Some thoughts on time, risk, and pay for locum general practitioners

Money

Locum GP rates have not been set by the BMA since 1999, reportedly because the Office of Fair Trading decided that the BMA setting a rate was anti-competitive. So in theory we individuals are on our own. My rates are calculated from the last published BMA rate with the review body awards added year by year in April. This works out at the 44.50 pounds/hour I quote on my site.

I think the shortage of locums is a general thing, but certainly it is true here in east London. I suppose I could force my rates up more in this "market". However, I would feel some moral qualms if I felt I was exploiting my colleagues, and I don't particularly feel comfortable with seeking stratospheric pay rates amidst the poverty that can still be seen in Hackney to this day. 24k is still a fair part time salary, and my partner and I are lucky not to have a big mortgage, no car (no need), no expensive hobbies, and (sadly), no children.

Time

I charge by the hour because I see it as my role to expedite the patient's medical assessment and treatment to the best of my ability. Although I accept I share part of the responsibility for the appropriate use of medical resources, others also have a role to play in determining the level of resources available to a given practice, namely the the partners, the PCT, the government, all of which are beyond my control.

So the standard I apply to my clinical practice is to ask: "Would I be happy if a member of my family were to be treated in the way that I propose to treat this person?" And act accordingly. If this means that consultations sometimes run to 12, 15, or even 30 minutes, so be it. There was a survey in the Observer a year or so back which showed that one third of GPs have private health insurance, and another 13% were considering it. That to me was a grave indicator of the increasing failure of the NHS. But I'd like my family to have the NHS at their disposal, so I keep working for it, but on my own terms.

NHS GP principals may be consciously or unconsciously aware that the NHS asks GPs (and other clinicians) to take on two roles which are separated in many health care systems, namely, the management of patients, and the management of population risk. Crudely, the GP principal faces a busy surgery of 30 patients each Monday morning, and gets to decide who to shortchange, postpone, delay, and who to deal with thoroughly and promptly.

My business model is an attempt to place myself firmly in the business of managing patients, and to place the management of population risk on the shoulders of those to whom it properly belongs (the government and PCTs).

It is slower to see non-English speakers who need advocates, the elderly, infants, and those with chronic physical or psychological problems. Things like pill checks, minor illness, and prescription supervision in self-empowered English speakers are usually straightforward and brisk, but even these presentations may clothe deeper underlying issues that cannot be hurried. For example, a meaningful medication review often takes longer than 10 minutes, particularly if it is then well-documented on a computer system.

The NANP site http://www.nanp.org.uk/ has useful discussions on some of these issues.


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Copyright Douglas Carnall 18 May 2002. dougie@carnall.org You may reproduce this text in any medium provided this copyright notice is maintained. You may reproduce derivative versions of this text provided that a link to the original version is also maintained.