Everyone has bad days at work, and at the moment, everybody is feeling
the pressure of fewer resources and less time with patients.
But if your bad days are becoming more common, is the answer to
ditch the day job and go freelance?
This week, Dr. Richard Fieldhouse, founder and chairman of the National
Association of Sessional gps joins me to take an honest and frank look
at the different models of working.
Is being a locum all it's cracked up to be?
Now, the graph isn't necessarily greener on the other side.
If you don't have regular work, you may fantasize about being in just one place
with the great connections, certainty, and stability that it brings us.
Now every way of working brings its own benefits and challenges.
It all comes down to control and agency.
If you want control over your working hours, in your workload,
more time for other strands to your career, but maybe less control over
how you work and your workplace, freelancing might really suit you.
But if you want less risk and more say in what we do around here, you
might want more regular employment.
We talk about why this isn't black and white, and what freelancers and locums
can learn about how to influence your work environment from permanent staff, and
what partners and consultants can learn.
About managing their workload, taking more control and responsibility
from locums and freelancers.
So if you are thinking about making a change in your career in 2026, this
conversation with Richard will really help you get clear on what's available,
it'll help you weigh up the pros and cons of each and help you let go of
the sneaking suspicion that one way of working is more worthy than another.
If you're in a high stress, high stakes, still blank medicine, and you're feeling
stressed or overwhelmed, burning out or getting out are not your only options.
I'm Dr. Rachel Morris, and welcome to You Are Not a Frog.
I am Richard Fieldhouse.
I am a GP and I am chairman and founder of the National Association of Sessional GPs,
and I've worked as a GP locum pretty much all my GP career apart from a small stint
as GP partner at the beginning and more recently for a a year as a salaried GP.
It's wonderful to have you on the podcast, Richard, and there's so many
different things we could talk about.
I'm particularly interested in what your views are of, of both sides of the coin.
So you've worked to the partner, you've worked as a locum, and you've seen
everything in between and your constantly talking to hundreds of people who are
doing various different iterations of, I guess, the same set of job.
And so we're gonna delve in, in this podcast to why people choose different
sort of ways of working, the advantages and the disadvantages of both.
But first of all, I just wanna dig down below the surface because many
doctors, many healthcare professionals just feel really stuck regardless of
their role, regardless of whether they are a locum, a bank staff or a partner,
a clinical director, or a consultant.
So when you've been talking to people, I guess people in the national
Association of Sessional, GPs, other locums or the partners you talk to
in practice or consultants, what do you hear them really longing foremost
in their careers and in their work?
I guess, uh, and, and patience as well.
I, I would say for me, what seems to be the common theme is that feeling
of kind of being wedged in this corner where there is an imbalance in their
career, in their home, lives, in, in kind of almost everything they do.
But in that it's an imbalance between control and responsibility.
If they are starting to feel that their boss or somehow the job they're
doing, they're starting to have less control, less flexibility, less uh,
freedom, that seems to cause anxiety.
And then, and then the responsibility if they, if coupled, okay, fair enough.
If they get, then get with that less responsibility,
that's balancing itself out.
But that doesn't really happen.
We tend to find ourselves having less control and more responsibility.
Sometimes in a job you can have tons of responsibility
that that can be overwhelming.
But if you've got control of that, if you can control that responsibility,
whether in, in forms of time or volume or or, or, or where and when you do it
that, gives that, that, that's great, and that can, that can help you balance.
I mean, I think as GPs, doctors, we love responsibility.
That's, we went this into this job.
you as, as a, as a, as a junior, as a, as a resident doctor, the day you
qualify after your GP training as a GP your GMC registration changes overnight
to be, to be, uh, uh, you, you are now, um, registered as a, as a doctor,
uh, but, but who, who has to take responsibility for everything they do?
Um, and, and you, you are no longer part of a kind of a hierarchy
or of, or having a line manager.
You, you have, you, you, you, you're now, you are now practicing
independently, and without supervision.
And, and that's the first time that happens.
Prior to your qualification as a gp, you are, you are effectively being supervised.
And I don't think of them.
We often appreciate the responsibility that goes with it.
It's a huge change in, in responsibility.
So we have to be in control.
There's a phrase that came into primary care, which I was having done, worked as
a GP locum for 30 years, about 15 years ago, this word started to talk, but when
people talk about locum work, GP locum work, they started to talk about shifts.
So what's, what's a shift?
Well, a shift.
So a shift to me is, a shift worker is someone who fits into a slot.
There's a start time, there's a finish time.
It's kind of like a, a clock mechanism with lots of cogs.
And someone take a co goes home, you fit into that cogs place and
you are part of this machine.
And that what, that, that word lends itself really well to how hospitals work.
Hospitals work 24 7.
If you are working as a locum in a hospital, you are fitting
into a shift as part of a team.
You can't run an entire neurology department, uh, on your, on your own.
You are part of your part, your mechanism is a component of that.
But when you are practicing as a GP in your consulting room, from the
moment that patient steps in to way beyond that patient leaves that room,
you are responsible and you have to be, you have to be con in control of
that, because if something goes south or pear shaped you, you, you, you,
you've, you've got to be responsible.
So fitting into a, if you are the type of GP who can, um, fail, very
comfortable managing balancing risk in a 10 minute appointment, feel really
comfortable and may might even enjoy that, enjoy the number of patients
you see, that's great, good on you.
But there are plenty of GPs who would, who, who, who find that untenable
and who really struggle with that.
And, and the way they work is they're much more into 20 minutes, half an hour.
My, my lovely wife Sarah, is one of those GPs who trust me as a patient
you really want to see because every patient she needs 30 minutes for, but
when fitting into 20 minutes or 15 minutes really finds that stressful.
And so I think with the complexity of disease these days and care and
management, um, and the, you know, the, fortunately the 10 minute appointments
seem to be really, um, um, heading out the door now much more into 15 minutes points.
But even so, there's still a constraint in that, that, that if you are, what,
what we as an organization for we have, we have a platform and what we
allow our members to do who work, those who work as freelance GP Locums, is
they put themselves out there on the platform to practice and say, look, I'm
a GP who does 20 minute appointments.
