✧A Locum (-L) is a replacement of ‘person’ in Special Person (Special Locum) that occurs with persodivergent individuals (or may be a side effect of some medications). The persodivergent individual (pwPD) considers their Special Locum (SL) a suitable substitute for the primary SP. For example, a pwDPD may have a 'backup' dependent person (DP) to rely on when their primary dependent person isn't available. This 'backup' would be considered a Dependent Locum (DL).✧
Example of what a Dependent Locum flag would look like.
✧Tagging for PD posts: @kpopwerewolf @radiomogai✧
For a full list of Special Person terms, I made this doc for a comprehensible list. If you'd like to use my PD flags as emojis, I made this discord server with them as heart emojis! (Originally made to react to my SP's messages).
DISCLAIMER: All of these terms already have existed in the community before I posted them. If you have genuine questions or concerns, feel free to reach out and I will try to work with you! These terms are meant to be inclusive of ALL experiences I have heard of or experienced myself, so I have no issue adding things if necessary. These posts are meant to be short and sweet descriptions, not full deep delves on what each means! Feel free to make your own deep dives posts about your own experiences with these and @ me, I’ll definitely repost as long as they’re done in a respectful manner.
Anya is live and ready to show you everything. Watch her strip, dance, and perform exclusive shows just for you. Interact in real-time and make your fantasies come true.
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It's been so long and I feel like redesigning my boi laughing. He's Chance but is called Freak in Warverse. I also made Locum in Warverse that's called Masque. Life is still busy bee as ever 🐝 💦. I made some fun facts about them as well 👀
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⦻ Freak ⦻
✗ A lunatic and has amnesia
✗ Acts dumb just for the sake of it
✗ Likes inventing stuff
⦻ Masque ⦻
✗ Hippy 60's
✗ Loves ropes and beads
✗ Will help guide you in the chaos
✗ If he wears his mask, he'll be nicknamed "Masqued"
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≿━━━━━━━━༺ 🖤 ༻━━━━━━━━≾
✗ Crystaltale by @crystaltale-official
✗ Warverse by @warverse
Anya is live and ready to show you everything. Watch her strip, dance, and perform exclusive shows just for you. Interact in real-time and make your fantasies come true.
✓ Live Streaming✓ Interactive Chat✓ Private Shows✓ HD Quality✓ Free Actions
Free to watch • No registration required • HD streaming
I thought I'd share my experience as a RVN locum as most of the research I used when recently starting was quite outdated. So, if like me you have no idea where to start, I hope that this post can be of some help to you! To start, you should decide whether you are going to start your own company or work for an umbrella company. The difference being that an umbrella company will provide you with a contract of employment, do your tax calculations and request payment from companies. Most people (me included) chose this route as it's much easier and depending on which company you use, only a small fee is deduced from your income. Starting a company I have no experience in, but have met many people who have done this and if you're willing to do it, it does have its own benefits such as any small business would. Once you're set up with an umbrella company, it's time to find work! This can be done by approaching practices directly, or more commonly through veterinary agencies. I found that it was easier to work with only one agent at a time so it was clear what dates I was working and for a good relationship with the agency. The agency will ask for your cv and details of what kind of work that you are looking for (long term, short term, full weeks, part time, etc.) and how far you are willing to travel. It's also worth considering how much you would like to be paid. Obviously this varies depending on where you live, if you know any locums in your area then don't be afraid to ask them what's the ballpark figure you should be aiming for based on your qualifications and experience. Once you've built a relationship with your agent, hopefully you can find some placements and start working. If it's your first time at the practice, try and get there a little early so someone can show you round before that emergency consult comes in because you want to stay in control. First impressions stick so try and introduce yourself to everyone. Chances are that they may call you back for more work in the future! I also found it useful to be that nurse that has everything in her nursing pouch. If you don't already have one I'd highly recommend getting one and filing it with all the essentials: pens, highlighter, sharpie, scissors, tourniquet, eye lube, cuff inflator, silver nitrate pen and anything else you consider standard as all practices are different and may not have these to hand. When it comes to the end of your week, make sure that you have a timesheet signed by the practice manager to ensure that you can approve payment. Most agents will request these and forward these to your umbrella company. If you found the work direct from a practice then you should set up the company that you're working with from your umbrella company separately. This is easy to do and your umbrella company should then allow you to request an invoice from the workplace. Always read contracts and confirmation of placements to avoid confusion! Worst case scenario if you don't enjoy a placement, you can at least be safe in the knowledge that you have a week or two leaving period :) I hope this helped and touched on the main questions that I had when transitioning from full time work to full time locuming. Feel free to message or add any further points 🤗
Staff shortages leave cash-strapped hospitals reliant on costly cover
OK, so there is so much that needs to be pointed out in this case. Buckle up, because this is going to be a long post. I’m going to take you on a short tour of what the deal is with locum doctor shifts and how the whole thing is often misinterpreted by the media and their dramatic articles, resulting in misunderstandings by the public at large.
