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Everyone has bad days at work, and
at the moment, everybody is feeling

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the pressure of fewer resources
and less time with patients.

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But if your bad days are becoming
more common, is the answer to

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ditch the day job and go freelance?

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This week, Dr. Richard Fieldhouse,
founder and chairman of the National

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Association of Sessional gps joins
me to take an honest and frank look

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at the different models of working.

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Is being a locum all
it's cracked up to be?

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Now, the graph isn't necessarily
greener on the other side.

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If you don't have regular work, you may
fantasize about being in just one place

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with the great connections, certainty,
and stability that it brings us.

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Now every way of working brings
its own benefits and challenges.

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It all comes down to control and agency.

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If you want control over your
working hours, in your workload,

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more time for other strands to your
career, but maybe less control over

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how you work and your workplace,
freelancing might really suit you.

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But if you want less risk and more
say in what we do around here, you

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might want more regular employment.

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We talk about why this isn't black and
white, and what freelancers and locums

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can learn about how to influence your
work environment from permanent staff, and

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what partners and consultants can learn.

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About managing their workload, taking
more control and responsibility

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from locums and freelancers.

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So if you are thinking about making
a change in your career in 2026, this

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conversation with Richard will really
help you get clear on what's available,

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it'll help you weigh up the pros and
cons of each and help you let go of

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the sneaking suspicion that one way of
working is more worthy than another.

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If you're in a high stress, high stakes,
still blank medicine, and you're feeling

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stressed or overwhelmed, burning out or
getting out are not your only options.

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I'm Dr. Rachel Morris, and
welcome to You Are Not a Frog.

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I am Richard Fieldhouse.

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I am a GP and I am chairman and founder of
the National Association of Sessional GPs,

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and I've worked as a GP locum pretty much
all my GP career apart from a small stint

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as GP partner at the beginning and more
recently for a a year as a salaried GP.

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It's wonderful to have you on the
podcast, Richard, and there's so many

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different things we could talk about.

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I'm particularly interested in what your
views are of, of both sides of the coin.

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So you've worked to the partner, you've
worked as a locum, and you've seen

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everything in between and your constantly
talking to hundreds of people who are

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doing various different iterations
of, I guess, the same set of job.

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And so we're gonna delve in, in this
podcast to why people choose different

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sort of ways of working, the advantages
and the disadvantages of both.

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But first of all, I just wanna dig
down below the surface because many

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doctors, many healthcare professionals
just feel really stuck regardless of

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their role, regardless of whether they
are a locum, a bank staff or a partner,

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a clinical director, or a consultant.

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So when you've been talking to
people, I guess people in the national

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Association of Sessional, GPs, other
locums or the partners you talk to

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in practice or consultants, what do
you hear them really longing foremost

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in their careers and in their work?

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I guess, uh, and, and patience as well.

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I, I would say for me, what seems to
be the common theme is that feeling

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of kind of being wedged in this corner
where there is an imbalance in their

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career, in their home, lives, in, in
kind of almost everything they do.

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But in that it's an imbalance
between control and responsibility.

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If they are starting to feel that
their boss or somehow the job they're

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doing, they're starting to have less
control, less flexibility, less uh,

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freedom, that seems to cause anxiety.

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And then, and then the responsibility
if they, if coupled, okay, fair enough.

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If they get, then get with
that less responsibility,

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that's balancing itself out.

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But that doesn't really happen.

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We tend to find ourselves having
less control and more responsibility.

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Sometimes in a job you can
have tons of responsibility

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that that can be overwhelming.

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But if you've got control of that, if
you can control that responsibility,

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whether in, in forms of time or volume
or or, or, or where and when you do it

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that, gives that, that, that's great,
and that can, that can help you balance.

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I mean, I think as GPs,
doctors, we love responsibility.

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That's, we went this into this job.

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you as, as a, as a, as a junior, as
a, as a resident doctor, the day you

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qualify after your GP training as a GP
your GMC registration changes overnight

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to be, to be, uh, uh, you, you are
now, um, registered as a, as a doctor,

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uh, but, but who, who has to take
responsibility for everything they do?

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Um, and, and you, you are no longer
part of a kind of a hierarchy

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or of, or having a line manager.

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You, you have, you, you, you,
you're now, you are now practicing

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independently, and without supervision.

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And, and that's the
first time that happens.

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Prior to your qualification as a gp, you
are, you are effectively being supervised.

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And I don't think of them.

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We often appreciate the
responsibility that goes with it.

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It's a huge change in, in responsibility.

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So we have to be in control.

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There's a phrase that came into primary
care, which I was having done, worked as

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a GP locum for 30 years, about 15 years
ago, this word started to talk, but when

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people talk about locum work, GP locum
work, they started to talk about shifts.

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So what's, what's a shift?

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Well, a shift.

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So a shift to me is, a shift worker
is someone who fits into a slot.

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There's a start time,
there's a finish time.

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It's kind of like a, a clock
mechanism with lots of cogs.

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And someone take a co goes home,
you fit into that cogs place and

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you are part of this machine.

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And that what, that, that word lends
itself really well to how hospitals work.

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Hospitals work 24 7.

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If you are working as a locum
in a hospital, you are fitting

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into a shift as part of a team.

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You can't run an entire neurology
department, uh, on your, on your own.

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You are part of your part, your
mechanism is a component of that.

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But when you are practicing as a GP
in your consulting room, from the

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moment that patient steps in to way
beyond that patient leaves that room,

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you are responsible and you have to
be, you have to be con in control of

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that, because if something goes south
or pear shaped you, you, you, you,

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you've, you've got to be responsible.

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So fitting into a, if you are the
type of GP who can, um, fail, very

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comfortable managing balancing risk in
a 10 minute appointment, feel really

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comfortable and may might even enjoy
that, enjoy the number of patients

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you see, that's great, good on you.

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But there are plenty of GPs who would,
who, who, who find that untenable

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and who really struggle with that.

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And, and the way they work is they're
much more into 20 minutes, half an hour.

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My, my lovely wife Sarah, is one of
those GPs who trust me as a patient

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you really want to see because every
patient she needs 30 minutes for, but

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when fitting into 20 minutes or 15
minutes really finds that stressful.

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And so I think with the complexity
of disease these days and care and

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management, um, and the, you know, the,
fortunately the 10 minute appointments

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seem to be really, um, um, heading out the
door now much more into 15 minutes points.

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But even so, there's still a constraint
in that, that, that if you are, what,

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what we as an organization for we
have, we have a platform and what we

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allow our members to do who work, those
who work as freelance GP Locums, is

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they put themselves out there on the
platform to practice and say, look, I'm

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a GP who does 20 minute appointments.

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If you're gonna hire me, you're
gonna have to hire me at 20 minutes,

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'cause if you hire me at 10 minutes
or 15 minutes, you, you're just

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not gonna get good value for money.

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I'm gonna be stressed.

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I'm gonna be, I'm not gonna
be forming at my peak.

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So it's, it's, it's having,
it's, it's about having that

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responsibility and control.

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So not, not for GPs, we need to not
be thinking in the mindset of a shift.

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We call it sessions.

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And you need to, as a chief, we
need to define those sessions,

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otherwise we're gonna struggle.

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I guess that's why you called yourself
the National Association of Sessional GPs.

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Not shift working, not shift working GPs.

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I, I would challenge that a bit though,
because I think consultants in hospitals,

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yes, there should be colleagues to cover
work so for an a e doctor, when they are

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off their shift, there is somebody else
on the shop floor seeing the patients.

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But there's a huge amount of
other work that the consultants

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do that that just has to get done,
whether they're on shifts or not.

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And you know, I was talking
to a community pediatrician

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recently who has a huge workload.

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She has no colleague, so they are all
hers, whether she's at work or not.

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So I think this, this concept that
you can just walk off and someone

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else covers you, doesn't really
hold true in hospitals either,

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particularly the more senior you get.

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And then, the juniors, we've all
seen that the issues with shift

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working and, and juniors who
just don't feel part of the team.

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And because they are just treated
like a cog in the wheel, that's

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massively disempowering and, and not
very great for teamwork and stuff.

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So I  don't think it
benefits anybody, does it?

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But it's this issue about control
that goes with the responsibility.

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'Cause I've noticed as doctors and
senior healthcare professionals, senior

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managers, senior nurses, senior allied
health professionals, we just take on the

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default responsibility for everything.

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And my observation is that when we get
sick of that and we can see the control

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dropping, maybe about the way we work,
how we are rostered onto shifts or you

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know, for example, you know, if I was in a
practice and they were saying, no, you're

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doing 10 minute appointments, and I just
thought that is, I can't, I can't do that.

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That's not suit the way I wanna work.

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That's when we go, okay, maybe another
way of working would suit me better.

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If I then go and be a locum GP or a
locum consultant, I have much more

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control over what I choose to say
yes and no to in terms of shifts.

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And also I can stipulate to some extent,
some people find it difficult to do that,

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you know, the number of appointments and
the length of the appointments that I do.

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So in my head, going to be a locum gives
perhaps the illusion of, of a bit more.

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Well, it definitely gives you more control
over some things, but in other ways it

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gives you, it gives you less control.

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Yes.

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And, and, um, and it can, that can
all in in terms of the way that

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the marketplace in terms of working
as a g Logan fluctuates as well.

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And I, and I, and by the way, I'm in
no way qualified to talk about hospital

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freelance consultants or locum work.

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I, it, it's something I've
had very little experience.

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But also it seems to go in,
in, um, in 10 year cycles.

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Every 10 years there's, uh, the, the,
the, um, the workforce seems to be, we

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seems to be over, over provided with GPs,
which is where we've very recently been.

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I think we're coming outta that again.

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Bang on 30 years ago, I
started NESGP 'cause when I

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qualified there were no jobs.

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And 10 years later, same thing,
a further 10, same thing.

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And it's the same thing at the moment.

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So if you're a gp Locuming listening,
locum listening to this, you're thinking,

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oh my God, I'll take any work you give me.

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And, and, and they, they're, they're
desperate for work in, in many situations.

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And again, geographically
different parts of the country.

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So yeah, very much you, you kind of,
you, you, you, you take what's on offer

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if, if there is anything on offer.

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Um, so, so it, it's, it's, in our ideal
world, yes, as what our aspiration is

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to have this perfect balance between
respo responsibility and control.

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But in the real world, it's
particularly at the moment,

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that's just simply not the case.

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And, and people are, are doing,
you know, reducing their prices,

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working more, fitting into 10 minutes
appointments, that kind of thing.

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Yeah, so in, in a market where
people need sessional doctors, great.

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But when they don't, suddenly
the control goes again.

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You were a partner for a few
years, and then you moved

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into being a sessional doctor.

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What did you think that that being a
sessional GP, that being a locum was going

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to solve, that it actually didn't solve?

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What it's, at the time, what, what
it solved is I was, I was young, I

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was married to another GP and having
children, and for that it was fantastic.

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Um, as, as co-parent,
co-parenting, two lovely boys.

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Um, and it worked really well.

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What it didn't solve, I guess, but I'm, I,
I think in that way I'm quite different.

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I think for a lot of locums it doesn't
solve is, it doesn't solve that itch,

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which is the, um, the sense of sense of
value, the sense of purpose of being a GP.

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Because we are told, we see so often
everywhere that in order to be a GP we

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have to do con this thing this continuity
of care, which, which we have so much

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research in general practice to show to
prove is an absolutely wonderful thing.

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Um, and it, it brings so much joy to many
GPs that are, are, are that, that we are

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00:13:55,824 --> 00:14:01,404
able to see patients again and again and
form these, these, these relationships,

214
00:14:01,404 --> 00:14:03,234
these therapeutic relationships with them.