If you're gonna hire me, you're gonna have to hire me at 20 minutes,
'cause if you hire me at 10 minutes or 15 minutes, you, you're just
not gonna get good value for money.
I'm gonna be stressed.
I'm gonna be, I'm not gonna be forming at my peak.
So it's, it's, it's having, it's, it's about having that
responsibility and control.
So not, not for GPs, we need to not be thinking in the mindset of a shift.
We call it sessions.
And you need to, as a chief, we need to define those sessions,
otherwise we're gonna struggle.
I guess that's why you called yourself the National Association of Sessional GPs.
Not shift working, not shift working GPs.
I, I would challenge that a bit though, because I think consultants in hospitals,
yes, there should be colleagues to cover work so for an a e doctor, when they are
off their shift, there is somebody else on the shop floor seeing the patients.
But there's a huge amount of other work that the consultants
do that that just has to get done, whether they're on shifts or not.
And you know, I was talking to a community pediatrician
recently who has a huge workload.
She has no colleague, so they are all hers, whether she's at work or not.
So I think this, this concept that you can just walk off and someone
else covers you, doesn't really hold true in hospitals either,
particularly the more senior you get.
And then, the juniors, we've all seen that the issues with shift
working and, and juniors who just don't feel part of the team.
And because they are just treated like a cog in the wheel, that's
massively disempowering and, and not very great for teamwork and stuff.
So I don't think it benefits anybody, does it?
But it's this issue about control that goes with the responsibility.
'Cause I've noticed as doctors and senior healthcare professionals, senior
managers, senior nurses, senior allied health professionals, we just take on the
default responsibility for everything.
And my observation is that when we get sick of that and we can see the control
dropping, maybe about the way we work, how we are rostered onto shifts or you
know, for example, you know, if I was in a practice and they were saying, no, you're
doing 10 minute appointments, and I just thought that is, I can't, I can't do that.
That's not suit the way I wanna work.
That's when we go, okay, maybe another way of working would suit me better.
If I then go and be a locum GP or a locum consultant, I have much more
control over what I choose to say yes and no to in terms of shifts.
And also I can stipulate to some extent, some people find it difficult to do that,
you know, the number of appointments and the length of the appointments that I do.
So in my head, going to be a locum gives perhaps the illusion of, of a bit more.
Well, it definitely gives you more control over some things, but in other ways it
gives you, it gives you less control.
Yes.
And, and, um, and it can, that can all in in terms of the way that
the marketplace in terms of working as a g Logan fluctuates as well.
And I, and I, and by the way, I'm in no way qualified to talk about hospital
freelance consultants or locum work.
I, it, it's something I've had very little experience.
But also it seems to go in, in, um, in 10 year cycles.
Every 10 years there's, uh, the, the, the, um, the workforce seems to be, we
seems to be over, over provided with GPs, which is where we've very recently been.
I think we're coming outta that again.
Bang on 30 years ago, I started NESGP 'cause when I
qualified there were no jobs.
And 10 years later, same thing, a further 10, same thing.
And it's the same thing at the moment.
So if you're a gp Locuming listening, locum listening to this, you're thinking,
oh my God, I'll take any work you give me.
And, and, and they, they're, they're desperate for work in, in many situations.
And again, geographically different parts of the country.
So yeah, very much you, you kind of, you, you, you, you take what's on offer
if, if there is anything on offer.
Um, so, so it, it's, it's, in our ideal world, yes, as what our aspiration is
to have this perfect balance between respo responsibility and control.
But in the real world, it's particularly at the moment,
that's just simply not the case.
And, and people are, are doing, you know, reducing their prices,
working more, fitting into 10 minutes appointments, that kind of thing.
Yeah, so in, in a market where people need sessional doctors, great.
But when they don't, suddenly the control goes again.
You were a partner for a few years, and then you moved
into being a sessional doctor.
What did you think that that being a sessional GP, that being a locum was going
to solve, that it actually didn't solve?
What it's, at the time, what, what it solved is I was, I was young, I
was married to another GP and having children, and for that it was fantastic.
Um, as, as co-parent, co-parenting, two lovely boys.
Um, and it worked really well.
What it didn't solve, I guess, but I'm, I, I think in that way I'm quite different.
I think for a lot of locums it doesn't solve is, it doesn't solve that itch,
which is the, um, the sense of sense of value, the sense of purpose of being a GP.
Because we are told, we see so often everywhere that in order to be a GP we
have to do con this thing this continuity of care, which, which we have so much
research in general practice to show to prove is an absolutely wonderful thing.
Um, and it, it brings so much joy to many GPs that are, are, are that, that we are
able to see patients again and again and form these, these, these relationships,
these therapeutic relationships with them.
And, and, and I kind of missed that and I, and I was told a lot as well,
what, why I wasn't I a proper GP?
Don't I miss that?
And colleagues would, would say, actually, Richard, I, I, I really
enjoyed Lo but I just feel I need to, I need to become a partner or a sur
because of that, um, continuity of care.
And, and so that, that I miss.
But then over the years I kind of, that's kind of gone full
circle I think, uh, in many ways.
Um, that, that actually I kind of, I kind of being, I feel kind of
being sold like a romantic novel.
Um, uh, it's a bit Mills and Boon and there are some great things
about response, uh, about continu today, don't get me wrong, but
also it does have its flip side.
Um, and, and I've even sat next to senior people at, at significant
primary care medical organizations, and they've said, look, you know, the
Kings Funds did this huge paper on continuity of care, but in it, they
said, there's potential flip side.
We've as a, as a, as a profession, we've done very, very little to, to even
start to look at what these could be.
And I said, maybe we should, as a profession, dear colleague,
start to explore that.
And it was this profound silence and, no, no, Richard, we don't
want to open that Pandora's box.
And, which is a real shame because I think that what I found, those, those colleagues
of mine who've gone back, who then returned back to Locuming had burnt out.
Um, and, and so often in our, as an organization, we, we set up
and run these, um, very formal GP locum peer support groups.
