them will be rewarded.

Copies of GMC registration forms can be obtained by emailing:
[email protected]
NHS Pensions Agency