215
00:14:03,646 --> 00:14:10,068
And, and, and I kind of missed that
and I, and I was told a lot as well,

216
00:14:10,128 --> 00:14:11,988
what, why I wasn't I a proper GP?

217
00:14:11,988 --> 00:14:12,858
Don't I miss that?

218
00:14:12,858 --> 00:14:16,488
And colleagues would, would say,
actually, Richard, I, I, I really

219
00:14:16,488 --> 00:14:21,078
enjoyed Lo but I just feel I need to,
I need to become a partner or a sur

220
00:14:21,348 --> 00:14:24,438
because of that, um, continuity of care.

221
00:14:25,128 --> 00:14:27,821
And, and so that, that I miss.

222
00:14:27,821 --> 00:14:33,311
But then over the years I kind
of, that's kind of gone full

223
00:14:33,311 --> 00:14:36,521
circle I think, uh, in many ways.

224
00:14:36,581 --> 00:14:41,561
Um, that, that actually I kind of,
I kind of being, I feel kind of

225
00:14:41,561 --> 00:14:43,331
being sold like a romantic novel.

226
00:14:44,111 --> 00:14:48,941
Um, uh, it's a bit Mills and Boon
and there are some great things

227
00:14:48,941 --> 00:14:52,421
about response, uh, about continu
today, don't get me wrong, but

228
00:14:52,421 --> 00:14:54,761
also it does have its flip side.

229
00:14:55,421 --> 00:15:01,421
Um, and, and I've even sat next to
senior people at, at significant

230
00:15:01,886 --> 00:15:05,006
primary care medical organizations,
and they've said, look, you know, the

231
00:15:05,006 --> 00:15:09,746
Kings Funds did this huge paper on
continuity of care, but in it, they

232
00:15:09,746 --> 00:15:12,176
said, there's potential flip side.

233
00:15:12,806 --> 00:15:16,826
We've as a, as a, as a profession,
we've done very, very little to, to even

234
00:15:16,826 --> 00:15:18,716
start to look at what these could be.

235
00:15:19,136 --> 00:15:22,796
And I said, maybe we should, as
a profession, dear colleague,

236
00:15:22,976 --> 00:15:23,936
start to explore that.

237
00:15:23,936 --> 00:15:27,926
And it was this profound silence
and, no, no, Richard, we don't

238
00:15:27,926 --> 00:15:29,816
want to open that Pandora's box.

239
00:15:30,206 --> 00:15:36,206
And, which is a real shame because I think
that what I found, those, those colleagues

240
00:15:36,206 --> 00:15:40,976
of mine who've gone back, who then
returned back to Locuming had burnt out.

241
00:15:41,486 --> 00:15:45,956
Um, and, and so often in our, as
an organization, we, we set up

242
00:15:45,956 --> 00:15:49,916
and run these, um, very formal
GP locum peer support groups.

243
00:15:49,916 --> 00:15:55,106
We call them GP locum chambers, meet
regularly, uh, uh, establish, establish,

244
00:15:55,166 --> 00:15:59,486
uh, professional, uh, uh, um, friendships
and, and, and, and really helps

245
00:15:59,486 --> 00:16:01,286
really resolve professional isolation.

246
00:16:01,976 --> 00:16:06,306
People have joined that because they've
been partners or salaried in a practice,

247
00:16:06,826 --> 00:16:10,916
but often for the, for the purpose
to, to have that continuity of care.

248
00:16:10,946 --> 00:16:16,106
Yet in these days in modern general
practice, it's really, really difficult

249
00:16:16,106 --> 00:16:18,206
to see the same patient again and again.

250
00:16:18,896 --> 00:16:23,756
Um, and, and with, with, with,
um, with triage and with, with

251
00:16:23,756 --> 00:16:29,046
multidisciplinary teams, uh, and all
this sort of thing, even GP partners

252
00:16:29,046 --> 00:16:30,776
are really struggling for, for that.

253
00:16:30,806 --> 00:16:34,646
And, and I've noticed that when I've been,
on a regular basis in a practice, just the

254
00:16:34,646 --> 00:16:37,016
patients just do not have that continuity.

255
00:16:37,016 --> 00:16:39,227
Yeah, certainly I've, I've
noticed a, a friend of mine's

256
00:16:39,227 --> 00:16:40,637
trying to speak to the same GP.

257
00:16:40,642 --> 00:16:43,157
It was, it was, it was really
hard just because of the models.

258
00:16:43,247 --> 00:16:46,102
And I'm not saying it, it, it's
right or wrong, it's just our,

259
00:16:46,107 --> 00:16:48,587
our models are having to change
because of the patient demand.

260
00:16:49,067 --> 00:16:52,727
But I just wanna go back to something
you said about this sort of, people

261
00:16:52,727 --> 00:16:56,867
felt they ought to go back and be a
partner or be, you know, in a practice

262
00:16:56,867 --> 00:16:59,287
because of this continuity of care.

263
00:16:59,287 --> 00:17:02,192
And I, I, I totally agree.

264
00:17:02,192 --> 00:17:05,132
It is, it is a joy to see the same
person and be able to deal with them,

265
00:17:05,132 --> 00:17:06,782
you know, from, from start to finish.

266
00:17:07,272 --> 00:17:10,982
You know, my dad was a GP, His version
of continuity of care is literally,

267
00:17:11,042 --> 00:17:15,392
he saw the mum, he worked through
her pregnancy with her, he delivered

268
00:17:15,392 --> 00:17:18,662
the baby, and then he delivered
the baby of the next generation.

269
00:17:18,662 --> 00:17:20,732
And then, I mean, that's,
that's continuity of care like

270
00:17:20,732 --> 00:17:22,652
40 years, isn't it really?

271
00:17:23,012 --> 00:17:27,392
Um, it's, so that's, that's changed,
you know, now nowadays, it's, you very

272
00:17:27,392 --> 00:17:28,892
rarely have that, that sort of thing.

273
00:17:28,892 --> 00:17:30,332
You're certainly not
delivering any babies.

274
00:17:30,692 --> 00:17:36,441
Um, but I just wonder whether we come
up with some excuses and some reasons

275
00:17:36,441 --> 00:17:41,661
to mask some of the guilt we feel
when we, you know, or, or, or, or to

276
00:17:41,661 --> 00:17:46,371
sort of silently beat someone up for
choosing a different way of working.

277
00:17:47,001 --> 00:17:49,851
You know, that sort of, well, you know,
you're missing out on continuity of care.

278
00:17:49,851 --> 00:17:51,231
You're missing out on this and that.

279
00:17:51,231 --> 00:17:56,511
And, and so subtly, if you choose to
work in a sessional freelance way,

280
00:17:56,511 --> 00:18:01,041
you are made to feel not quite as
good as, or you're not quite doing

281
00:18:01,041 --> 00:18:02,901
the right thing for your patients.

282
00:18:02,901 --> 00:18:08,496
So it's this sort of subtle way
of maybe the people who are in the

283
00:18:08,496 --> 00:18:10,656
system feeling a bit resentful.

284
00:18:10,656 --> 00:18:13,596
I'd love to do that, but actually
these are what, what matters and,

285
00:18:13,596 --> 00:18:18,223
and genuinely believe it, or we
just beat ourselves up about being

286
00:18:18,223 --> 00:18:22,033
selfish for choosing a way of working
that's actually gonna suit us better.

287
00:18:22,313 --> 00:18:27,413
And the worst offenders of of, of, of this
thing, uh, beating, uh, are, are us GP

288
00:18:27,413 --> 00:18:29,453
locums ourselves, beating ourselves up.

289
00:18:29,453 --> 00:18:31,973
So often we say, oh,
actually I'm just a locum.

290
00:18:32,590 --> 00:18:35,740
You think, stop there, let's rewind.

291
00:18:36,160 --> 00:18:38,410
You know, why are you just a locum?

292
00:18:38,470 --> 00:18:44,410
Um, and, and, and I, I, I've, I've had GP
partners in, in practice, say, Richard,

293
00:18:44,410 --> 00:18:45,880
when are you going to get a proper job?

294
00:18:46,450 --> 00:18:50,620
You know, it's, we, we kind of gaslight
ourselves and we kind of, but, but

295
00:18:50,620 --> 00:18:56,170
I, I think in, in every, you know, GP
conference kind of headline, sub headline,

296
00:18:56,170 --> 00:18:58,120
it's, it's about continuity of care.

297
00:18:58,120 --> 00:19:01,480
It's this, we, we, we, we've,
we've, we've, as a profession,

298
00:19:01,480 --> 00:19:05,620
we've really nailed our, our,
our, our one flag to the one mask.

299
00:19:05,680 --> 00:19:09,400
And I think we are really
struggling to provide it.

300
00:19:09,460 --> 00:19:13,780
I, I was thinking, I, I've
lived in sunny Chichester for.

301
00:19:14,070 --> 00:19:15,180
Pretty much all my life.

302
00:19:15,180 --> 00:19:17,520
It was my 60th birthday yesterday.

303
00:19:17,620 --> 00:19:18,055
Oh, oh,

304
00:19:18,090 --> 00:19:18,690
don't look it.

305
00:19:18,750 --> 00:19:19,200
I know.

306
00:19:19,290 --> 00:19:19,740
Thank you.

307
00:19:19,740 --> 00:19:20,025
Thank you.

308
00:19:20,490 --> 00:19:22,440
Um, and I've, and I've
lived here all my life.

309
00:19:22,440 --> 00:19:23,670
I'm very, very boring.

310
00:19:23,730 --> 00:19:27,625
And, and romantically I think of what
a great city it is and all of that.

311
00:19:27,625 --> 00:19:31,980
But of course, I go out the door
and ev I think every day of my life

312
00:19:31,980 --> 00:19:35,040
that I've spent around Chichester,
you know, walking through or walking

313
00:19:35,040 --> 00:19:38,190
around or cycling around or driving
around, there's always roadworks.

314
00:19:38,490 --> 00:19:41,250
There's always roadworks,
or it's potholes.

315
00:19:41,570 --> 00:19:42,510
But hold on a minute.

316
00:19:42,570 --> 00:19:46,830
You know, if we didn't have
roadworks, we'd have more potholes.

317
00:19:47,190 --> 00:19:52,470
You can't build streets and, without
having some way to, some, some

318
00:19:52,470 --> 00:19:58,050
replacements to, to maintain them and
to give the kind of road arrest and

319
00:19:58,050 --> 00:19:59,910
actually repair it, keep it up to date.

320
00:20:00,360 --> 00:20:06,540
And, and there is so much about this
silent role of a GP locum, actually, you

321
00:20:06,540 --> 00:20:10,650
are stepping in to allow other people who
are providing that continuity to have a

322
00:20:10,650 --> 00:20:14,520
break or to, or to go off sick because
they, they've, they've hit a pothole.

323
00:20:14,610 --> 00:20:16,710
And that, that's a, that's a,
that's a lovely thing to do,

324
00:20:16,710 --> 00:20:18,960
but it's so rarely celebrated.

325
00:20:19,380 --> 00:20:22,710
Um, and, and, and
particularly by us GP locums.

326
00:20:22,980 --> 00:20:26,190
Another thing is that, is the agility.

327
00:20:26,190 --> 00:20:32,040
It's that we, uh, we are there to
allow, um, access to, for patients.

328
00:20:32,040 --> 00:20:36,135
If it wasn't for us working that day
or that afternoon or that week, patient

329
00:20:36,195 --> 00:20:39,435
wouldn't have been able to see a GP or
come into the practice and see someone.