We call them GP locum chambers, meet regularly, uh, uh, establish, establish,
uh, professional, uh, uh, um, friendships and, and, and, and really helps
really resolve professional isolation.
People have joined that because they've been partners or salaried in a practice,
but often for the, for the purpose to, to have that continuity of care.
Yet in these days in modern general practice, it's really, really difficult
to see the same patient again and again.
Um, and, and with, with, with, um, with triage and with, with
multidisciplinary teams, uh, and all this sort of thing, even GP partners
are really struggling for, for that.
And, and I've noticed that when I've been, on a regular basis in a practice, just the
patients just do not have that continuity.
Yeah, certainly I've, I've noticed a, a friend of mine's
trying to speak to the same GP.
It was, it was, it was really hard just because of the models.
And I'm not saying it, it, it's right or wrong, it's just our,
our models are having to change because of the patient demand.
But I just wanna go back to something you said about this sort of, people
felt they ought to go back and be a partner or be, you know, in a practice
because of this continuity of care.
And I, I, I totally agree.
It is, it is a joy to see the same person and be able to deal with them,
you know, from, from start to finish.
You know, my dad was a GP, His version of continuity of care is literally,
he saw the mum, he worked through her pregnancy with her, he delivered
the baby, and then he delivered the baby of the next generation.
And then, I mean, that's, that's continuity of care like
40 years, isn't it really?
Um, it's, so that's, that's changed, you know, now nowadays, it's, you very
rarely have that, that sort of thing.
You're certainly not delivering any babies.
Um, but I just wonder whether we come up with some excuses and some reasons
to mask some of the guilt we feel when we, you know, or, or, or, or to
sort of silently beat someone up for choosing a different way of working.
You know, that sort of, well, you know, you're missing out on continuity of care.
You're missing out on this and that.
And, and so subtly, if you choose to work in a sessional freelance way,
you are made to feel not quite as good as, or you're not quite doing
the right thing for your patients.
So it's this sort of subtle way of maybe the people who are in the
system feeling a bit resentful.
I'd love to do that, but actually these are what, what matters and,
and genuinely believe it, or we just beat ourselves up about being
selfish for choosing a way of working that's actually gonna suit us better.
And the worst offenders of of, of, of this thing, uh, beating, uh, are, are us GP
locums ourselves, beating ourselves up.
So often we say, oh, actually I'm just a locum.
You think, stop there, let's rewind.
You know, why are you just a locum?
Um, and, and, and I, I, I've, I've had GP partners in, in practice, say, Richard,
when are you going to get a proper job?
You know, it's, we, we kind of gaslight ourselves and we kind of, but, but
I, I think in, in every, you know, GP conference kind of headline, sub headline,
it's, it's about continuity of care.
It's this, we, we, we, we've, we've, we've, as a profession,
we've really nailed our, our, our, our one flag to the one mask.
And I think we are really struggling to provide it.
I, I was thinking, I, I've lived in sunny Chichester for.
Pretty much all my life.
It was my 60th birthday yesterday.
Oh, oh,
don't look it.
I know.
Thank you.
Um, and I've, and I've lived here all my life.
I'm very, very boring.
And, and romantically I think of what a great city it is and all of that.
But of course, I go out the door and ev I think every day of my life
that I've spent around Chichester, you know, walking through or walking
around or cycling around or driving around, there's always roadworks.
There's always roadworks, or it's potholes.
But hold on a minute.
You know, if we didn't have roadworks, we'd have more potholes.
You can't build streets and, without having some way to, some, some
replacements to, to maintain them and to give the kind of road arrest and
actually repair it, keep it up to date.
And, and there is so much about this silent role of a GP locum, actually, you
are stepping in to allow other people who are providing that continuity to have a
break or to, or to go off sick because they, they've, they've hit a pothole.
And that, that's a, that's a, that's a lovely thing to do,
but it's so rarely celebrated.
Um, and, and, and particularly by us GP locums.
Another thing is that, is the agility.
It's that we, uh, we are there to allow, um, access to, for patients.
If it wasn't for us working that day or that afternoon or that week, patient
wouldn't have been able to see a GP or come into the practice and see someone.
There's that fresh pair of eyes.
The countless times I've spoken to colleagues who are working as
GP and they've picked something up because the regular GP was just got
so used to seeing the same patient.
We build in these, these, um, these heuristics about a patient we built in
these, these patterns, these stories.
As humans, we love to see patterns.
Um, we love to see clear roads.
Uh, we love to we, we, but as a, as as as a GP, I'm often picking
up what someone else missed.
And I'm sure other GPs are picking up what I missed.
I know they do.
So, um, there's this lovely romantic, touchy feely continuity
of care, which as a profession with this sort of confirmation bias,
we've gone out and said, right, continuity, let's go out and write.
It's so much research to prove that it works.
Yeah.
But let's look at the side effects.
No, no.
We don't want to see the downsides of it.
But I think that we as an organization, see um, anecdotally, very much, those
people who have come a cropper with, with a, a way of working as a primary
care, where the sense of purpose as a GP hasn't matched their sense of purpose.
There's been a clash.
There's too much friction and, and they've lost sight of all those
buffers, all those simple patterns that they would need to, to help them
get outta their circle of stress.
And I think there are, you know, some patients absolutely would benefit from
continuity of care, but most people just just want to get in and sit and say, say
doctor, that I just wanna be able to talk to someone when I, when I need to, rather
than, you know, waiting a long time.
I think underlying all this is this sort of feeling that it's not a proper job.
You know, that somehow there's this hierarchy in medicine or healthcare
of actually you are the bees needs.
If you are a clinical leader or a senior partner in a department, you know,
doing something with, with continuity.
I'm always astounded by people who are working as partners and also have very
senior leadership roles elsewhere.
' Cause I think to myself, how on earth can you do that?
And I always look at them and think, how is anybody getting the best out of you?
Because a partner is a really, involved job.
You have to decide that you want to run that business.
That's very, really quite hard to run with all the funding
dropping and stuff like that.
And there are some people that are a hundred percent brilliant at that,
and that's where they need to focus.