Firstly, where did the figure of £155/hr come from? What grade of doctor was this? And what were the circumstances surrounding the appointment? How understaffed was that department? How short notice was the job on offer? These things all matter when it comes to a fair price for a shift you aren’t obligated to do. The money offered depends a lot on which hospital you are at, or how desperate the situation is, but it is hard to accept uncited figures at face value. We know absolutely nothing about where that figure comes from.
I haven’t met (or heard of) people at SHO or even registrar level getting anywhere near that much per hour, nor has anyone mentioned being paid at that level on the junior doctor group. Consultants, possibly. But if you are an experienced and fully trained consultant taking ultimate legal responsibility for many sick patients, at short notice, in a hospital you don’t usually work, around your already busy life, then that what you are paid would (and should) reflect that.
What do locums do?
They take on short-term work. Mostly, this is on a shift-by-shift basis, but occasionally they might need to cover a run of shifts due to employees being on sick leave, or an unfilled slot on the on-call rota.They may sometimes locum in hospitals they’ve worked, but this doesn’t have to be the case. So locums will often be working in a new hospital, where they don’t know where everything is, or how the wards are laid out. This includes things like finding important equipment, knowing where the notes are, and navigating their way around the hospital during their on-call. They won’t know the important bleep/contact numbers of people they will need to contact (though they’ll get a hold of them sharpish from switchboard) They usually don’t know anyone there, so they won’t have the working relationship with other staff that makes working somewhere and getting stuff done a bit easier. They don’t know their local guidelines or procedures, which forms to use, or where all those things are even kept. It’s like the horrible few days at the start of your rotations, except they might go through this almost every shift. This is why it’s riskier to work locum shifts; it’s more stressful and as you don’t know how everything works, it might take longer. It is widely thought to be riskier professionally, too. It is NOT an easy way out.
Do the people complaining actually care about doctors, though?
I’m also sick of people who actually don’t give a hoot about doctors arguing on my behalf. I’m a salaried NHS doctor; the kind you argue that locum pay isn’t fair to. I picked a trust grade job knowing full well I could locum in a severely undersubscribed specialty and earn tens of thousands more than I’m earning now. By all accounts I should be livid that somebody occasionally works the same shift I do for a lot more money.
But I don’t resent locums for earning more. Why? Because I don;t just work in the system, I live in it. I’ve worked severely understaffed shifts. Shifts where we just couldn’t get a locum, sometimes because of the price offered, and sometimes just because it’s hard to get someone to give up precious time at the last minute. I’ve also been begged to put in extra time or change my shifts at very short notice, to cover dangerous staff shortages. I’ve only ever put in extra shifts when begged to by my department; my spare time is precious enough as it is.
It is not the fault of locums that hospitals are understaffed and there is high turnover and poor morale in many places. Medicine and nursing are becoming increasingly leaky pipelines; as pressure increases and the NHS becomes an ever more understaffed, stressful environment to work in, less and less people will want to stay. Putting even more strain on those who remain.