330
00:20:40,245 --> 00:20:41,595
There's that fresh pair of eyes.

331
00:20:41,595 --> 00:20:45,795
The countless times I've spoken
to colleagues who are working as

332
00:20:45,795 --> 00:20:50,265
GP and they've picked something up
because the regular GP was just got

333
00:20:50,265 --> 00:20:52,155
so used to seeing the same patient.

334
00:20:52,185 --> 00:20:57,615
We build in these, these, um, these
heuristics about a patient we built in

335
00:20:57,615 --> 00:20:59,295
these, these patterns, these stories.

336
00:20:59,295 --> 00:21:01,725
As humans, we love to see patterns.

337
00:21:02,115 --> 00:21:04,275
Um, we love to see clear roads.

338
00:21:04,575 --> 00:21:08,214
Uh, we love to we, we, but as a,
as as as a GP, I'm often picking

339
00:21:08,214 --> 00:21:09,294
up what someone else missed.

340
00:21:09,324 --> 00:21:12,024
And I'm sure other GPs are
picking up what I missed.

341
00:21:12,414 --> 00:21:13,164
I know they do.

342
00:21:13,684 --> 00:21:19,581
So, um, there's this lovely
romantic, touchy feely continuity

343
00:21:19,581 --> 00:21:22,821
of care, which as a profession with
this sort of confirmation bias,

344
00:21:22,821 --> 00:21:25,581
we've gone out and said, right,
continuity, let's go out and write.

345
00:21:25,761 --> 00:21:27,441
It's so much research
to prove that it works.

346
00:21:27,441 --> 00:21:27,681
Yeah.

347
00:21:28,221 --> 00:21:29,481
But let's look at the side effects.

348
00:21:29,511 --> 00:21:30,141
No, no.

349
00:21:30,141 --> 00:21:31,971
We don't want to see the downsides of it.

350
00:21:31,971 --> 00:21:39,001
But I think that we as an organization,
see um, anecdotally, very much, those

351
00:21:39,001 --> 00:21:43,471
people who have come a cropper with,
with a, a way of working as a primary

352
00:21:43,471 --> 00:21:50,101
care, where the sense of purpose as a GP
hasn't matched their sense of purpose.

353
00:21:50,156 --> 00:21:51,176
There's been a clash.

354
00:21:51,176 --> 00:21:56,276
There's too much friction and, and
they've lost sight of all those

355
00:21:56,846 --> 00:22:01,796
buffers, all those simple patterns
that they would need to, to help them

356
00:22:01,796 --> 00:22:03,986
get outta their circle of stress.

357
00:22:04,426 --> 00:22:07,936
And I think there are, you know, some
patients absolutely would benefit from

358
00:22:07,936 --> 00:22:11,486
continuity of care, but most people just
just want to get in and sit and say, say

359
00:22:11,486 --> 00:22:14,776
doctor, that I just wanna be able to talk
to someone when I, when I need to, rather

360
00:22:14,776 --> 00:22:16,636
than, you know, waiting a long time.

361
00:22:17,210 --> 00:22:21,440
I think underlying all this is this sort
of feeling that it's not a proper job.

362
00:22:21,440 --> 00:22:25,910
You know, that somehow there's this
hierarchy in medicine or healthcare

363
00:22:25,940 --> 00:22:29,240
of actually you are the bees needs.

364
00:22:29,270 --> 00:22:33,710
If you are a clinical leader or a senior
partner in a department, you know,

365
00:22:33,710 --> 00:22:35,930
doing something with, with continuity.

366
00:22:35,960 --> 00:22:42,020
I'm always astounded by people who are
working as partners and also have very

367
00:22:42,020 --> 00:22:43,760
senior leadership roles elsewhere.

368
00:22:44,073 --> 00:22:46,203
' Cause I think to myself, how
on earth can you do that?

369
00:22:46,203 --> 00:22:50,793
And I always look at them and think, how
is anybody getting the best out of you?

370
00:22:50,793 --> 00:22:54,077
Because a partner is a
really, involved job.

371
00:22:54,077 --> 00:22:56,567
You have to decide that you
want to run that business.

372
00:22:57,248 --> 00:23:00,017
That's very, really quite hard
to run with all the funding

373
00:23:00,017 --> 00:23:01,097
dropping and stuff like that.

374
00:23:01,097 --> 00:23:04,127
And there are some people that are
a hundred percent brilliant at that,

375
00:23:04,517 --> 00:23:06,467
and that's where they need to focus.

376
00:23:06,917 --> 00:23:09,677
And then there's other people that
think, well, you know, they go

377
00:23:09,677 --> 00:23:11,747
into leadership in, in other roles.

378
00:23:11,777 --> 00:23:16,547
In which case if you split your attention
too much, you are focusing on having

379
00:23:16,547 --> 00:23:19,337
to run that business or having to, you
know, be part of the leadership team

380
00:23:19,337 --> 00:23:22,847
for your department, yet you've got
another, you know, really serious job

381
00:23:22,847 --> 00:23:25,393
over here, it's, it's not gonna work.

382
00:23:25,393 --> 00:23:28,033
If there's one thing I've learned
over time doing this podcast, it's

383
00:23:28,033 --> 00:23:31,123
like you've gotta focus on one thing
and do one thing really, really well.

384
00:23:31,633 --> 00:23:34,765
Um, or do something as
like the, what's the word?

385
00:23:34,765 --> 00:23:38,455
The sort of day job that, that,
that keeps going whilst you focus

386
00:23:38,455 --> 00:23:39,475
on the really hard thing over here.

387
00:23:39,535 --> 00:23:43,015
Everything in your week cannot be hard,
I think is what I'm, what I'm saying.

388
00:23:43,015 --> 00:23:48,175
And everything in the week cannot
take all that responsibility for you.

389
00:23:48,175 --> 00:23:50,935
But I, that's where I see
doctors burning themselves out.

390
00:23:50,935 --> 00:23:55,705
So if they could be a partner but didn't
have any responsibility at home and

391
00:23:55,705 --> 00:23:58,975
had all the time in the world and, and
stuff like that, and they love the sort

392
00:23:58,975 --> 00:24:01,825
of leadership business side of things,
then they're probably gonna thrive.

393
00:24:02,081 --> 00:24:05,411
I really do think that
all GPs are leaders.

394
00:24:05,411 --> 00:24:06,581
It's a leadership role.

395
00:24:06,611 --> 00:24:09,401
It's you, you know, you kind of a leader.

396
00:24:09,461 --> 00:24:13,901
When you think of your patients, you
are kind of in that respect, a leader.

397
00:24:14,291 --> 00:24:18,131
Um, I think it fulfills the leadership
definitions very, very well.

398
00:24:18,131 --> 00:24:22,001
We just do not think of it in that
way, but it, it kind of goes with that.

399
00:24:22,001 --> 00:24:28,001
So then to also be a partner in a
practice, um, or also have other

400
00:24:28,091 --> 00:24:32,081
leadership roles, when you are doing
one job, your mind is kind of slightly

401
00:24:32,081 --> 00:24:36,851
thinking of the other job and, and
that's really, that is really difficult.

402
00:24:37,391 --> 00:24:41,763
Um, so yeah, I, I, I, I very much
agree with your sentiments, how we

403
00:24:41,763 --> 00:24:47,403
can square that and, and allow people
to just be clinical directors at an

404
00:24:47,403 --> 00:24:52,233
ICB or just be senior GPs running
a practice without necessarily

405
00:24:52,233 --> 00:24:53,403
the patient load, I don't know.

406
00:24:53,951 --> 00:24:56,716
Well, I'm just wondering, you know, I,
if, if there is something about the,

407
00:24:56,741 --> 00:25:03,026
the sessional work, which means that if
you found somewhere that was, you could

408
00:25:03,026 --> 00:25:08,825
go in, do your job and finish without
the having to sort of work a around it.

409
00:25:08,825 --> 00:25:12,935
Some, someone told me that clinical
leaders in the NHS like partners,

410
00:25:12,935 --> 00:25:18,155
clinical directors do like 40% of their
leadership work or even 60% of their

411
00:25:18,155 --> 00:25:21,845
leadership work out of hours, like at
home or in the evening, the weekend.

412
00:25:21,845 --> 00:25:24,605
Now, I haven't been able to find
that statistic to back it up, but

413
00:25:24,605 --> 00:25:27,125
it certainly rings true for me
and the leaders that I've seen.

414
00:25:27,455 --> 00:25:30,670
And what I've noticed that
when people do go into senior

415
00:25:30,670 --> 00:25:31,870
leadership, 'cause Yeah, I agree.

416
00:25:31,870 --> 00:25:34,870
I think all doctors are leaders,
like all and most healthcare

417
00:25:34,870 --> 00:25:38,170
professionals, leaders, because the
minute you have been working for more

418
00:25:38,170 --> 00:25:40,540
than like a couple of years, you're
supervising somebody else, aren't you?

419
00:25:40,540 --> 00:25:42,130
You're supervising a junior coming up.

420
00:25:42,130 --> 00:25:45,250
So even if you are not see
yourself as a leader, you are.

421
00:25:45,250 --> 00:25:47,350
'Cause people are asking you
things, asking you questions,

422
00:25:47,350 --> 00:25:48,850
wanting to know stuff from you.

423
00:25:49,690 --> 00:25:53,080
So there's, there's that sort of
leader with a, probably with a small L.

424
00:25:53,170 --> 00:25:56,740
But then there's the leader with the
big L where you do feel that default

425
00:25:56,740 --> 00:26:01,270
responsibility of like, if anything goes
wrong here, I'm gonna have to cover in

426
00:26:01,270 --> 00:26:02,620
certainly the partner in a practice.

427
00:26:02,620 --> 00:26:06,220
You feel like that as a clinical lead
for a hospital's department, I think

428
00:26:06,225 --> 00:26:07,750
you, you, you possibly feel that as well.

429
00:26:07,750 --> 00:26:09,850
So there's that extra responsibility.

430
00:26:09,850 --> 00:26:13,690
And having more than one role
with that default responsibility.

431
00:26:13,690 --> 00:26:16,630
I mean maybe there's a bit of,
well, quite a lot at home as well.

432
00:26:17,380 --> 00:26:21,580
I think to have three roles where you've
got that default responsibility of the

433
00:26:21,580 --> 00:26:24,760
leadership, i've gotta cover if anything
goes wrong, of the kids at home, if

434
00:26:24,760 --> 00:26:28,060
someone goes off, you know, kids off
school, I've got to cover and pick them

435
00:26:28,060 --> 00:26:33,960
up and, and something else like a PCN
clinical director, it's just like, how

436
00:26:34,030 --> 00:26:36,130
on earth, how on earth can you do that?

437
00:26:36,130 --> 00:26:40,330
It's so, there's just too much mental
load then too much emotional load.

438
00:26:40,330 --> 00:26:43,210
And that is where I see people burn
out when they don't have time to do

439
00:26:43,690 --> 00:26:47,620
anything better yet, in my own life, I
definitely have seen that the more I can

440
00:26:47,620 --> 00:26:53,230
focus on one thing and do that one thing
well, that is where I have the impact.

441
00:26:53,230 --> 00:26:59,233
But it does rely on me getting over the
guilt and the shame of not being good

442
00:26:59,233 --> 00:27:03,283
enough because I haven't followed the
traditional career and I don't have the

443
00:27:03,283 --> 00:27:07,213
badge of a consultant or a, or a partner.

444
00:27:07,527 --> 00:27:10,028
That, that very much suggests
what, what, what, how it, how you,

445
00:27:10,058 --> 00:27:12,968
how it works as a, as a GP locum.