And then there's other people that think, well, you know, they go
into leadership in, in other roles.
In which case if you split your attention too much, you are focusing on having
to run that business or having to, you know, be part of the leadership team
for your department, yet you've got another, you know, really serious job
over here, it's, it's not gonna work.
If there's one thing I've learned over time doing this podcast, it's
like you've gotta focus on one thing and do one thing really, really well.
Um, or do something as like the, what's the word?
The sort of day job that, that, that keeps going whilst you focus
on the really hard thing over here.
Everything in your week cannot be hard, I think is what I'm, what I'm saying.
And everything in the week cannot take all that responsibility for you.
But I, that's where I see doctors burning themselves out.
So if they could be a partner but didn't have any responsibility at home and
had all the time in the world and, and stuff like that, and they love the sort
of leadership business side of things, then they're probably gonna thrive.
I really do think that all GPs are leaders.
It's a leadership role.
It's you, you know, you kind of a leader.
When you think of your patients, you are kind of in that respect, a leader.
Um, I think it fulfills the leadership definitions very, very well.
We just do not think of it in that way, but it, it kind of goes with that.
So then to also be a partner in a practice, um, or also have other
leadership roles, when you are doing one job, your mind is kind of slightly
thinking of the other job and, and that's really, that is really difficult.
Um, so yeah, I, I, I, I very much agree with your sentiments, how we
can square that and, and allow people to just be clinical directors at an
ICB or just be senior GPs running a practice without necessarily
the patient load, I don't know.
Well, I'm just wondering, you know, I, if, if there is something about the,
the sessional work, which means that if you found somewhere that was, you could
go in, do your job and finish without the having to sort of work a around it.
Some, someone told me that clinical leaders in the NHS like partners,
clinical directors do like 40% of their leadership work or even 60% of their
leadership work out of hours, like at home or in the evening, the weekend.
Now, I haven't been able to find that statistic to back it up, but
it certainly rings true for me and the leaders that I've seen.
And what I've noticed that when people do go into senior
leadership, 'cause Yeah, I agree.
I think all doctors are leaders, like all and most healthcare
professionals, leaders, because the minute you have been working for more
than like a couple of years, you're supervising somebody else, aren't you?
You're supervising a junior coming up.
So even if you are not see yourself as a leader, you are.
'Cause people are asking you things, asking you questions,
wanting to know stuff from you.
So there's, there's that sort of leader with a, probably with a small L.
But then there's the leader with the big L where you do feel that default
responsibility of like, if anything goes wrong here, I'm gonna have to cover in
certainly the partner in a practice.
You feel like that as a clinical lead for a hospital's department, I think
you, you, you possibly feel that as well.
So there's that extra responsibility.
And having more than one role with that default responsibility.
I mean maybe there's a bit of, well, quite a lot at home as well.
I think to have three roles where you've got that default responsibility of the
leadership, i've gotta cover if anything goes wrong, of the kids at home, if
someone goes off, you know, kids off school, I've got to cover and pick them
up and, and something else like a PCN clinical director, it's just like, how
on earth, how on earth can you do that?
It's so, there's just too much mental load then too much emotional load.
And that is where I see people burn out when they don't have time to do
anything better yet, in my own life, I definitely have seen that the more I can
focus on one thing and do that one thing well, that is where I have the impact.
But it does rely on me getting over the guilt and the shame of not being good
enough because I haven't followed the traditional career and I don't have the
badge of a consultant or a, or a partner.
That, that very much suggests what, what, what, how it, how you,
how it works as a, as a GP locum.
Um, what, what, what's been, what's brilliant about it is that, you, you
have a constraint, you have a start time, you have a finish time, and if you, you,
you have to do all your job, all, all you can within that time that you are
being paid for, that they've allocated the, the afternoon or the room for.
Hit one o'clock, someone else is in that room.
Everything you've done has got to be finished.
You can't finish it that evening or tomorrow 'cause you won't be there.
I've worked in up to 30 different practices a year, up to 10
different practices in a month.
You have to, when you finish, you have to properly finish.
And if you, you, you can't, if you wake up in the night so often I think
I did as a locum and I think locums, do you think, oh God, did I do this?
Did I do that?
As an organization we developed, um, lots of different
templates, but one of those is.
It's sort of right, you finish your session, you've look at this template
and, and think, go through each patient in your, in your mind or through the screen.
And what, which of these is gonna wake you up at 4:00 AM?
Write it down, write what's gonna wake you up.
And, and, and so, you know, so, so we can stop that, that, that anxiety.
And, and the number of times I have actually found, I've,
I've been back to the practice.
I had to phone them up or I suddenly realized, I remember one, one, one
holiday in the Rhinogs in Wales hiking thinking, oh my God, I didn't do such
and such a, a blood test on a patient.
And I felt terrible.
And it kind of ruined my holiday, which is crazy, but not crazy.
And, um, I have no way of doing anything about that.
I suppose that happens to every GP.
But it's, it's, but it's something that we all, as GPs feel, we have that sort
of guilt and that that feeling of, of of, oh damn, that's really embarrassing and
bad for the poor patient and, you know.
What can I do about it?
I guess if you're a, if, if you're going back to the same place day after day,
you gonna spot it quicker, perhaps.
I, I had that on a train.
It was a really crowded commuter train.
I'd done a locum session in the morning and I suddenly realized
very important thing I should have checked with the patient and I
had to try and phone the practice.
But we had everyone on the track, like, how can you be confidential, standing
in a carriage going, I'm just gonna tell you the date of birth and the, I'm gonna
tick, talk in code the name and oh gosh.
Yeah.
But that, but you're right.
I mean, that doesn't necessarily stop If you're aloc, that can, that can,
that can happen anywhere, can't it?
I think people try and get some agency control and become a sessional doctor or
a locum or, or stop being the clinical lead or stop being a partner because
they want more agency and more, more control over their shifts and their rotas.
Although as you said, that doesn't always happen.
But I think there's a bit of a myth that as a, as a leader and as a partner, you
have massive amounts of control anyway because I think sometimes because of
the responsibility, you feel a real lack of control, that you have to do it.