Who are the locum doctors?
Most locum shifts are filled by people already in jobs, a fact quietly acknowledged in the above article (but rather buried amongst all the ignorance). Part time doctors aren’t allowed to do locum shifts, probably because they fear that everyone might go part time if they didn’t make it financially very limiting to do so. This means that quite a few doctors who already have full-time jobs do the odd extra shift, on a day off or during their annual leave. There are some doctors (or nurses) who have left full-time training altogether and just do locum jobs, however even this is not usually a permanent (or even longterm) arrangement. In my experience, it’s often people who are working out what they want to do after FY2, or people who have a few months between one job finishing and another starting. Many of them are doctors who are doing a PhD or Masters or other research (often necessary for senior jobs) , so that they can finance their further studies. The myth of greedy career locums who are purely maximising their earnings by taking on the most expensive short term jobs is certainly overblown; whilst there are probably a small minorityof people out there focusing on earning as much as possible, most people are just trying to remain financially viable or earn a little extra.
What are the government doing about this?
They aren’t dramatically increasing hospital funding. Instead, they are enforcing a cap on locum rates, meaning that they are forcing hospitals to not oay mroe than a certain amount per hour. The aim is to decrease the money spent on locum staff , but the effect of this is complex and may be hurting the system more than it is helping.
The cap affects internal locum rates more than agency rates. Enfocing much payrates means that the majority of locums, people who were going to do an extra shift on top of existing work, will think twice about whether that shift will be worth time away from their family (or their bed). If people no longer want to do these jobs for that pay, then less locum shifts will be filled. After all, there are only a finite number of doctors in the UK. In medicine, it’s well known that some hospitals struggle to fill locum shifts because their pay is not at all competitive. Trying to cut down what we pay people to work extra, last minute is likely going to mean that many of those desperately needed shifts remain unfilled. As things stand, the caps could even be costing hospitals more than uncapped rates. The reason is that hospitals are allowed to lift the cap at very short notice. If a post remains unfilled just before the shift, prices often go up dramatically in a desperate attempt to get someone to agree. By the time someone accepts, this may well be more than they would have agreed to in the pre-cap days. That’s if it’s even accepted. By that point in time, most people have already made plans and are less likely to be able to take on the shifts. So even raising your locum pay significantly may not get you cover if you only do it short notice.
Noboody is obligated to work for a price they find unacceptable.
And yes, people can shop around until they find somewhere wiling to offer the kind of money they would find personally worth it. Nobody has to do locums, so they also get to choose where to do these shifts. I find it funny when people accuse locums of ‘shopping around’; um yeah, naturally. Are YOU suggesting that if someone’s offering their services on the free market, they should deliberately find the lowest paying employer? I explained above how the NHS as an employer sometimes shoots itself in the foot, practically penalising doctors who try to save it money. And of course the current government policy (which practically comes across as a vendetta against NHS workers by now) is evaporating our goodwill and bringing us to the end of our collective tether.
The article acknowledges (barely) that most doctors who locum are already salaried employees who pick up an extra few shifts here and there. And this matters. Because if you are already working full time, and weighing up whether to spend that time with your loved ones or at work, what you are getting paid completely matters.
How could we decrease locum spending?