446
00:27:13,058 --> 00:27:18,008
Um, what, what, what's been, what's
brilliant about it is that, you, you

447
00:27:18,008 --> 00:27:21,998
have a constraint, you have a start time,
you have a finish time, and if you, you,

448
00:27:22,148 --> 00:27:27,173
you have to do all your job, all, all
you can within that time that you are

449
00:27:27,173 --> 00:27:30,953
being paid for, that they've allocated
the, the afternoon or the room for.

450
00:27:31,163 --> 00:27:33,293
Hit one o'clock, someone
else is in that room.

451
00:27:33,563 --> 00:27:35,483
Everything you've done
has got to be finished.

452
00:27:35,483 --> 00:27:38,513
You can't finish it that evening or
tomorrow 'cause you won't be there.

453
00:27:38,783 --> 00:27:42,653
I've worked in up to 30 different
practices a year, up to 10

454
00:27:42,653 --> 00:27:43,883
different practices in a month.

455
00:27:44,213 --> 00:27:47,333
You have to, when you finish,
you have to properly finish.

456
00:27:47,873 --> 00:27:52,193
And if you, you, you can't, if you
wake up in the night so often I think

457
00:27:52,223 --> 00:27:55,673
I did as a locum and I think locums,
do you think, oh God, did I do this?

458
00:27:55,673 --> 00:27:56,483
Did I do that?

459
00:27:57,113 --> 00:28:00,383
As an organization we
developed, um, lots of different

460
00:28:00,413 --> 00:28:01,943
templates, but one of those is.

461
00:28:02,438 --> 00:28:06,578
It's sort of right, you finish your
session, you've look at this template

462
00:28:06,818 --> 00:28:10,418
and, and think, go through each patient in
your, in your mind or through the screen.

463
00:28:10,658 --> 00:28:13,478
And what, which of these is
gonna wake you up at 4:00 AM?

464
00:28:13,748 --> 00:28:16,778
Write it down, write
what's gonna wake you up.

465
00:28:17,138 --> 00:28:21,188
And, and, and so, you know, so, so
we can stop that, that, that anxiety.

466
00:28:21,738 --> 00:28:24,018
And, and the number of times
I have actually found, I've,

467
00:28:24,018 --> 00:28:25,278
I've been back to the practice.

468
00:28:25,278 --> 00:28:29,468
I had to phone them up or I suddenly
realized, I remember one, one, one

469
00:28:29,598 --> 00:28:33,828
holiday in the Rhinogs in Wales hiking
thinking, oh my God, I didn't do such

470
00:28:33,828 --> 00:28:35,550
and such a, a blood test on a patient.

471
00:28:35,730 --> 00:28:37,260
And I felt terrible.

472
00:28:37,260 --> 00:28:40,800
And it kind of ruined my holiday,
which is crazy, but not crazy.

473
00:28:40,890 --> 00:28:44,370
And, um, I have no way of
doing anything about that.

474
00:28:44,370 --> 00:28:45,870
I suppose that happens to every GP.

475
00:28:46,140 --> 00:28:48,900
But it's, it's, but it's something that
we all, as GPs feel, we have that sort

476
00:28:48,900 --> 00:28:52,955
of guilt and that that feeling of, of of,
oh damn, that's really embarrassing and

477
00:28:53,490 --> 00:28:55,470
bad for the poor patient and, you know.

478
00:28:55,885 --> 00:28:57,145
What can I do about it?

479
00:28:57,145 --> 00:29:00,145
I guess if you're a, if, if you're going
back to the same place day after day,

480
00:29:00,145 --> 00:29:01,975
you gonna spot it quicker, perhaps.

481
00:29:02,110 --> 00:29:03,325
I, I had that on a train.

482
00:29:03,325 --> 00:29:04,645
It was a really crowded commuter train.

483
00:29:04,645 --> 00:29:06,955
I'd done a locum session in the
morning and I suddenly realized

484
00:29:07,255 --> 00:29:10,325
very important thing I should have
checked with the patient and I

485
00:29:10,325 --> 00:29:12,355
had to try and phone the practice.

486
00:29:12,355 --> 00:29:16,675
But we had everyone on the track, like,
how can you be confidential, standing

487
00:29:16,675 --> 00:29:20,305
in a carriage going, I'm just gonna tell
you the date of birth and the, I'm gonna

488
00:29:20,545 --> 00:29:22,945
tick, talk in code the name and oh gosh.

489
00:29:22,975 --> 00:29:23,305
Yeah.

490
00:29:23,455 --> 00:29:24,325
But that, but you're right.

491
00:29:24,325 --> 00:29:28,195
I mean, that doesn't necessarily stop
If you're aloc, that can, that can,

492
00:29:28,285 --> 00:29:29,995
that can happen anywhere, can't it?

493
00:29:30,715 --> 00:29:38,037
I think people try and get some agency
control and become a sessional doctor or

494
00:29:38,037 --> 00:29:42,297
a locum or, or stop being the clinical
lead or stop being a partner because

495
00:29:42,297 --> 00:29:46,297
they want more agency and more, more
control over their shifts and their rotas.

496
00:29:46,707 --> 00:29:48,837
Although as you said, that
doesn't always happen.

497
00:29:48,837 --> 00:29:52,917
But I think there's a bit of a myth that
as a, as a leader and as a partner, you

498
00:29:52,917 --> 00:29:56,989
have massive amounts of control anyway
because I think sometimes because of

499
00:29:56,989 --> 00:30:01,425
the responsibility, you feel a real
lack of control, that you have to do it.

500
00:30:01,425 --> 00:30:04,485
Yes, you might have a bit con a bit
of control over it if you then decide

501
00:30:04,485 --> 00:30:08,745
to, so if the whole practice can go
to 20 minutes appointments or not.

502
00:30:09,315 --> 00:30:13,365
But then again, if that person
doesn't turn up and you are on annual

503
00:30:13,365 --> 00:30:16,335
leave and there's nobody to cover
you, you have to go in and do it.

504
00:30:16,335 --> 00:30:20,503
Or you have to be, you are the one
working out of hours on that, on that

505
00:30:20,503 --> 00:30:24,673
complaint that's come in about a member
of a member of staff and things like that.

506
00:30:24,673 --> 00:30:29,276
So I think this illusion of control, I
think, I think worse, works both ways.

507
00:30:29,276 --> 00:30:32,816
What we're trying to do is get some
agency back, get some control back.

508
00:30:33,266 --> 00:30:38,099
But one path seem has a little bit of
guilt and shame around it because like you

509
00:30:38,099 --> 00:30:39,869
said, when you're gonna be a proper GP.

510
00:30:39,869 --> 00:30:42,659
And the other path has a lot of
guilt and shame from the difficult

511
00:30:42,659 --> 00:30:46,319
responsibility, and so you're stuck
between a rock and a hard place, really.

512
00:30:46,822 --> 00:30:47,392
Yeah.

513
00:30:47,392 --> 00:30:47,812
Yeah.

514
00:30:47,817 --> 00:30:51,142
And, and, and I guess, I think
that's where our pay grade comes in.

515
00:30:51,142 --> 00:30:57,142
That's where, you know, there is a choice
we make when we go to medical school,

516
00:30:57,142 --> 00:31:00,832
though we've might not realize it at the
age of 16 when we start, you know, start.

517
00:31:01,732 --> 00:31:04,432
But, but actually that's
what we're taking on.

518
00:31:04,612 --> 00:31:10,252
Um, and that, that is gonna be,
that, that is, we, lots of, lots of

519
00:31:10,252 --> 00:31:12,502
responsibility, but lots of control.

520
00:31:12,502 --> 00:31:16,388
And I think, in any career
there's always going to be that.

521
00:31:16,838 --> 00:31:19,988
I think with, with, with a general
practice at the moment, two

522
00:31:19,988 --> 00:31:25,118
things is, one is that control and
responsibility balance has changed.

523
00:31:25,118 --> 00:31:30,068
It kind of, it seems to be become a little
bit unfair and more unequal every year.

524
00:31:30,068 --> 00:31:34,238
We seemed as, as GPs we're getting
less control, we're having more

525
00:31:34,238 --> 00:31:36,008
targets, KPIs, all that sort thing.

526
00:31:36,368 --> 00:31:40,208
But also we're getting more
responsibilities, you know, taking

527
00:31:40,208 --> 00:31:42,038
on more hospital prescribing.

528
00:31:42,248 --> 00:31:46,298
We're having to take on much, much
more risk because of access and

529
00:31:46,298 --> 00:31:49,958
capacity at hospitals and waiting lists
and, and even workforce in general

530
00:31:49,958 --> 00:31:53,648
practice and lack of consulting rooms
and, and all that kind of thing.

531
00:31:53,858 --> 00:31:55,988
So that's one thing.

532
00:31:56,478 --> 00:32:00,438
And I think the other thing about
responsibility and control is just

533
00:32:00,438 --> 00:32:05,208
the volume of work, the amount of
time we have to be doing it in.

534
00:32:05,238 --> 00:32:13,158
Now, if, if you're, if it's just 9 to
5, you then have the, you can then go

535
00:32:13,158 --> 00:32:17,988
home, unwind, take up a leisure pursuit,
walk the dog, whatever it is, whatever's

536
00:32:17,988 --> 00:32:20,688
your bag is, you can then, um, unwind.

537
00:32:20,688 --> 00:32:22,518
You can relax, you can, you can de-stress.

538
00:32:22,518 --> 00:32:25,398
You can think about, you can
have that creativity that helps

539
00:32:25,398 --> 00:32:27,648
you manage future problems.

540
00:32:28,042 --> 00:32:31,552
I was talking to a colleague
recently about the, um, one's hard

541
00:32:31,552 --> 00:32:33,772
drive becoming, being 80% full.

542
00:32:33,772 --> 00:32:37,042
And if it starts to go above that
and we start to fill a hard drive

543
00:32:37,042 --> 00:32:39,472
up, the computer starts to slow down.

544
00:32:39,892 --> 00:32:43,847
And, and I think that's so true of so
many GPs is they don't get home till

545
00:32:43,847 --> 00:32:47,837
at 10 o'clock at night and then it's,
you know, what's a bit of Detectorists

546
00:32:47,837 --> 00:32:52,127
and then it's off to bed, and then it's
same as same old, same old and taking

547
00:32:52,427 --> 00:32:56,057
laptops home and doing work from home and.

548
00:32:56,057 --> 00:33:00,227
So it, it, it's, it's, it's the, the
change in balance and it's the increase

549
00:33:00,227 --> 00:33:04,487
in, in, in volume or the decrease in
volume of, of, of, of that leisure time.

550
00:33:05,034 --> 00:33:09,684
So I think locums possibly understand
a bit more about boundaries

551
00:33:09,714 --> 00:33:11,334
because they have to, right?

552
00:33:11,334 --> 00:33:12,924
Because you're not going in the next day.

553
00:33:13,164 --> 00:33:14,814
You, you have to get everything done.

554
00:33:15,024 --> 00:33:17,514
So you have to understand more
about limits and boundaries.

555
00:33:17,514 --> 00:33:24,789
So what advice would you, you know,
as a sessional GP give to, you know, a

556
00:33:24,789 --> 00:33:27,339
senior partner or a senior consultant.

557
00:33:27,369 --> 00:33:29,739
And then I'm gonna ask the other
question as well, where partners

558
00:33:29,739 --> 00:33:34,329
and consultants, what advice
would they give to Locums around?

559
00:33:34,539 --> 00:33:37,659
Well, actually being able to change
things and influence and stuff when

560
00:33:37,659 --> 00:33:41,019
they're, and, and that feeling of
lack of control when they do go?