Yes, you might have a bit con a bit of control over it if you then decide
to, so if the whole practice can go to 20 minutes appointments or not.
But then again, if that person doesn't turn up and you are on annual
leave and there's nobody to cover you, you have to go in and do it.
Or you have to be, you are the one working out of hours on that, on that
complaint that's come in about a member of a member of staff and things like that.
So I think this illusion of control, I think, I think worse, works both ways.
What we're trying to do is get some agency back, get some control back.
But one path seem has a little bit of guilt and shame around it because like you
said, when you're gonna be a proper GP.
And the other path has a lot of guilt and shame from the difficult
responsibility, and so you're stuck between a rock and a hard place, really.
Yeah.
And, and, and I guess, I think that's where our pay grade comes in.
That's where, you know, there is a choice we make when we go to medical school,
though we've might not realize it at the age of 16 when we start, you know, start.
But, but actually that's what we're taking on.
Um, and that, that is gonna be, that, that is, we, lots of, lots of
responsibility, but lots of control.
And I think, in any career there's always going to be that.
I think with, with, with a general practice at the moment, two
things is, one is that control and responsibility balance has changed.
It kind of, it seems to be become a little bit unfair and more unequal every year.
We seemed as, as GPs we're getting less control, we're having more
targets, KPIs, all that sort thing.
But also we're getting more responsibilities, you know, taking
on more hospital prescribing.
We're having to take on much, much more risk because of access and
capacity at hospitals and waiting lists and, and even workforce in general
practice and lack of consulting rooms and, and all that kind of thing.
So that's one thing.
And I think the other thing about responsibility and control is just
the volume of work, the amount of time we have to be doing it in.
Now, if, if you're, if it's just 9 to 5, you then have the, you can then go
home, unwind, take up a leisure pursuit, walk the dog, whatever it is, whatever's
your bag is, you can then, um, unwind.
You can relax, you can, you can de-stress.
You can think about, you can have that creativity that helps
you manage future problems.
I was talking to a colleague recently about the, um, one's hard
drive becoming, being 80% full.
And if it starts to go above that and we start to fill a hard drive
up, the computer starts to slow down.
And, and I think that's so true of so many GPs is they don't get home till
at 10 o'clock at night and then it's, you know, what's a bit of Detectorists
and then it's off to bed, and then it's same as same old, same old and taking
laptops home and doing work from home and.
So it, it, it's, it's, it's the, the change in balance and it's the increase
in, in, in volume or the decrease in volume of, of, of, of that leisure time.
So I think locums possibly understand a bit more about boundaries
because they have to, right?
Because you're not going in the next day.
You, you have to get everything done.
So you have to understand more about limits and boundaries.
So what advice would you, you know, as a sessional GP give to, you know, a
senior partner or a senior consultant.
And then I'm gonna ask the other question as well, where partners
and consultants, what advice would they give to Locums around?
Well, actually being able to change things and influence and stuff when
they're, and, and that feeling of lack of control when they do go?
Because I think both groups could learn from each other around that.
So let's start off with the boundaries.
Heaven forbid if I was, was, was, was proffering my
advice to a, to a GP partner.
I suppose what it would be is along the lines of, there's a definition, um, lack
of constraints is the enemy of creativity.
So an artist, if they say, say to say to a kid, you know, right?
Paint me a picture of some flowers.
You know, here's paints and crayons on all of that, freak out.
But if you say, right here's blue, green, and red piece of paper,
and some ink, now draw just using that, then we can be creative.
The, the best artists, I think, uh, uh, that, that their,
their artworks are constrained.
They've used very simple tools.
And I think when you are, um, a professional and in a
leadership role, like, like every gp, you need that creativity.
But if, if, if, if you are not, if you're not giving it enough importance
in your day, in your life, if you are just, um, dismissing it as
potentially frivolous, um, it's a no.
It's a really, i part of important part of your toolbox to have that capacity
to, to stop, to unwind, to do something that's totally different, whether that's
a bit of yoga or jogging or painting or walking some something, something that
you can, can get that extra capacity, sort of defragment your hard drive.
So it would be actually planning, booking, actual time out.
Not, not so much, it's not so much what you do do, it's what you
don't do, um, in terms of your, your professional way of working.
And that's gonna benefit you, your relationships, your, your,
your, your, your ability to think creatively about your career and
the way you, you learn and reflect.
You're not gonna be able to reflect and learn and grow as a professional
if you're not giving yourself time and spending yourself instead just going
through results or whatever it is you are finding yourself having to do.
Yeah, it's interesting.
So you say it's obviously block of time for your, your hobbies
and your leisure pursuit.
So I think one of the best ways to do that is, you know, have something
you have to go to, like tennis lesson at seven o'clock, so you gotta go.
Um, but I think there's also something about blocking off
the time for the leadership work that you don't, you don't have.
When I've been talking to partners, I'm like, how much time have you
got blocked off in your week to do the partnership work and or how many
official time have you been given?
And people say like, quarter of a session or something like that.
It's just unbelievable.
It's like, how can you do that in that?
And as a partner, you can raise that issues.
And people might say to me, oh, well we don't have enough
appointments, enough time.
Well, okay, it, it might cost you, but if every partner had enough
time blocked off during the working week to actually do the partnership
work, the partnership might actually start to solve some of the issues.
But yes, income would go down, and like, these things are figureoutable.
And yes, that's reality, but you gotta choose.
So I, I think there's this sort of denying of reality about
how long things actually take.
And so, yeah, there's some, some things about, about saying no.
And we do a lot of work around boundaries and saying no.
And often it's because we feel so bad and we don't wanna let people down and
we feel guilty rather than patient harm.
So, so there's that.
So there's booking in the time for work, saying no and actually
putting in the boundaries and, and knowing that you can do that.
I've noticed myself that there's things that feel very urgent and
after I've closed my computer and done something else, I suddenly don't
feel quite so urgent any, anymore.
What would consultants and partners say to Locums that they could do differently to
actually feel that they weren't, I don't know, second class citizens or someone
that doesn't have any control once they're in the workplace just doing that surgery?
