Locums in the time of COVID-19

Dr Sophie Haroon, Medicolegal Consultant at Medical Protection, looks at how the COVID-19 pandemic has impacted the work of locums

COVID-19 has been a cataclysmic event and a defining point for everyone, especially those of us working in medicine. Despite several reports about the impact of the pandemic on NHS staff, ^[1] less is known about the effects on locums. What assistance is available for locums? What specific challenges might they have faced during COVID-19 and how can we mitigate these?

Background

In 2018, the GMC reported there were 43,500 locum doctors ^[2] on the UK medical register. Locums were more likely to be GPs, middle-aged, female and to have qualified overseas. Some were solely locums; others mixed locum work on top of substantive contracts, undertaken regularly or ad hoc.

Given that one in five licensed doctors are working in this capacity, they clearly form an important part of the workforce across primary and secondary care.

Challenges for locums in COVID-19

Working as a locum has its own challenges even in normal times – new job, new location, new team – but further issues have arisen as a result of the pandemic:

• Loss of locum posts – Redeployment of staff, services being put on hold, cancellation of annual leave and, thankfully, lack of demand at the various Nightingale hospitals have resulted in fewer rota gaps in secondary care or unfilled sessions in primary care. For some locums, work disappeared overnight.^[3]
• Shielding – A recent report by the Health Foundation stated that locums are substantially over-represented among GPs at very high risk from COVID-19.^[4] Less than 10% of the GP workforce are locums, but locums make up 17% of GPs at very high risk. If a locum is shielding and unable to work, they do not get paid. Shielding has therefore impacted the finances of locums quite significantly.
• Sick leave – If a locum cannot work due to illness, they are generally not entitled to any financial support other than statutory sick pay (although some exceptions do apply^[5]). Self-isolation is crucial for those with symptoms, those who test positive, or those who are a case contact, but it will carry a financial impact for the individuals concerned.
• Death in service benefit – Locums are usually excluded from this provision as they are not part of the NHS Pension Scheme. Fortunately, the Government has agreed to a set amount for any frontline workers during the pandemic.^[6] This package varies across the four nations of the UK. Nevertheless, it provides some financial assurance.
• Accommodation – Many locums travel miles to take up a post. Some hospitals can offer accommodation although this can risk exposing doctors working in low-risk and high-risk areas to each other. Where accommodation is not provided, the usual recourse is to stay in hotels or similar, but availability practically disappeared in lockdown meaning locums faced logistical difficulties in taking up any post miles from home.
• Health concerns and other risk factors – Many locums are drawn from an older age group and some are of BAME ethnicity, both risk factors for COVID-19.^[7]
• Social isolation – The locum life is one of transience, often living away from core home support. This coupled with the stress of working in the pandemic – long hours, very sick patients, excess deaths – mean locums can be more vulnerable to mental strain yet have less recourse to support.

The last straw?

Anecdotally, some locums have called it a day. The threefold impact of working away from home, their own risk factors and the stress and strain of the pandemic, has found some hanging up their stethoscope for good.

Solutions

Risk assessments – Some locums have said that the Trusts at which they were commissioned to work, and their locum agencies, have been very on the ball and thorough, undertaking health risk assessments at the start of the pandemic and then again during. This has enabled locum staff to be deployed to the most appropriate area to serve the needs of the clinical service without placing them at undue risk. For others this has not been the case,^[8] be it for locum or non-locum staff. There is various guidance available on staff risk assessments.^[9] Importantly, if you are a locum and you’re not getting a risk assessment, ask for one – from the locum agency or the Trust deployed to, if the contract is longer-term.

Working differently – Make use of online inductions before getting to a new post. Make use of remote consulting to keep clinics going. Make use of teleconferencing to touch base with peers.

Use the downtime wisely – If this is a dry period in the job history, utilise the time to undertake CPD, for example an online course that you always wanted to do. This will help ensure your CV is polished and ready to go when the restrictions lift and posts become available.

Medicolegal issues – Medical Protection members have access to a wide range of material dealing with these issues, such as webinars ^[10], our podcast series^[11] and articles.^[12] Readers are encouraged to use this material; it all counts as essential CPD.