561
00:33:41,019 --> 00:33:44,577
Because I think both groups could
learn from each other around that.

562
00:33:44,577 --> 00:33:46,737
So let's start off with the boundaries.

563
00:33:47,211 --> 00:33:49,896
Heaven forbid if I was,
was, was, was proffering my

564
00:33:49,896 --> 00:33:51,906
advice to a, to a GP partner.

565
00:33:51,906 --> 00:33:59,736
I suppose what it would be is along the
lines of, there's a definition, um, lack

566
00:33:59,766 --> 00:34:03,906
of constraints is the enemy of creativity.

567
00:34:04,419 --> 00:34:09,489
So an artist, if they say, say
to say to a kid, you know, right?

568
00:34:09,489 --> 00:34:11,019
Paint me a picture of some flowers.

569
00:34:11,019 --> 00:34:14,199
You know, here's paints and
crayons on all of that, freak out.

570
00:34:14,199 --> 00:34:17,029
But if you say, right here's blue,
green, and red piece of paper,

571
00:34:17,029 --> 00:34:20,679
and some ink, now draw just using
that, then we can be creative.

572
00:34:20,724 --> 00:34:24,129
The, the best artists, I think,
uh, uh, that, that their,

573
00:34:24,134 --> 00:34:25,899
their artworks are constrained.

574
00:34:25,899 --> 00:34:27,549
They've used very simple tools.

575
00:34:28,179 --> 00:34:32,619
And I think when you are,
um, a professional and in a

576
00:34:32,619 --> 00:34:36,549
leadership role, like, like every
gp, you need that creativity.

577
00:34:36,759 --> 00:34:41,289
But if, if, if, if you are not, if
you're not giving it enough importance

578
00:34:41,289 --> 00:34:45,879
in your day, in your life, if you
are just, um, dismissing it as

579
00:34:45,879 --> 00:34:48,429
potentially frivolous, um, it's a no.

580
00:34:48,429 --> 00:34:53,739
It's a really, i part of important part
of your toolbox to have that capacity

581
00:34:53,739 --> 00:34:58,389
to, to stop, to unwind, to do something
that's totally different, whether that's

582
00:34:58,389 --> 00:35:03,009
a bit of yoga or jogging or painting or
walking some something, something that

583
00:35:03,009 --> 00:35:07,599
you can, can get that extra capacity,
sort of defragment your hard drive.

584
00:35:08,199 --> 00:35:13,389
So it would be actually planning,
booking, actual time out.

585
00:35:13,929 --> 00:35:16,539
Not, not so much, it's not so
much what you do do, it's what you

586
00:35:16,539 --> 00:35:21,009
don't do, um, in terms of your,
your professional way of working.

587
00:35:21,009 --> 00:35:25,269
And that's gonna benefit you,
your relationships, your, your,

588
00:35:25,269 --> 00:35:31,029
your, your, your ability to think
creatively about your career and

589
00:35:31,239 --> 00:35:33,339
the way you, you learn and reflect.

590
00:35:33,339 --> 00:35:36,969
You're not gonna be able to reflect
and learn and grow as a professional

591
00:35:36,999 --> 00:35:41,199
if you're not giving yourself time and
spending yourself instead just going

592
00:35:41,199 --> 00:35:44,319
through results or whatever it is you
are finding yourself having to do.

593
00:35:44,749 --> 00:35:45,799
Yeah, it's interesting.

594
00:35:45,799 --> 00:35:48,799
So you say it's obviously block
of time for your, your hobbies

595
00:35:48,799 --> 00:35:49,639
and your leisure pursuit.

596
00:35:49,639 --> 00:35:52,129
So I think one of the best ways to
do that is, you know, have something

597
00:35:52,129 --> 00:35:56,449
you have to go to, like tennis lesson
at seven o'clock, so you gotta go.

598
00:35:56,659 --> 00:35:59,239
Um, but I think there's also
something about blocking off

599
00:35:59,239 --> 00:36:03,319
the time for the leadership work
that you don't, you don't have.

600
00:36:03,319 --> 00:36:06,284
When I've been talking to partners,
I'm like, how much time have you

601
00:36:06,284 --> 00:36:09,944
got blocked off in your week to do
the partnership work and or how many

602
00:36:10,004 --> 00:36:11,414
official time have you been given?

603
00:36:11,714 --> 00:36:14,384
And people say like, quarter of
a session or something like that.

604
00:36:14,384 --> 00:36:16,184
It's just unbelievable.

605
00:36:16,184 --> 00:36:18,014
It's like, how can you do that in that?

606
00:36:18,014 --> 00:36:20,939
And as a partner, you
can raise that issues.

607
00:36:20,939 --> 00:36:23,249
And people might say to me,
oh, well we don't have enough

608
00:36:23,249 --> 00:36:24,359
appointments, enough time.

609
00:36:24,359 --> 00:36:28,799
Well, okay, it, it might cost you,
but if every partner had enough

610
00:36:28,799 --> 00:36:31,949
time blocked off during the working
week to actually do the partnership

611
00:36:31,949 --> 00:36:34,829
work, the partnership might actually
start to solve some of the issues.

612
00:36:35,009 --> 00:36:38,979
But yes, income would go down, and
like, these things are figureoutable.

613
00:36:39,159 --> 00:36:42,099
And yes, that's reality,
but you gotta choose.

614
00:36:42,099 --> 00:36:44,709
So I, I think there's this sort
of denying of reality about

615
00:36:44,709 --> 00:36:46,989
how long things actually take.

616
00:36:47,409 --> 00:36:51,729
And so, yeah, there's some, some
things about, about saying no.

617
00:36:51,729 --> 00:36:54,909
And we do a lot of work around
boundaries and saying no.

618
00:36:54,909 --> 00:36:57,819
And often it's because we feel so bad
and we don't wanna let people down and

619
00:36:57,819 --> 00:37:00,425
we feel guilty rather than patient harm.

620
00:37:00,755 --> 00:37:02,165
So, so there's that.

621
00:37:02,165 --> 00:37:06,275
So there's booking in the time
for work, saying no and actually

622
00:37:06,545 --> 00:37:09,485
putting in the boundaries and,
and knowing that you can do that.

623
00:37:09,485 --> 00:37:11,975
I've noticed myself that there's
things that feel very urgent and

624
00:37:11,975 --> 00:37:15,345
after I've closed my computer and
done something else, I suddenly don't

625
00:37:15,345 --> 00:37:18,195
feel quite so urgent any, anymore.

626
00:37:18,727 --> 00:37:25,595
What would consultants and partners say to
Locums that they could do differently to

627
00:37:25,595 --> 00:37:29,885
actually feel that they weren't, I don't
know, second class citizens or someone

628
00:37:29,885 --> 00:37:34,865
that doesn't have any control once they're
in the workplace just doing that surgery?

629
00:37:35,547 --> 00:37:40,674
My advice too to GP locums would be just
to, so I've always said to my sons as

630
00:37:40,674 --> 00:37:45,384
well, I've always said to my two boys,
I've just said, volunteer for as much,

631
00:37:45,624 --> 00:37:48,024
always ask if you can help someone.

632
00:37:48,024 --> 00:37:53,064
Always go to when you, when you finish
your work, when you finish what you've,

633
00:37:53,094 --> 00:37:56,544
what you've kind of agreed to do,
say the patients, any paperwork, any

634
00:37:56,544 --> 00:38:00,654
admin, go around and ask a few people,
is there anything else I can do?

635
00:38:00,834 --> 00:38:02,694
I've got, you know, I've got some time.

636
00:38:03,084 --> 00:38:07,224
Um, or, or maybe have not, you
know, what, what can I do to help?

637
00:38:07,404 --> 00:38:09,594
What can I do that, what have I missed?

638
00:38:09,984 --> 00:38:13,014
Um, um, is, is a just check in.

639
00:38:13,124 --> 00:38:17,174
Triangulate, um, yourself
with the rest of the team.

640
00:38:17,204 --> 00:38:22,124
'Cause a practice is a team, and there,
there's a big tendency for as, as, as,

641
00:38:22,124 --> 00:38:26,174
as GP locums to kinda be shown your
room and, and, and you kind of can

642
00:38:26,174 --> 00:38:30,254
stay there for, for four or five hours
and then it's like a rush out because

643
00:38:30,254 --> 00:38:34,124
you, in the afternoon, you're on call
somewhere else, a 45 minutes drive away

644
00:38:34,124 --> 00:38:35,534
and you're really stressed about that.

645
00:38:35,534 --> 00:38:37,484
You know, so, so we can just rush out.

646
00:38:37,484 --> 00:38:39,644
So I would say check in.

647
00:38:40,064 --> 00:38:44,244
I would also say ask for
feedback and give feedback.

648
00:38:44,784 --> 00:38:47,904
Show that you are thinking ahead.

649
00:38:47,934 --> 00:38:50,064
Show that you are open-minded.

650
00:38:50,364 --> 00:38:57,684
Show that you are open to criticism or
cr open to learning or cri, just, just,

651
00:38:58,164 --> 00:39:04,044
just be cognizant that, that you, you are
a team player, and that you, you want to

652
00:39:04,044 --> 00:39:11,634
learn, but also you, you can't pay a, a,
a McKinsey consultant to anyone else to

653
00:39:11,634 --> 00:39:17,897
come into a, a, your consulting room like
you can a GP locum to open up your e EMIS

654
00:39:17,897 --> 00:39:21,887
or system or an operating system to see
the patients, talk to the patients chat,

655
00:39:21,977 --> 00:39:23,717
chat about the GPs they've seen before.

656
00:39:23,897 --> 00:39:26,567
We have this absolutely
unique perspective.

657
00:39:26,777 --> 00:39:28,037
So powerful.

658
00:39:28,427 --> 00:39:33,257
And that, and, and, and we're holding
this incredible soft intelligence

659
00:39:33,257 --> 00:39:37,772
about the practice, how the practice
works, how the practice operates.

660
00:39:38,042 --> 00:39:44,372
When, when we have our chamber meetings,
and often, uh, uh, they're lovely affairs.

661
00:39:44,372 --> 00:39:45,692
They're really good fun.

662
00:39:45,692 --> 00:39:49,322
But, but sometimes the GP locum will
start saying, oh, actually, you know, I've

663
00:39:49,322 --> 00:39:50,672
been working in such and such practice.

664
00:39:50,837 --> 00:39:52,497
Oh, you don't wanna work there.

665
00:39:52,497 --> 00:39:52,937
It's awful.

666
00:39:53,132 --> 00:39:54,542
You know, they do this
and some are other locs.

667
00:39:54,722 --> 00:39:55,652
Oh yeah, I've worked there.

668
00:39:55,652 --> 00:39:56,852
Oh, and yeah.

669
00:39:56,857 --> 00:40:00,182
And, and all the other locals,
especially the newly um, the newly

670
00:40:00,182 --> 00:40:03,297
qualified GP locums will be saying, oh,
you know, I won't work there either.

671
00:40:03,397 --> 00:40:07,172
And, and we kind of, sort of, we have
a policy say, look, hold on a minute.

672
00:40:07,562 --> 00:40:10,652
Look, you know, that poor practice is
probably really, really struggling.

673
00:40:10,712 --> 00:40:13,922
And, and have you have,
you mentioned this to them?

674
00:40:13,922 --> 00:40:19,322
So again, we've created templates and,
and just a, just a, a way of working that

675
00:40:19,322 --> 00:40:23,972
that is actually, these practices would
be desperate to know what you've just

676
00:40:23,972 --> 00:40:29,957
said and what we found as an organization,
as a network of, of locum chambers is it

677
00:40:30,017 --> 00:40:34,377
when a, when a locum in a meeting presses
that red button about a practice, we stop,

678
00:40:34,587 --> 00:40:37,827
we say, right, everyone, here's a little
questionnaire we're gonna send you all.