My advice too to GP locums would be just to, so I've always said to my sons as
well, I've always said to my two boys, I've just said, volunteer for as much,
always ask if you can help someone.
Always go to when you, when you finish your work, when you finish what you've,
what you've kind of agreed to do, say the patients, any paperwork, any
admin, go around and ask a few people, is there anything else I can do?
I've got, you know, I've got some time.
Um, or, or maybe have not, you know, what, what can I do to help?
What can I do that, what have I missed?
Um, um, is, is a just check in.
Triangulate, um, yourself with the rest of the team.
'Cause a practice is a team, and there, there's a big tendency for as, as, as,
as GP locums to kinda be shown your room and, and, and you kind of can
stay there for, for four or five hours and then it's like a rush out because
you, in the afternoon, you're on call somewhere else, a 45 minutes drive away
and you're really stressed about that.
You know, so, so we can just rush out.
So I would say check in.
I would also say ask for feedback and give feedback.
Show that you are thinking ahead.
Show that you are open-minded.
Show that you are open to criticism or cr open to learning or cri, just, just,
just be cognizant that, that you, you are a team player, and that you, you want to
learn, but also you, you can't pay a, a, a McKinsey consultant to anyone else to
come into a, a, your consulting room like you can a GP locum to open up your e EMIS
or system or an operating system to see the patients, talk to the patients chat,
chat about the GPs they've seen before.
We have this absolutely unique perspective.
So powerful.
And that, and, and, and we're holding this incredible soft intelligence
about the practice, how the practice works, how the practice operates.
When, when we have our chamber meetings, and often, uh, uh, they're lovely affairs.
They're really good fun.
But, but sometimes the GP locum will start saying, oh, actually, you know, I've
been working in such and such practice.
Oh, you don't wanna work there.
It's awful.
You know, they do this and some are other locs.
Oh yeah, I've worked there.
Oh, and yeah.
And, and all the other locals, especially the newly um, the newly
qualified GP locums will be saying, oh, you know, I won't work there either.
And, and we kind of, sort of, we have a policy say, look, hold on a minute.
Look, you know, that poor practice is probably really, really struggling.
And, and have you have, you mentioned this to them?
So again, we've created templates and, and just a, just a, a way of working that
that is actually, these practices would be desperate to know what you've just
said and what we found as an organization, as a network of, of locum chambers is it
when a, when a locum in a meeting presses that red button about a practice, we stop,
we say, right, everyone, here's a little questionnaire we're gonna send you all.
Everybody who's worked there, we're gonna ask five questions,
five very simple questions.
It, it's, what did you really look like most about this practice?
What one thing could this practice do better to help you work there
or other work, locums work there?
What one thing worried you about this practice?
And then a couple of other questions and then we collate that and we
give it back to the practice.
And then the, so the practice has these anonymized insights from a bunch
of locums in this peer support group.
And it's really, really powerful.
And we, we've even created a CQC methodology for that as well, for, for
free, you know, all free for practice as an organization, we want our GP locums, we
think working as a GP locum, you're kind of, your main job is to support practices.
That's what really you're there for.
You are there to support practice, to support their patients, uh, and, and you
doing as good a job and you, you've got you using your unique insight to help
those practices pick up on stuff that, because you've got that fresh pair of
eyes, you've, you can spread, spread, best practice, some other practices.
There's so much we have to offer to practice.
But if we just leave the second hour, our, our, our clock clock gets to one
o'clock, whatever that we are missing give, being able to give so much.
So volunteer this information freely to practices and, and, and they will
thank you for it in all sorts of ways.
I absolutely love that reframe, that actually you are there to support best
practice in, in general practice overall and being able to feedback, what a gift.
Because you've seen what works in other practice there.
So you can share that and you can say, well, this isn't working
here, but, uh, but this is, and let's, let's take that back.
You know, there's, that 90 day rule isn't there, that once you've been working
somewhere for 90 days, you just, you just don't notice things anymore because you've
got such a unique perspective on that.
So ab absolutely love that.
And
It's like when you go back to your parents' house, have
you not been there for ages?
And you think that, how long have you had that orange carpet there?
It's dis, you know?
Why do you keep your stuff in that drawer?
It doesn't
I know.
any sense.
And yeah.
You're not 90 day old.
I, I love that.
I think what we've been talking about is people desperate to get some control
back over their workload, over their timetable and over this feeling of if I
don't do it all, no one's gonna do it.
So therefore I, therefore I have to.
And I think people think that the grass is greener on either side.
The grass is greener by being a sessional doctor or being a locum.
And I guess you get the sessional GPs who are employed GPs.
It's like this halfway house between a partner, you're a salaried GP,
they used to be called salaried G, GPs, portfolio GPs, and you
know your freelance, freelancers.
And then you've got that cohort looking thinking, oh, I wish I, if only I
was a partner, I'd have more control over how things are done, i'd feel
like I was actually achieving stuff.
Or if I was a consultant or a clinical lead there in both.
They're just looking at the other people going, you've, you've got
it, you've got it, okay, as it were, or crumbs, I could never cope
with that, et cetera, et cetera.
But I think what I have noticed is that it just doesn't matter what
your job title or what your role is.
It's all about how you are crafting a career that is right for you, that means
you can do things that are in your zone of genius and you can earn a living, right?
Because we've all gotta earn a living, but not every single thing that you are doing
is that hugely high responsible thing.
And so anything goes, but we just need to remove the shame and the judgment
from what your career choice is.
But secondly, I think everyone just needs a bit more empowering about
control because responsibility without control is, is the recipe for burnout.
100%. There's been loads of studies that have shown that.
So it's about how do you get more control of your work and your workload.
And for some people it may be going freelance, but for some people it
might be actually saying no to yourself and picking those internal boundaries
in or, or raising things that work.
So what would you say to people that are saying, well, if I stop doing
the things that keep everything going, what's gonna happen next?
I can't just do that.
What would you advise somebody who's just thinking,
I would, yeah, I would, in an ideal world, I think in general practice we
would be a lot more open-minded, perhaps a lot more kinder to these different
ways of working and maybe just make it much easier to transition between them.