Mental health and wellbeing – All Medical Protection members can access our free counselling service ^[13] as well as a range of material on managing stress and preventing burnout in our Wellbeing Hub. There is a whole host of material for mental and physical wellbeing available from various resources including the GMC, Royal Colleges, Trusts, the BMA, GP educational resources like Red Whale and NB Medical to more public facing material like Mind, Headspace and PHE.^[14]

Financial help – The financial implications of the pandemic on locums have been outlined above and there is support is available for doctors. There are several charities that can assist doctors at this time. A good starting point to accessing them is via ‘Help me, I’m a doctor’.^[15] Their online questionnaire helps guide towards which charities can assist for any given situation. If a locum is on a break from work and wants to suspend their medical indemnity, they should discuss this with Medical Protection, ensuring they are clear on how soon their indemnity can be reinstated when they restart work. Importantly, keep in mind the GMC guidance on the requirements for indemnity.^[16]

Change in job landscape – Is there work that is not face-to-face that can be undertaken (particularly useful if you are ‘at-risk’), eg for NHS 111? Or is it time to think about a substantive post? It has been reported that many locum GPs are moving to sessional posts.^[17]

Hope – This is not a cliché. One of the characteristics of being a locum is flexibility. As the NHS attempts to pick up the backlog, prepare for the second wave and mitigate against staff shortages (due to staff illness, shielding or other reasons for self-isolation), the jobs are reappearing.

Conclusion

The COVID-19 pandemic has been an unprecedented time for healthcare staff. Some unique challenges have arisen for locums. Not all can, or will, be overcome. But whatever the future holds over the coming months, there are opportunities and mitigation measures that locums can apply to get through this time. Medical Protection is, and will always be, here to help its members, not only with medicolegal matters but also wider issues of wellbeing.

• You can also listen to a podcast with Dr Sophie Haroon, where she interviews Dr Munib Haroon, locum consultant community paediatrician, about his experiences of being a locum during the COVID-19 pandemic, including discussing some issues that locums more widely have faced. Visit medicalprotection.org/covid19-podcast

References

^[1] see for example: https://www.rcplondon.ac.uk/news/COVID-19-and-its-impact-nhs-workforce; https://www.nhsconfed.org/resources/2020/08/covid19-and-the-female-health-and-care-workforce

^[2] GMC, What our data tells us about locum doctors – Working paper 5 – April 2018

^[3] http://www.pulsetoday.co.uk/news/gp-partners-to-continue-offering-less-locum-work/20041228.article

^[4] https://www.health.org.uk/publications/long-reads/how-might-COVID-19-affect-the-number-of-gps-available-to-see-patients-in-england

^[5] https://www.nhsprofessionals.nhs.uk/COVID-19/Bank-Members-FAQ

^[6] https://www.gov.uk/government/news/new-guarantee-on-death-in-service-benefits-for-frontline-health-and-care-staff-during-pandemic

^[7] https://www.nhsconfed.org/resources/2020/04/the-impact-of-covid19-on-bme-communities-and-staff; https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-COVID-19-analysed/7027471.article

^[8] https://www.bbc.co.uk/news/health-53021628

^[9] https://www.bma.org.uk/advice-and-support/COVID-19/your-health/COVID-19-risk-assessment

^[10] https://www.medicalprotection.org/covid19-webinars#uk

^[11] https://www.medicalprotection.org/covid19-podcast

^[12] https://www.nasgp.org.uk/medicolegal-risks-for-gp-locums-during-COVID-19

^[13] https://www.medicalprotection.org/uk/medicolegal-advice/counselling-service

^[14] https://www.bma.org.uk/advice-and-support/COVID-19/your-health/COVID-19-your-wellbeing;

https://www.gmc-uk.org/ethical-guidance/ethical-hub/COVID-19-questions-and-answers;

https://www.mind.org.uk/information-support/coronavirus/;

https://www.gov.uk/government/publications/COVID-19-guidance-for-the-public-on-mental-health-and-wellbeing/guidance-for-the-public-on-the-mental-health-and-wellbeing-aspects-of-coronavirus-COVID-19

^[15] https://www.doctorshelp.org.uk/

^[16] https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/information-for-doctors-on-the-register/insurance-indemnity-and-medico-legal-support

^[17] https://www.gponline.com/locum-gp-exodus-salaried-roles-COVID-19-pandemic-hits-income/article/1691632