679
00:40:38,037 --> 00:40:41,007
Everybody who's worked there,
we're gonna ask five questions,

680
00:40:41,127 --> 00:40:42,357
five very simple questions.

681
00:40:42,747 --> 00:40:46,317
It, it's, what did you really look
like most about this practice?

682
00:40:46,857 --> 00:40:51,872
What one thing could this practice
do better to help you work there

683
00:40:51,872 --> 00:40:53,342
or other work, locums work there?

684
00:40:53,492 --> 00:40:56,612
What one thing worried
you about this practice?

685
00:40:57,002 --> 00:40:59,852
And then a couple of other questions
and then we collate that and we

686
00:40:59,852 --> 00:41:01,232
give it back to the practice.

687
00:41:01,262 --> 00:41:04,532
And then the, so the practice has
these anonymized insights from a bunch

688
00:41:04,532 --> 00:41:06,212
of locums in this peer support group.

689
00:41:06,722 --> 00:41:08,402
And it's really, really powerful.

690
00:41:08,432 --> 00:41:12,958
And we, we've even created a CQC
methodology for that as well, for, for

691
00:41:13,013 --> 00:41:18,143
free, you know, all free for practice as
an organization, we want our GP locums, we

692
00:41:18,143 --> 00:41:22,643
think working as a GP locum, you're kind
of, your main job is to support practices.

693
00:41:22,823 --> 00:41:24,543
That's what really you're there for.

694
00:41:24,543 --> 00:41:27,893
You are there to support practice, to
support their patients, uh, and, and you

695
00:41:27,893 --> 00:41:31,973
doing as good a job and you, you've got
you using your unique insight to help

696
00:41:32,183 --> 00:41:36,218
those practices pick up on stuff that,
because you've got that fresh pair of

697
00:41:36,218 --> 00:41:40,148
eyes, you've, you can spread, spread,
best practice, some other practices.

698
00:41:40,628 --> 00:41:42,998
There's so much we have
to offer to practice.

699
00:41:42,998 --> 00:41:47,828
But if we just leave the second hour,
our, our, our clock clock gets to one

700
00:41:47,828 --> 00:41:51,488
o'clock, whatever that we are missing
give, being able to give so much.

701
00:41:51,488 --> 00:41:56,678
So volunteer this information freely
to practices and, and, and they will

702
00:41:56,678 --> 00:41:58,838
thank you for it in all sorts of ways.

703
00:41:59,145 --> 00:42:02,205
I absolutely love that reframe, that
actually you are there to support best

704
00:42:02,205 --> 00:42:08,115
practice in, in general practice overall
and being able to feedback, what a gift.

705
00:42:08,145 --> 00:42:10,515
Because you've seen what
works in other practice there.

706
00:42:10,545 --> 00:42:12,705
So you can share that and you
can say, well, this isn't working

707
00:42:12,705 --> 00:42:15,585
here, but, uh, but this is, and
let's, let's take that back.

708
00:42:15,585 --> 00:42:18,375
You know, there's, that 90 day rule isn't
there, that once you've been working

709
00:42:18,375 --> 00:42:22,465
somewhere for 90 days, you just, you just
don't notice things anymore because you've

710
00:42:22,465 --> 00:42:25,045
got such a unique perspective on that.

711
00:42:25,045 --> 00:42:26,305
So ab absolutely love that.

712
00:42:26,305 --> 00:42:26,395
And

713
00:42:26,440 --> 00:42:28,480
It's like when you go back
to your parents' house, have

714
00:42:28,480 --> 00:42:29,500
you not been there for ages?

715
00:42:29,500 --> 00:42:32,680
And you think that, how long have
you had that orange carpet there?

716
00:42:32,680 --> 00:42:33,460
It's dis, you know?

717
00:42:33,625 --> 00:42:35,335
Why do you keep your stuff in that drawer?

718
00:42:35,335 --> 00:42:35,545
It doesn't

719
00:42:35,560 --> 00:42:35,680
I know.

720
00:42:35,695 --> 00:42:36,295
any sense.

721
00:42:37,018 --> 00:42:37,408
And yeah.

722
00:42:37,408 --> 00:42:38,398
You're not 90 day old.

723
00:42:38,403 --> 00:42:39,328
I, I love that.

724
00:42:39,454 --> 00:42:43,728
I think what we've been talking about
is people desperate to get some control

725
00:42:43,728 --> 00:42:49,368
back over their workload, over their
timetable and over this feeling of if I

726
00:42:49,368 --> 00:42:51,738
don't do it all, no one's gonna do it.

727
00:42:51,738 --> 00:42:53,418
So therefore I, therefore I have to.

728
00:42:53,418 --> 00:42:57,708
And I think people think that the
grass is greener on either side.

729
00:42:57,738 --> 00:43:02,528
The grass is greener by being a
sessional doctor or being a locum.

730
00:43:02,948 --> 00:43:06,578
And I guess you get the sessional
GPs who are employed GPs.

731
00:43:06,848 --> 00:43:10,298
It's like this halfway house between
a partner, you're a salaried GP,

732
00:43:10,418 --> 00:43:13,538
they used to be called salaried
G, GPs, portfolio GPs, and you

733
00:43:13,538 --> 00:43:16,178
know your freelance, freelancers.

734
00:43:16,808 --> 00:43:20,667
And then you've got that cohort looking
thinking, oh, I wish I, if only I

735
00:43:20,667 --> 00:43:24,567
was a partner, I'd have more control
over how things are done, i'd feel

736
00:43:24,567 --> 00:43:26,067
like I was actually achieving stuff.

737
00:43:26,067 --> 00:43:28,527
Or if I was a consultant or a
clinical lead there in both.

738
00:43:28,527 --> 00:43:30,597
They're just looking at the other
people going, you've, you've got

739
00:43:30,597 --> 00:43:35,307
it, you've got it, okay, as it
were, or crumbs, I could never cope

740
00:43:35,307 --> 00:43:36,717
with that, et cetera, et cetera.

741
00:43:36,717 --> 00:43:40,677
But I think what I have noticed is
that it just doesn't matter what

742
00:43:40,677 --> 00:43:42,567
your job title or what your role is.

743
00:43:42,567 --> 00:43:48,432
It's all about how you are crafting a
career that is right for you, that means

744
00:43:48,432 --> 00:43:53,932
you can do things that are in your zone of
genius and you can earn a living, right?

745
00:43:53,932 --> 00:43:57,949
Because we've all gotta earn a living, but
not every single thing that you are doing

746
00:43:57,949 --> 00:44:01,129
is that hugely high responsible thing.

747
00:44:01,571 --> 00:44:06,575
And so anything goes, but we just need
to remove the shame and the judgment

748
00:44:06,575 --> 00:44:09,095
from what your career choice is.

749
00:44:09,605 --> 00:44:13,486
But secondly, I think everyone just
needs a bit more empowering about

750
00:44:13,486 --> 00:44:18,496
control because responsibility without
control is, is the recipe for burnout.

751
00:44:18,888 --> 00:44:21,468
100%. There's been loads of
studies that have shown that.

752
00:44:22,158 --> 00:44:25,278
So it's about how do you get more
control of your work and your workload.

753
00:44:25,278 --> 00:44:28,968
And for some people it may be going
freelance, but for some people it

754
00:44:28,968 --> 00:44:32,058
might be actually saying no to yourself
and picking those internal boundaries

755
00:44:32,058 --> 00:44:34,188
in or, or raising things that work.

756
00:44:34,188 --> 00:44:37,008
So what would you say to people that
are saying, well, if I stop doing

757
00:44:37,008 --> 00:44:40,056
the things that keep everything
going, what's gonna happen next?

758
00:44:40,056 --> 00:44:41,556
I can't just do that.

759
00:44:41,586 --> 00:44:44,982
What would you advise
somebody who's just thinking,

760
00:44:45,147 --> 00:44:52,047
I would, yeah, I would, in an ideal
world, I think in general practice we

761
00:44:52,047 --> 00:44:59,157
would be a lot more open-minded, perhaps
a lot more kinder to these different

762
00:44:59,217 --> 00:45:05,487
ways of working and maybe just make it
much easier to transition between them.

763
00:45:05,877 --> 00:45:11,157
Every year I do dozens of free webinar
talks to any VTS scheme in the country

764
00:45:11,157 --> 00:45:14,907
that will wants to talk, I will happily
give it for an hour and I chat about

765
00:45:14,907 --> 00:45:16,677
working as a locum and all of that.

766
00:45:16,677 --> 00:45:19,737
But it's to newly GPs
are about to qualify.

767
00:45:20,127 --> 00:45:23,587
And kind of what I always say is it
just, it didn't used to be the case,

768
00:45:23,587 --> 00:45:29,287
but the great thing about working as a
GP is it's so much easier these days,

769
00:45:29,377 --> 00:45:34,847
easier in terms of, it's not as shameful
as it was many, many years ago to

770
00:45:34,847 --> 00:45:37,757
change roles, um, to be, to start off.

771
00:45:38,357 --> 00:45:44,057
When you qualify, actually, providing
you can get some good peer support, like

772
00:45:44,057 --> 00:45:46,127
through our chambers or something else,
have really good peer support, then

773
00:45:46,127 --> 00:45:50,447
working as a locum is a brilliant way to
sort of try before you buy, to try out

774
00:45:50,507 --> 00:45:55,127
lots of different practices, different
parts of the country, rural, city, you

775
00:45:55,127 --> 00:45:57,677
name it, try all those different things.

776
00:45:58,097 --> 00:46:02,717
And then, and then, um, depending on,
on where you want to go, your, your,

777
00:46:02,747 --> 00:46:06,017
your, the way your family operates,
your partner, what their career is,

778
00:46:06,017 --> 00:46:09,557
is up to at the moment, kids, all
that kind of thing, there are, there

779
00:46:09,557 --> 00:46:13,427
are different times when it suits you
to be in, in, in a different place.

780
00:46:13,427 --> 00:46:17,957
It may well be that the, the, you know,
that's time between the kids going to

781
00:46:17,957 --> 00:46:22,787
university and you've still got another
10 years of career, if that might be a

782
00:46:22,787 --> 00:46:24,497
really good time to become a partner.

783
00:46:24,557 --> 00:46:25,907
You've got that more time.

784
00:46:26,087 --> 00:46:28,847
You're juggling less things, hopefully.

785
00:46:29,477 --> 00:46:33,377
Um, maybe, but prior to that,
salaried might be better.

786
00:46:33,617 --> 00:46:34,877
But then again, there's the.

787
00:46:35,457 --> 00:46:38,337
You, you are, there's the, the,
the control of the holidays is not

788
00:46:38,337 --> 00:46:39,207
being able to take the holidays.

789
00:46:39,312 --> 00:46:42,132
So you might, that therefore for
you if, depending on what your

790
00:46:42,132 --> 00:46:44,112
partner does, working as a locum.

791
00:46:44,472 --> 00:46:47,072
If it was easier to transition.

792
00:46:47,192 --> 00:46:51,212
And if there wasn't this, it seems
a huge leap becoming a partner.

793
00:46:51,422 --> 00:46:56,852
Every partner I've ever met, I've just,
or just, or just inspired by how much

794
00:46:56,852 --> 00:47:00,902
work it is and all the stuff they do
that they don't otherwise talk about.

795
00:47:01,202 --> 00:47:03,902
And they'll mention it, um, in passing.