Every year I do dozens of free webinar talks to any VTS scheme in the country
that will wants to talk, I will happily give it for an hour and I chat about
working as a locum and all of that.
But it's to newly GPs are about to qualify.
And kind of what I always say is it just, it didn't used to be the case,
but the great thing about working as a GP is it's so much easier these days,
easier in terms of, it's not as shameful as it was many, many years ago to
change roles, um, to be, to start off.
When you qualify, actually, providing you can get some good peer support, like
through our chambers or something else, have really good peer support, then
working as a locum is a brilliant way to sort of try before you buy, to try out
lots of different practices, different parts of the country, rural, city, you
name it, try all those different things.
And then, and then, um, depending on, on where you want to go, your, your,
your, the way your family operates, your partner, what their career is,
is up to at the moment, kids, all that kind of thing, there are, there
are different times when it suits you to be in, in, in a different place.
It may well be that the, the, you know, that's time between the kids going to
university and you've still got another 10 years of career, if that might be a
really good time to become a partner.
You've got that more time.
You're juggling less things, hopefully.
Um, maybe, but prior to that, salaried might be better.
But then again, there's the.
You, you are, there's the, the, the control of the holidays is not
being able to take the holidays.
So you might, that therefore for you if, depending on what your
partner does, working as a locum.
If it was easier to transition.
And if there wasn't this, it seems a huge leap becoming a partner.
Every partner I've ever met, I've just, or just, or just inspired by how much
work it is and all the stuff they do that they don't otherwise talk about.
And they'll mention it, um, in passing.
And you think you've done what?
That's incredible.
You, you're on that committee?
That thing exists that you have to do that?
All these jobs and all these roles and you, how do you manage?
I'm so glad I'm a local.
I don't have to do that.
Juggling all these different things.
And so what you were saying earlier on about being a GP partner and, and
having to spend so much of that doing leadership stuff, well, couldn't you just
be a GP partner and just see patients?
Um, and, and, and, and have that as your, your, so you, you have that, you
are the one, be able to keep the balls, the plates spinning for that continuity.
You might almost like you are the continuity partner.
Your leadership role in this practice is to make sure that, that those patients
that need continuity get continuity.
What a lovely role for a GP partner to be, not having to go to the prescribing
meeting or PCN, all that sort of stuff.
And you'd do that in a, in an actual business, wouldn't you?
You wouldn't have the CFO wouldn't be doing everything
and the, you know, et cetera.
But for some reason there's this sort of flatness that all the partners
had to decide everything, and that's just, it's just not doable.
How would you advise someone who was thinking of doing, not a
career change, but just organizing the way they work differently?
'Cause that's, that's, that's all that it is.
But is sort of, there's something niggling at them might be sense
of losing their sense of worth or identity or, you know, status.
What would you advise them?
I would advise, I think probably more like what I said, um, as a GP locum when you're
finishing for the morning or the afternoon or whatever is, is speak to people.
Ask, talk to other people, join a peer support group.
But you, you need to have that head space.
You need to have that 20% of your hard drive free.
Um, you need to have the creativity, the, the energy, um, should I say, be
to, to have, so that you then can be creative with it or reflective with it.
It's a huge decision to make.
If you're feeling in that way, you may well have been doing something, you
may have got yourself into a habit.
You've been doing it for longer than 90 days, so you don't know you are doing it.
You kind of need that mentorish type support from
an individual or from a group.
You need trust.
You need that psychological safety.
You need that buzz.
And in, in our chambers, we really focus on psychological safety and
having buzz, having a sense of fun, having, you know, so you can laugh
and have a chat with your friends.
You make sure that you've got GPs who are not just your colleagues,
but your friends as well.
And if you've got that, and so you can, you are there, you are in a position to
be open to advice, to ask for advice.
You've got colleagues to help.
You might not say even advice just to, just to, to this is what we would advise
the patient is, is to talk a a about it, and have that time to, to not be
thinking about the day job all the time.
So easily said for many.
And I think if, if people are, if you're thinking, gosh, that's just not me, I will
never have that, then you are precisely the sort of people who probably need to
be having that, that reflective timeout.
And I think on the identity level, you know, I think rather than for me,
rather than thinking, well, I left, you know, I left because I couldn't
hack it, that wasn't true at all.
I left because I found something else I wanted to, to focus on.
And at that point, the way I was working wasn't, wasn't working
for me and it, it didn't suit me.
And I just would stress this, the importance of really
focusing on one main thing.
And yeah, there can be a few things around that, but the one thing that you
feel like is your baby and your, you are responsible for, I'm, I'm guessing for you
Richard, that is the, the NASGP, right?
And that'd be very hard to do if you also were a partner somewhere
else, and, and having to manage all that responsibility too.
Um, and, and you'll have much more impact focusing on one main thing.
The second thing I would, I would say that I just sort of realized is along
the You Are Not a Frog theme, so we're this frog, you're this frog in the
pan of boiling water that's slowly heating up and the workload is getting
worse and the control has gone down.
You have options.
Like frogs can only burn out or jump out and leave, leave entirely.
But you could like do something to, to turn down the heat in the pan.
Like so many people haven't actually asked for what they actually need or looked
at the way that they're working within their employed job, or as a consultant,
a salaried GP or as a, a partner or or another healthcare profession,
they haven't actually explored, could, could the sessions be changed?
Could the timings be changed?
Could they have longer appointments?
Things that actually would turn down the heat for you.
So there's that one.
They're then jumping out of your pan into a different pan.
And that different pan might be, yeah, the pan of being freelance or the
pan of being salaried or even jumping outta freelance into being a partner.
That might work for you.
That might absolutely suit you.
But sometimes you don't know till you've done it, do you?
And so trying stuff out, there's no, there's no shame in that.
And then you've got the final option of like getting out of
pans altogether and you could jump into a pond, like do something.
Totally different.
And sometimes I know I've been like, I just wanna go and work
in a coffee shop making coffees.
But I take myself with me, right?
That's the problem.
