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How locum chambers reduce risk R


Dr Richard Fieldhouse says that being linked to a locum chambers can reduce risk


isk is made up of two elements – risk that a patient is exposed to,


and risk that a GP is exposed to. In the patient’s case, it is the risk to their health, and in the case of the GP it is the risk (inter alia) to their GMC registration. In either case, it’s the GP who has ultimate responsibility for this management of risk. However, the uncomfortable


bed partner of responsibility is control. GPs who run and manage a practice are in the best position to have the perfect balance of responsibility and control, having the ability to make decisions and plan services. A salaried GP, however,


who is unlikely to have anywhere near the same control as their employing GPs, and may not be party to ongoing discussions relating to patient services, still has to take on the full clinical responsibility for patients using these services. And a conventional locum, working as a self-employed individual, in often dozens of different GP surgeries every year, is very unlikely to have any control over their working environment, yet will have to take full clinical responsibility for all their practice’s actions. It really is a situation where GP locums often find themselves in positions of ‘enforced underperformance’.


Enforced


underperformance There are many high- risk areas faced by GP locums that can expose patients to increased risk. These are listed below:


Arriving for work – Because so many locums manage their self-employed businesses themselves with little or no training, misunderstandings about


what’s expected can occur, with double-bookings or missed bookings a common occurrence. It is not atypical for a locum to turn up for surgery to find they are on-call, with no other GPs around, supervising a new GP registrar, there’s no nurse, with their supposed ‘duty GP’ session ending when they are meant to be an hour across town to do an on-call for a single-handed practice. Amidst all of this confusion, patients are being let down and are being exposed to risk by an exhausted and exasperated GP.


Prescribing is a minefield There are inherent risks in relation to GP locums signing repeat scripts, and locums often feel forced into doing them. Repeat prescriptions are risky business, because locums will likely have no idea whether the practice allows its receptionists to add medications, or whether there’s a robust system of medication reviews, so that repeats are being checked with each patient. Locums should refuse to sign these prescriptions or, even more sensibly, negotiate an allotment of time to do this, but ever mindful of not wanting to appear unhelpful, it is all too easy to simply oblige. Acute prescribing is straightforward, with the patient sitting right in front of you, but there are still the vagaries of the IT system to negotiate, and opaque policies and procedures on alerting fellow prescribers to allergies and drugs prescribed by specialists that often don’t feature in the notes – yet are the ones most likely to cause a problem.


Archaic IT systems – Leaving aside their antiquity, they’re all different. Systems


from the same software publisher have similar names, but vary significantly, and even the same version can be set up entirely differently. Then there is the travesty


of the username/password. Across the board, locums are often given generic usernames and passwords. This can cause significant problems in that it may be difficult to identify the GP locum in the event of a complaint or claim. We’re told so often how important


you feel they’re exposing one to unnecessary risk is unacceptable. Many GP locums do not have the luxury to pick and choose where they work, let alone do anything about it – they have mortgages to pay. It’s no better than a practice not booking a locum again because they thought they were a bad GP. But confronting a practice


does not generally work in the locum’s favour. You should refuse to see more


By forming as a chambers, GPs will create a collective mandate to confront practices


it is to keep good notes, yet if composing notes anonymously, how great is the temptation to cut corners when, chances are, no- one will know it was you?


In sickness – No-one likes being ill, and this is exacerbated by the effect that you know that an unexpected absence will have workload consequences for your colleagues. But what if you’re a locum GP, who will not only suffer the financial loss, but also the double whammy of damaging one’s reliability and being replaced by a healthy locum? So come flu or snow, abdominal pain, stress or depression, you’ll get locum GPs turning up for work when really they would be much better turning up as a patient.


GP chambers Not turning up to surgery again following a bad experience is not the answer, to simply not go back to a practice because


than the agreed number of patients, refuse to supervise the registrar if you’re not comfortable doing so, refuse to review urgent results because you’ve not been trained to, refuse to sign prescriptions when you have no idea of their provenance. You and many others do, but the reality is that you will never be asked back and by adopting such an approach you may compromise patient care. So how can working


as part of a locum GP chambers significantly tackle this situation and in turn reduce individual risk? Once a group of GPs have formed together as a team with its own corporate identity and trade, forming as a single undertaking (a chambers), they have a collective mandate to confront practices. It’s a professional obligation to be part of a wider clinical governance process and most practices understand this.


MEDICOLEGAL FEATURE


SESSIONAL GP | VOLUME 3 | ISSUE 2 | 2011 | UNITED KINGDOM www.mps.org.uk


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