796
00:47:03,902 --> 00:47:05,042
And you think you've done what?

797
00:47:05,042 --> 00:47:05,852
That's incredible.

798
00:47:05,852 --> 00:47:07,052
You, you're on that committee?

799
00:47:07,262 --> 00:47:09,422
That thing exists that
you have to do that?

800
00:47:09,752 --> 00:47:12,932
All these jobs and all these
roles and you, how do you manage?

801
00:47:12,962 --> 00:47:14,372
I'm so glad I'm a local.

802
00:47:14,372 --> 00:47:15,542
I don't have to do that.

803
00:47:15,879 --> 00:47:17,829
Juggling all these different things.

804
00:47:18,117 --> 00:47:21,821
And so what you were saying earlier
on about being a GP partner and, and

805
00:47:22,061 --> 00:47:25,301
having to spend so much of that doing
leadership stuff, well, couldn't you just

806
00:47:25,301 --> 00:47:27,491
be a GP partner and just see patients?

807
00:47:27,881 --> 00:47:33,011
Um, and, and, and, and have that as
your, your, so you, you have that, you

808
00:47:33,011 --> 00:47:37,601
are the one, be able to keep the balls,
the plates spinning for that continuity.

809
00:47:37,631 --> 00:47:39,731
You might almost like you
are the continuity partner.

810
00:47:39,731 --> 00:47:44,291
Your leadership role in this practice is
to make sure that, that those patients

811
00:47:44,291 --> 00:47:46,421
that need continuity get continuity.

812
00:47:46,961 --> 00:47:50,471
What a lovely role for a GP partner to
be, not having to go to the prescribing

813
00:47:50,471 --> 00:47:52,391
meeting or PCN, all that sort of stuff.

814
00:47:52,780 --> 00:47:54,850
And you'd do that in a, in an
actual business, wouldn't you?

815
00:47:54,850 --> 00:47:57,370
You wouldn't have the CFO
wouldn't be doing everything

816
00:47:57,370 --> 00:47:59,260
and the, you know, et cetera.

817
00:47:59,260 --> 00:48:02,560
But for some reason there's this sort
of flatness that all the partners

818
00:48:02,560 --> 00:48:05,740
had to decide everything, and
that's just, it's just not doable.

819
00:48:06,520 --> 00:48:11,830
How would you advise someone
who was thinking of doing, not a

820
00:48:11,830 --> 00:48:14,560
career change, but just organizing
the way they work differently?

821
00:48:14,590 --> 00:48:16,360
'Cause that's, that's,
that's all that it is.

822
00:48:16,840 --> 00:48:20,800
But is sort of, there's something
niggling at them might be sense

823
00:48:20,800 --> 00:48:26,320
of losing their sense of worth
or identity or, you know, status.

824
00:48:26,320 --> 00:48:27,941
What would you advise them?

825
00:48:29,088 --> 00:48:36,918
I would advise, I think probably more like
what I said, um, as a GP locum when you're

826
00:48:36,918 --> 00:48:41,418
finishing for the morning or the afternoon
or whatever is, is speak to people.

827
00:48:41,628 --> 00:48:44,838
Ask, talk to other people,
join a peer support group.

828
00:48:45,408 --> 00:48:48,138
But you, you need to have that head space.

829
00:48:48,138 --> 00:48:51,708
You need to have that 20%
of your hard drive free.

830
00:48:52,218 --> 00:48:58,728
Um, you need to have the creativity,
the, the energy, um, should I say, be

831
00:48:58,728 --> 00:49:02,838
to, to have, so that you then can be
creative with it or reflective with it.

832
00:49:03,088 --> 00:49:05,158
It's a huge decision to make.

833
00:49:05,188 --> 00:49:09,778
If you're feeling in that way, you may
well have been doing something, you

834
00:49:09,778 --> 00:49:11,848
may have got yourself into a habit.

835
00:49:11,848 --> 00:49:15,178
You've been doing it for longer than 90
days, so you don't know you are doing it.

836
00:49:15,508 --> 00:49:19,768
You kind of need that
mentorish type support from

837
00:49:19,768 --> 00:49:21,328
an individual or from a group.

838
00:49:21,328 --> 00:49:22,198
You need trust.

839
00:49:22,198 --> 00:49:24,328
You need that psychological safety.

840
00:49:24,808 --> 00:49:26,338
You need that buzz.

841
00:49:26,338 --> 00:49:29,878
And in, in our chambers, we really
focus on psychological safety and

842
00:49:29,878 --> 00:49:34,588
having buzz, having a sense of fun,
having, you know, so you can laugh

843
00:49:34,588 --> 00:49:35,758
and have a chat with your friends.

844
00:49:35,758 --> 00:49:39,928
You make sure that you've got GPs
who are not just your colleagues,

845
00:49:39,928 --> 00:49:41,218
but your friends as well.

846
00:49:41,788 --> 00:49:45,748
And if you've got that, and so you can,
you are there, you are in a position to

847
00:49:45,748 --> 00:49:48,298
be open to advice, to ask for advice.

848
00:49:48,298 --> 00:49:49,978
You've got colleagues to help.

849
00:49:49,978 --> 00:49:54,578
You might not say even advice just to,
just to, to this is what we would advise

850
00:49:54,578 --> 00:50:01,458
the patient is, is to talk a a about
it, and have that time to, to not be

851
00:50:01,458 --> 00:50:04,338
thinking about the day job all the time.

852
00:50:04,608 --> 00:50:06,198
So easily said for many.

853
00:50:06,528 --> 00:50:11,148
And I think if, if people are, if you're
thinking, gosh, that's just not me, I will

854
00:50:11,148 --> 00:50:15,108
never have that, then you are precisely
the sort of people who probably need to

855
00:50:15,108 --> 00:50:18,001
be having that, that reflective timeout.

856
00:50:18,312 --> 00:50:23,430
And I think on the identity level,
you know, I think rather than for me,

857
00:50:23,460 --> 00:50:27,510
rather than thinking, well, I left,
you know, I left because I couldn't

858
00:50:27,540 --> 00:50:29,970
hack it, that wasn't true at all.

859
00:50:30,300 --> 00:50:33,840
I left because I found something
else I wanted to, to focus on.

860
00:50:34,080 --> 00:50:37,260
And at that point, the way I was
working wasn't, wasn't working

861
00:50:37,260 --> 00:50:39,030
for me and it, it didn't suit me.

862
00:50:39,428 --> 00:50:42,018
And I just would stress this,
the importance of really

863
00:50:42,018 --> 00:50:43,668
focusing on one main thing.

864
00:50:43,668 --> 00:50:46,938
And yeah, there can be a few things
around that, but the one thing that you

865
00:50:46,938 --> 00:50:50,958
feel like is your baby and your, you are
responsible for, I'm, I'm guessing for you

866
00:50:50,958 --> 00:50:54,348
Richard, that is the, the NASGP, right?

867
00:50:54,403 --> 00:50:57,253
And that'd be very hard to do if
you also were a partner somewhere

868
00:50:57,253 --> 00:50:59,803
else, and, and having to manage
all that responsibility too.

869
00:51:00,403 --> 00:51:03,853
Um, and, and you'll have much more
impact focusing on one main thing.

870
00:51:04,212 --> 00:51:07,752
The second thing I would, I would say
that I just sort of realized is along

871
00:51:07,752 --> 00:51:11,202
the You Are Not a Frog theme, so we're
this frog, you're this frog in the

872
00:51:11,482 --> 00:51:14,622
pan of boiling water that's slowly
heating up and the workload is getting

873
00:51:14,622 --> 00:51:16,002
worse and the control has gone down.

874
00:51:16,374 --> 00:51:17,364
You have options.

875
00:51:17,364 --> 00:51:21,354
Like frogs can only burn out or
jump out and leave, leave entirely.

876
00:51:21,924 --> 00:51:25,284
But you could like do something to,
to turn down the heat in the pan.

877
00:51:25,284 --> 00:51:29,664
Like so many people haven't actually asked
for what they actually need or looked

878
00:51:29,664 --> 00:51:34,224
at the way that they're working within
their employed job, or as a consultant,

879
00:51:34,224 --> 00:51:38,784
a salaried GP or as a, a partner or
or another healthcare profession,

880
00:51:38,784 --> 00:51:43,004
they haven't actually explored,
could, could the sessions be changed?

881
00:51:43,004 --> 00:51:44,114
Could the timings be changed?

882
00:51:44,114 --> 00:51:45,104
Could they have longer appointments?

883
00:51:45,104 --> 00:51:46,754
Things that actually would
turn down the heat for you.

884
00:51:46,754 --> 00:51:47,684
So there's that one.

885
00:51:48,224 --> 00:51:50,954
They're then jumping out of
your pan into a different pan.

886
00:51:51,164 --> 00:51:54,044
And that different pan might be, yeah,
the pan of being freelance or the

887
00:51:54,044 --> 00:51:57,344
pan of being salaried or even jumping
outta freelance into being a partner.

888
00:51:57,824 --> 00:51:58,844
That might work for you.

889
00:51:58,844 --> 00:52:00,284
That might absolutely suit you.

890
00:52:00,284 --> 00:52:02,864
But sometimes you don't know
till you've done it, do you?

891
00:52:02,864 --> 00:52:06,434
And so trying stuff out, there's
no, there's no shame in that.

892
00:52:07,064 --> 00:52:09,314
And then you've got the final
option of like getting out of

893
00:52:09,314 --> 00:52:12,104
pans altogether and you could jump
into a pond, like do something.

894
00:52:12,569 --> 00:52:13,529
Totally different.

895
00:52:13,529 --> 00:52:16,649
And sometimes I know I've been
like, I just wanna go and work

896
00:52:16,649 --> 00:52:18,599
in a coffee shop making coffees.

897
00:52:19,709 --> 00:52:22,529
But I take myself with me, right?

898
00:52:22,529 --> 00:52:23,339
That's the problem.

899
00:52:23,339 --> 00:52:26,759
You know, you take yourself and
the drivenness and the wanting to

900
00:52:26,759 --> 00:52:28,529
achieve and the identity stuff.

901
00:52:28,529 --> 00:52:31,769
So I know the minute I get to a coffee
shop, I'll be like, right, let's

902
00:52:31,769 --> 00:52:33,689
make this, let's franchise it out.

903
00:52:33,839 --> 00:52:36,269
What can we do to make
this even more impressive?

904
00:52:36,274 --> 00:52:38,459
You know, so you take yourself with you.

905
00:52:38,459 --> 00:52:40,379
So it's all got to come
from within, hasn't it?

906
00:52:40,379 --> 00:52:45,509
It's got like your, your job satisfaction
and the meaning in life has got to be from

907
00:52:45,509 --> 00:52:50,454
internal motivation rather than what your
job title is or how successful you look.

908
00:52:50,699 --> 00:52:54,539
And it's all about what enables you
to focus on the one thing that's

909
00:52:54,539 --> 00:52:59,009
important and to live in the way that
you want to live, remembering that

910
00:52:59,009 --> 00:53:02,159
no one on their deathbed ever said, I
wish I'd spent more time at the office.

911
00:53:02,853 --> 00:53:06,513
it's, I suppose having the privilege
of having the head space to be able

912
00:53:06,513 --> 00:53:11,766
to make that switch because the, the
changing tracks in itself takes the

913
00:53:11,766 --> 00:53:15,966
ability to make a decision to come, to
come to a sit decision and, and do that.

