Many medical students and junior doctors know exactly which specialty they want to join even before applying for medical school, fulfilling a childhood dream.
Others, however, wait to experience different specialties during medical school and their early career before making a final decision.
Working as a locum after your foundation years is a good way to gain insight into different areas of medicine before making that final decision. There are some considerations you need to think about before deciding whether being a locum is for you.
What is a locum doctor?
A locum doctor moves between various roles in different locations, often filling in rota gaps or covering for other doctors who may be unavailable.
You’ll be able to move around and take up posts in places you may never have thought of before - meeting new people and living in new towns or cities.
Accommodation and working hours
Short-term locums may mean that you’ll need to arrange accommodation. It’s worth finding out whether the hospital you’ll be working at can arrange on-site accommodation for you.
Longer term locums might give you the opportunity to see whether you’d like to work in a certain location if there’s an opportunity.
Locum posts may also allow you to choose your hours and the days you want to work. Part-time working may be easier to find and you can also take breaks from work completely. You might also be able to combine locum work with other employment outside medicine or have more time for hobbies.
The downside is that you won’t be paid if you’re not working. This includes sick leave, holiday or if you’ve decided to take some time off.
It's worth getting advice on policies that can cover you if you can’t work for any reason, and finding out about pensions, parental leave and other special leave or entitlements.
You might be able to combine locum work with other employment outside medicine or have more time for hobbies.
Working in approved practice settings
All designated bodies in the UK that have established clinical governance processes, including appraisal systems that support doctors with their revalidation, are recognised as approved practice settings (APS).
UK and international graduates who have full GMC registration must work in an APS until their first revalidation or until they join general practice or the specialist register. Find out more about approved practice settings on the GMC website.
As a locum, you must make sure you have a connection with a designated body. If you’re doing locum work in addition to your formal training, you need to make sure your educational supervisor is aware of this so that any reporting requirements set by your responsible officer or training body are complied with.
Choosing your career path
Make it clear to your senior colleagues if you want to find out more about a particular specialty and that you’re looking for opportunities to improve your knowledge, competence and experience.
If you don’t have a preference and just want to earn some money and get some additional experience, think about what you want to get out of the job and whether this particular locum will offer that.
Join a locum agency and keep an eye on the medical press. Locum roles may be advertised locally or nationally. You may also be made aware of locum posts through friends and ex-colleagues.
Check your contracts carefully when joining locum agencies. Find out how much you’ll be paid, how and when. Some locum roles count towards training and may mean you have a clinical and educational supervisor.
Check you have the correct indemnity
Talk to your medical defence organisation about what indemnity is needed for your role. Contact us to talk to our membership team and find out more.
If you join a locum agency, what cover does this provide, if any? The GMC say you must have adequate insurance or indemnity cover as soon as you start providing clinical care in the UK.
Induction and handovers
Unless you’re returning to the same hospital for each locum, you’ll have to accept that you’ll be starting afresh each time. Make sure you’re given an induction, so you know how to use the hospital computer system, order investigations, obtain results and document your interactions with patients.
You will need a login for the system and a card to ensure you can gain entry to all the places you need to go within the hospital and its grounds. Patient safety can be put at risk if you’re not able to log on or attend a ward or department quickly due to access problems.
An induction should provide you with information about the trust policies and protocols relevant to your role and where to find them. Find out who your senior colleagues are and how to contact them. Check if you’re on the cardiac arrest team and how to put a call out following a cardiac arrest. Have a list of the important phone numbers you’ll need.
As well as receiving a handover at the start of your shift, make sure to pass on any important information at the end, such as whether there are any outstanding investigations or results or patients in need of review.
Just as importantly, familiarise yourself with any rest rooms and places where you can relax, eat and take a break. It may be better to bring your own food so you don’t go without.
If tasks are delegated to you, work within the limits of your competence and experience. Don’t be pressured into doing anything you’re not happy with.
Get to know your colleagues
You may be working with junior as well as senior colleagues. Find out what role your colleagues have so you know the best person to contact if you need them.
Be careful if you’re delegating tasks to others and be mindful of the GMC’s guidance on delegation. If you delegate to someone else, you need to be satisfied this is appropriate, and that they are competent to do what you’ve asked.
Similarly, if tasks are delegated to you, work within the limits of your competence and experience. Don’t be pressured into doing anything you’re not happy with.
Be friendly and polite, particularly to the nursing and other support staff. How you treat them and how they respond to you can make all the difference when you’re working as a locum.
Clear up after yourself rather than leaving a mess for someone else to deal with, and don’t be afraid to ask if you’re not sure about something.
Stay on top of your learning
Although you may not be working in a single specialty and you may not have postgraduate exams to do, it’s still important to keep your knowledge and skills up to date and engage in professional development. You should have a responsible officer – make sure you know who this is and continue with your annual appraisals to allow you to revalidate.
You may not have the same opportunities for continuing professional development (CPD) as you would in a training post or any protected time for teaching. We offer free e-learning courses and you can also make the most of our guides, webinars and our CPD courses with preferential rates for members.
The e-learning for healthcare website is also available to NHS employees.
Keep good records
Documenting your interactions with patients and colleagues is always important, especially as a locum. If you’re in a short-term post, you may not be available to discuss a patient with a colleague, so any written communication will be vital to ensure safe, ongoing care for patients.
If you obtain advice from a senior colleague, make a record of this in the patient’s notes, including the name and grade of the person you spoke to. When you sign off, print your name and add your GMC number. This will allow the hospital to locate you should they need to in the future.
Locum posts can have their advantages and disadvantages, but they’re worth considering if you want more flexibility and freedom, or are still deciding what you might want to do in the future.