Minimising risk as a GP locum

Working in unfamiliar surroundings means locum GPs need to take extra steps to mitigate risks and ensure patient safety is not compromised. Dr Naeem Nazem offers some tips on avoiding the pitfalls

THE role of a GP locum can be busy, challenging and extremely rewarding. Locums often have greater autonomy over the extent and nature of their work, and the variety of working in different practices can help them develop skills over a broad range of clinical areas.

Working in unfamiliar surroundings can bring additional challenges, however. By taking extra steps, these risk can be mitigated to ensure patient safety is not compromised.

Work within competence

It’s fair to say that most locum GPs may have worked in posts that were quite different from the way that they had been described. It may be that the systems in use are outdated, or the support staff is lacking.

Locum GPs are reminded to work within their own competence and should not feel pressurised into taking on an unmanageable volume of work or tasks they feel are beyond their expertise.  

Care should be taken when signing repeat prescriptions, particularly for unfamiliar patients. All doctors are reminded of the GMC’s guidance on safe prescribing, which states that a doctor is individually responsible for every prescription they issue. including repeat scripts.

Locum GPs should therefore ensure they have sufficient knowledge of a patient’s medical history before signing any prescription, irrespective of whether it is a new or repeat medication.

Patient records

Locums are generally aware of the importance of maintaining detailed patient records, especially as they may only see a patient on one occasion. Good notes are essential to ensure an appropriate handover of patients and to minimise the risks of adverse events.

Not only does a good medical entry benefit the patient, but it can also provide GPs with a robust defence against any subsequent complaint or claim.

Record keeping should: 

• be comprehensive and contemporaneous
• contain all relevant information, as this may be the only source of information for the next doctor involved in the patient’s care
• include details of any proposed follow-up actions such as further investigations or treatment.

To minimise risks, locum GPs should always:

• double-check any relevant medical information with patients
• document these discussions
• handover any significant or concerning case/s to a colleague.

Safe patient handover

Poor communication during handovers is a common factor in clinical negligence and regulatory actions encountered by MDDUS. Crucial information can be missed in a busy setting and mistakes can happen in any situation that involves a handover.

This can lead to delayed and incorrect diagnoses, repeated investigations and incorrect treatment. The very nature of a locums role means they often have only a brief involvement in a patient’s overall medical care.

In addition to good record keeping and in the absence of a formal handover process, the locum GP should consider whether there is anything specific they need to handover in person at the end of a shift. This may include, for example, any patients they were particularly concerned about or any urgent investigations requested or referrals initiated.

An effective and accurate handover protects the patient, ensures continuity of care and allows GPs to prioritise workload according to clinical need. Time should be taken with handovers to insure patient care is properly coordinated and managed.

Access to information and IT support

Practices have a responsibility to ensure locums are safely inducted into the service. They should create and maintain an information pack, containing all the necessary information and guidelines to enable a locum GP to work safely and effectively.

Relevant documents to include in the information pack include patient referral protocols, practice prescribing formularies as well as practice management guidelines.

The induction should include the location of emergency equipment, with instructions for use and emergency drugs.

KEY POINTS:

A locum GP must: 

• recognise and work within their competence
• make comprehensive and contemporaneous records
• take time to handover appropriately to ensure patient care is properly coordinated and managed
• ensure there is a robust induction process to allow them to work safely and effectively.
  
  

Dr Naeem Nazem is Head of Medical at MDDUS

This article first appeared on GPonline

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Read more on clinical handovers, delegation and referral.