914
00:53:16,326 --> 00:53:20,646
And I was, and as, as you're talking, I
was thinking in my life, what has really

915
00:53:20,646 --> 00:53:24,561
helped me just kind of have the head
space and it was actually, it was about,

916
00:53:24,621 --> 00:53:26,931
uh, it was about seven, eight years ago.

917
00:53:27,111 --> 00:53:28,161
My dad's an art teacher.

918
00:53:28,161 --> 00:53:29,451
He's always been an art teacher.

919
00:53:29,451 --> 00:53:32,481
He teaches pottery in his
spare time, still does.

920
00:53:32,541 --> 00:53:35,631
And um, and I thought, oh,
actually I could try a bit of that.

921
00:53:35,631 --> 00:53:39,171
So I went to his pottery class
and I remember being covered

922
00:53:39,171 --> 00:53:41,271
in clay without my Apple Watch.

923
00:53:41,271 --> 00:53:43,821
On with no phone, which is the
first time I'd done that in a long

924
00:53:43,821 --> 00:53:47,601
time and stuck with two hours on a
piece of slippery clay on a wheel.

925
00:53:47,961 --> 00:53:51,874
And after that two hours, I just
thought, oh my God, I've just been

926
00:53:51,874 --> 00:53:54,874
thinking so many things that aren't work.

927
00:53:54,994 --> 00:53:55,204
Okay.

928
00:53:55,204 --> 00:53:58,054
A lot of it is about what, why about
this damn thing stay in the middle.

929
00:53:58,354 --> 00:54:03,529
But a lot of it was, was, was just, just
the ability to, to form and shape stuff.

930
00:54:03,529 --> 00:54:11,239
But I then, I then since then started
to more and more in my off time rather

931
00:54:11,239 --> 00:54:16,999
than go for a walk where I, we'd talk
about work or, or, um, or read a, trying

932
00:54:16,999 --> 00:54:20,299
to read a book and then start thinking
about work and usually sort of like work

933
00:54:20,299 --> 00:54:24,289
related books, which just makes you think
more about work, is actually try stuff

934
00:54:24,289 --> 00:54:26,389
that was, was nothing to do with that.

935
00:54:26,989 --> 00:54:31,549
And, and, and, and, and having that,
that ability to shape new things and try

936
00:54:31,879 --> 00:54:37,189
different ways of seeing stuff, and, and,
and, and I now do lots of, uh, painting

937
00:54:37,219 --> 00:54:38,839
and drawing and all that kind of stuff.

938
00:54:38,914 --> 00:54:43,879
And it, and I find that that, for me,
for me personally, really helps just

939
00:54:43,999 --> 00:54:50,269
think abstractly about, have an abstract
approach to life and work all that.

940
00:54:50,269 --> 00:54:52,650
So that I'm thinking
about your 90 day rule.

941
00:54:52,650 --> 00:54:55,110
What, what have you done
for nine years or 19 years?

942
00:54:55,110 --> 00:55:00,240
You know, you so some, it, it's just,
so I, what can we do slightly different?

943
00:55:00,240 --> 00:55:04,650
That, that is, is the trigger, the
switch that actually starts that change

944
00:55:04,800 --> 00:55:09,420
process to, to, to get ourselves out
of any ruts we've got ourselves into.

945
00:55:09,562 --> 00:55:12,982
Yeah, and I think that, you know, even
just taking time off, like prolong

946
00:55:12,982 --> 00:55:16,882
like two or three weeks or a sabbatical
for six weeks just gets you far

947
00:55:16,882 --> 00:55:21,057
enough away from what you are doing
to begin to think, okay, well, does,

948
00:55:21,142 --> 00:55:22,972
does that title actually matter to me?

949
00:55:23,527 --> 00:55:24,577
How is it I wanna live?

950
00:55:24,577 --> 00:55:26,077
What is it that I'm
really starting to enjoy?

951
00:55:26,077 --> 00:55:28,747
But it does take a, a
bit of a bit of distance.

952
00:55:28,747 --> 00:55:31,847
So if someone is genuinely not knowing
what to do, don't make any rash

953
00:55:31,847 --> 00:55:35,417
decisions before you feel like just
giving yourself time to decompress.

954
00:55:35,837 --> 00:55:38,747
Otherwise, what happens is you just
throw the baby out the dark bath water

955
00:55:39,197 --> 00:55:42,527
and you end up doing something that you
never really wanted to do, but you just

956
00:55:42,527 --> 00:55:44,027
thought that was the only, only option.

957
00:55:44,027 --> 00:55:47,627
And I'm sure you've seen people like
that join the, the freelance brigade

958
00:55:47,627 --> 00:55:50,927
when actually they would've been
better in a, in a regular salary

959
00:55:50,927 --> 00:55:54,587
job, you know, not having to manage
all that in uncertainty and stuff.

960
00:55:54,587 --> 00:55:59,787
So if you had sort of three top tips
to give people about all of this or

961
00:55:59,787 --> 00:56:05,607
about how to work that gives you more
control and agency and, and just enjoy

962
00:56:05,607 --> 00:56:07,947
life as a clinician, what would it be?

963
00:56:08,698 --> 00:56:14,308
I would say first thing is get
your sense of purpose in order.

964
00:56:14,708 --> 00:56:20,558
I'm going back here to this, this whole
thing about, that continuity of care

965
00:56:20,558 --> 00:56:23,768
is, is, is the be all and end all.

966
00:56:23,768 --> 00:56:27,188
There is much more to
general practice than that.

967
00:56:27,188 --> 00:56:31,688
It's what, what, what, what
do you like to do as a person?

968
00:56:31,688 --> 00:56:34,898
If you are, you are gonna be a,
the best GP you are gonna be is the

969
00:56:34,898 --> 00:56:40,868
GP that, that, that starts off the
day with energy and joy and looking

970
00:56:40,868 --> 00:56:42,158
forward to what you're going to do.

971
00:56:42,248 --> 00:56:45,218
And I think, again, all sorts of studies
shows that if you're happy in your

972
00:56:45,218 --> 00:56:50,618
work, you, you perform much better,
more efficiently, more effectively.

973
00:56:50,798 --> 00:56:53,468
You said earlier, earlier on,
we were talking about, you

974
00:56:53,468 --> 00:56:57,398
know, GP partners taking more
time off to be happier at work.

975
00:56:57,398 --> 00:56:59,498
But, but that might
affect the monetary level.

976
00:56:59,588 --> 00:57:00,938
It might not actually.

977
00:57:01,118 --> 00:57:05,948
It may well be, but if they're happier
and more creative and have that space and

978
00:57:06,278 --> 00:57:09,968
happier teams, they actually might come
up with some much better ways of working,

979
00:57:10,238 --> 00:57:11,798
more efficient and more effective.

980
00:57:12,008 --> 00:57:15,668
So it's, I think it's a sort of,
can be a, a synergistic effect.

981
00:57:15,991 --> 00:57:20,791
I people when they've joined our chambers,
and they've, they've clearly had, they,

982
00:57:20,791 --> 00:57:25,171
they had burnt out as partners, and
I've, I've, I, I know three GPs over the

983
00:57:25,171 --> 00:57:29,701
years who said pretty much exactly the
same thing is that they love medicine.

984
00:57:29,821 --> 00:57:30,991
They love medicine.

985
00:57:31,071 --> 00:57:34,821
But they'd started to feel as a GP
that they didn't love medicine anymore.

986
00:57:35,001 --> 00:57:36,651
They stopped, they had some time off.

987
00:57:36,801 --> 00:57:40,491
They started locuming and they
realized they love medicine.

988
00:57:40,611 --> 00:57:44,421
It was, thank God, it wasn't that, that,
that were, that they weren't enjoying

989
00:57:44,511 --> 00:57:47,341
it was being that stuck in a rut.

990
00:57:47,611 --> 00:57:51,421
It was having that, that, that issue
being a partner that they, in their

991
00:57:51,421 --> 00:57:55,561
particular partnership had this issue
with responsibility and control.

992
00:57:55,699 --> 00:57:58,309
What's just striking me, Richard, is
that yeah, you are talking about the jump

993
00:57:58,309 --> 00:58:03,979
from being a, a, a partner to being a,
a freelancer, but also there, there's

994
00:58:03,979 --> 00:58:07,999
that jump from, say if you are managing
a team in a hospital and you'd, you know,

995
00:58:08,059 --> 00:58:12,139
it's absolutely draining the life out of
you, it's absolutely fine to stop doing

996
00:58:12,139 --> 00:58:13,819
that and just see the patients as well.

997
00:58:14,599 --> 00:58:17,749
So it's, it, it's this jump
from, I've gotta be this leader.

998
00:58:17,749 --> 00:58:19,849
I've gotta be in leadership here
to actually, I just wanna do

999
00:58:19,849 --> 00:58:21,769
what actually I'm really good at.

1000
00:58:21,799 --> 00:58:28,189
And that feels like a demotion, it feels
like a status issue, but it, if you can

1001
00:58:28,189 --> 00:58:32,329
get yourself over that, then it could be
the absolute best thing you've ever done.

1002
00:58:32,779 --> 00:58:35,601
Gosh, we could go and talk about this for
ages, but Richard, it's been absolutely

1003
00:58:35,601 --> 00:58:37,191
wonderful having you on the podcast.

1004
00:58:37,191 --> 00:58:41,301
How can people contact you or
find out more about the National

1005
00:58:41,301 --> 00:58:42,981
Association of Sessional GPs?

1006
00:58:43,308 --> 00:58:44,718
Yeah, Google us.

1007
00:58:44,718 --> 00:58:51,233
We've got, we, we are,
um, www.nasgp.org.uk.

1008
00:58:51,233 --> 00:58:54,443
Contact us through email
is probably the best way.

1009
00:58:54,813 --> 00:58:57,916
We've, we've, got, we've, we've
launched a relatively recently, a

1010
00:58:57,916 --> 00:59:01,873
brand new sessional GP community
that anyone can join for free.

1011
00:59:01,873 --> 00:59:05,323
And it's about, its forums and it's,
and it's, we've got one tonight.

1012
00:59:05,323 --> 00:59:08,803
We've got these labs we are running
for, just allow anyone who wants

1013
00:59:08,803 --> 00:59:12,973
to, any GP wants you to sign in and
talk to other GPs about a specific

1014
00:59:13,033 --> 00:59:15,223
topic just to, just to network.

1015
00:59:15,613 --> 00:59:19,058
Um, we've got a fantastic, well our
platform as well, practice managers

1016
00:59:19,298 --> 00:59:21,103
practices can all join for free as well.

1017
00:59:21,103 --> 00:59:24,553
And it can help them hire locums,
our members through, through

1018
00:59:24,553 --> 00:59:28,093
the platform, uh, out of hours
and, and, and daytime as well.

1019
00:59:28,093 --> 00:59:29,743
So that all, that's all helps.

1020
00:59:29,968 --> 00:59:30,358
Great.

1021
00:59:30,358 --> 00:59:31,708
We'll put all those
links in the show notes.

1022
00:59:31,708 --> 00:59:34,168
Richard, you're doing absolutely
great work and thank you so

1023
00:59:34,168 --> 00:59:35,338
much for being on the podcast.

1024
00:59:35,600 --> 00:59:35,973
Thank you.

1025
00:59:35,978 --> 00:59:36,328
My pleasure.

1026
00:59:37,996 --> 00:59:38,926
Thanks for listening.

1027
00:59:39,026 --> 00:59:43,486
Don't forget, you can get extra bonus
episodes and audio courses along with

1028
00:59:43,576 --> 00:59:48,406
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1029
00:59:48,486 --> 00:59:52,946
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1030
00:59:52,946 --> 00:59:55,916
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1031
00:59:56,290 --> 00:59:59,810
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