You know, you take yourself and the drivenness and the wanting to
achieve and the identity stuff.
So I know the minute I get to a coffee shop, I'll be like, right, let's
make this, let's franchise it out.
What can we do to make this even more impressive?
You know, so you take yourself with you.
So it's all got to come from within, hasn't it?
It's got like your, your job satisfaction and the meaning in life has got to be from
internal motivation rather than what your job title is or how successful you look.
And it's all about what enables you to focus on the one thing that's
important and to live in the way that you want to live, remembering that
no one on their deathbed ever said, I wish I'd spent more time at the office.
it's, I suppose having the privilege of having the head space to be able
to make that switch because the, the changing tracks in itself takes the
ability to make a decision to come, to come to a sit decision and, and do that.
And I was, and as, as you're talking, I was thinking in my life, what has really
helped me just kind of have the head space and it was actually, it was about,
uh, it was about seven, eight years ago.
My dad's an art teacher.
He's always been an art teacher.
He teaches pottery in his spare time, still does.
And um, and I thought, oh, actually I could try a bit of that.
So I went to his pottery class and I remember being covered
in clay without my Apple Watch.
On with no phone, which is the first time I'd done that in a long
time and stuck with two hours on a piece of slippery clay on a wheel.
And after that two hours, I just thought, oh my God, I've just been
thinking so many things that aren't work.
Okay.
A lot of it is about what, why about this damn thing stay in the middle.
But a lot of it was, was, was just, just the ability to, to form and shape stuff.
But I then, I then since then started to more and more in my off time rather
than go for a walk where I, we'd talk about work or, or, um, or read a, trying
to read a book and then start thinking about work and usually sort of like work
related books, which just makes you think more about work, is actually try stuff
that was, was nothing to do with that.
And, and, and, and, and having that, that ability to shape new things and try
different ways of seeing stuff, and, and, and, and I now do lots of, uh, painting
and drawing and all that kind of stuff.
And it, and I find that that, for me, for me personally, really helps just
think abstractly about, have an abstract approach to life and work all that.
So that I'm thinking about your 90 day rule.
What, what have you done for nine years or 19 years?
You know, you so some, it, it's just, so I, what can we do slightly different?
That, that is, is the trigger, the switch that actually starts that change
process to, to, to get ourselves out of any ruts we've got ourselves into.
Yeah, and I think that, you know, even just taking time off, like prolong
like two or three weeks or a sabbatical for six weeks just gets you far
enough away from what you are doing to begin to think, okay, well, does,
does that title actually matter to me?
How is it I wanna live?
What is it that I'm really starting to enjoy?
But it does take a, a bit of a bit of distance.
So if someone is genuinely not knowing what to do, don't make any rash
decisions before you feel like just giving yourself time to decompress.
Otherwise, what happens is you just throw the baby out the dark bath water
and you end up doing something that you never really wanted to do, but you just
thought that was the only, only option.
And I'm sure you've seen people like that join the, the freelance brigade
when actually they would've been better in a, in a regular salary
job, you know, not having to manage all that in uncertainty and stuff.
So if you had sort of three top tips to give people about all of this or
about how to work that gives you more control and agency and, and just enjoy
life as a clinician, what would it be?
I would say first thing is get your sense of purpose in order.
I'm going back here to this, this whole thing about, that continuity of care
is, is, is the be all and end all.
There is much more to general practice than that.
It's what, what, what, what do you like to do as a person?
If you are, you are gonna be a, the best GP you are gonna be is the
GP that, that, that starts off the day with energy and joy and looking
forward to what you're going to do.
And I think, again, all sorts of studies shows that if you're happy in your
work, you, you perform much better, more efficiently, more effectively.
You said earlier, earlier on, we were talking about, you
know, GP partners taking more time off to be happier at work.
But, but that might affect the monetary level.
It might not actually.
It may well be, but if they're happier and more creative and have that space and
happier teams, they actually might come up with some much better ways of working,
more efficient and more effective.
So it's, I think it's a sort of, can be a, a synergistic effect.
I people when they've joined our chambers, and they've, they've clearly had, they,
they had burnt out as partners, and I've, I've, I, I know three GPs over the
years who said pretty much exactly the same thing is that they love medicine.
They love medicine.
But they'd started to feel as a GP that they didn't love medicine anymore.
They stopped, they had some time off.
They started locuming and they realized they love medicine.
It was, thank God, it wasn't that, that, that were, that they weren't enjoying
it was being that stuck in a rut.
It was having that, that, that issue being a partner that they, in their
particular partnership had this issue with responsibility and control.
What's just striking me, Richard, is that yeah, you are talking about the jump
from being a, a, a partner to being a, a freelancer, but also there, there's
that jump from, say if you are managing a team in a hospital and you'd, you know,
it's absolutely draining the life out of you, it's absolutely fine to stop doing
that and just see the patients as well.
So it's, it, it's this jump from, I've gotta be this leader.
I've gotta be in leadership here to actually, I just wanna do
what actually I'm really good at.
And that feels like a demotion, it feels like a status issue, but it, if you can
get yourself over that, then it could be the absolute best thing you've ever done.
Gosh, we could go and talk about this for ages, but Richard, it's been absolutely
wonderful having you on the podcast.
How can people contact you or find out more about the National
Association of Sessional GPs?
Yeah, Google us.
We've got, we, we are, um, www.nasgp.org.uk.
Contact us through email is probably the best way.
We've, we've, got, we've, we've launched a relatively recently, a
brand new sessional GP community that anyone can join for free.
And it's about, its forums and it's, and it's, we've got one tonight.
We've got these labs we are running for, just allow anyone who wants
to, any GP wants you to sign in and talk to other GPs about a specific
topic just to, just to network.
Um, we've got a fantastic, well our platform as well, practice managers
practices can all join for free as well.
And it can help them hire locums, our members through, through
the platform, uh, out of hours and, and, and daytime as well.
So that all, that's all helps.
Great.
We'll put all those links in the show notes.
Richard, you're doing absolutely great work and thank you so
much for being on the podcast.
Thank you.
My pleasure.
Thanks for listening.
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