Perhaps don’t make locum pay and normal staffing two separate pots of money. Right now, trusts can run out of money for permanent staff (and so will refuse to hire more people even when necessary) but can at the same time afford to pay much more to get a locum to cover the same post. Perhaps changing how we organise funding for staffing may make it easier for trusts to invest longterm into
I hear that places like Australia have staff who are purely hired to float between departments and cover absences, sickness, holiday leave etc. NHS trusts, by comparison, sometimes can’t even afford to hire enough doctors in a department to ensure they all get to actually take their mandatory leave. If you don’t book far enough in advance there won’t be enough people covering, and it’ll be no holiday for you, whether you are entitled to it or not. And sometiems, if your departmental staffing is particularly dire, there may not be enough people for all of you to talke all your leave, even holiday leave was dictated to you as fixed leave. Years of cutting spending means that unless staff are working flat-out all the time, it’s often assumed that departments are too well staffed. This is what I mean by taking slack out of the system; but it NEEDS slack, desperately. People fall sick, people go on holiday. If we had enough slack in the system in terms of regular salaried staff (who are much cheaper than locum staff)
The NHS could (and probably should) just pay doctors a bigger cut than locum agencies. Right now, hospitals have two ways of getting locum doctors: through external companies called locum agencies (who take a huge cut), and through their own in-house bank of doctors who are currently (or have been) employed there. Weirdly, hospital ‘in-house bank’ rates for locum shifts are usually much lower than what external locum agencies pay doctors. Which is funny, because locum agencies also get a huge cut, sometimes as much as what the doctor gets, making the overall cost of getting cover through agencies much, much higher. This means that when doctors try to offer locum shifts to hospitals directly, they are usually offered a much smaller amount than if they went through agencies. Even worse, most doctors I know who work with hospitals and agree to be paid less by doing internal cover end up being messed around when it comes to being paid, whereas agencies pay quickly. In all, this means doctors are financially punished by poorly thought out rules and
The NHS could save a lot of money just by cutting out the middle man. Pay doctors what the agencies pay, and most of them would be willing to deal with hospitals directly, cutting out agencies altogether and saving the NHS a fortune. I personally think this would be a lot more straightforward, and probably save more money than the locum cap, whilst also encouraging a relationship between doctors and their employer without unnecessary agencies.
Why can’t we just make lots more places at med school?
It’s really not that simple. It’s both shortsighted and missing the point to argue that we just need to increase medical school places. We could double the number of medical students (remember, though, the government subsidise a part of their training!), however, if working conditions after they graduate remain dire, or become worse, they will still leave medicine. You can let in as many as you like, but you need to keep them in medicine afterwards, otherwise they will go abroad or leave medicine altogether. You could then introduce rather scary rules forcing them to ‘do their time’ in the NHS, but this would probably do two things; discourage people from even applying to medicine, or increase the already high rates of dropout, mental thealth problems, other health problems, and suicide. I emphatically do not believe that making conditions more pressured would do anything to improve morale or keep people in. Being forced to stay in a job you no longer want to do won’t make you an empathetic doctor who loves their job and wants to go the extra mile, but a dispirited one who has run out of goodwill for the system they work in. That’s not the kind of medicine I want, nor do I want my family to be treated by doctors who hate their job, resent their employer and who have given up hope or caring. And yet, that is what my colleagues are increasingly forced into feeling.
Our problem now is that the number of people leaving is increasing, because we are treating them worse. Even the most idealistic of 17 year olds who ignores what is going on in healthcare now will eventually be on the front line of the NHS deaing with the reality; we therefore need to make that reality better.
Working out how many medical students we need is actually a delicate balance; You need to have a proportional number of jobs at every training level for this to work out; flooding the system now won’t produce any FY1s (first year doctors) til 6 years’ time. It won’t produce any registrars til at least 10 years’ time. Will our system need a sudden flood of doctors all at the same seniority level? Probably not! Whilst we could tweak that balance and train a little more than before, it would be silly to suddenly train many thousands more every year. It would also be difficutlt; medical schools only have the resources for a finite number of students! My med school accidentally accepted too many people into my year, so I can tell you that it can be very difficult to accommodate even a few extra students. To train thousands upon thousands more doctors will actually probably require either existing med schools to expand significantly (new buildings, new lecture theatres, new computer labs, new science labs etc) or for entirely new med schools to be built. Not exactly a cheap option.
It would be much easier, faster and probably be cheaper for us if we worked on keeping most of the doctors who we’ve already put effort into training. We’ve had problems before with bottlenecks in training; you end up with highly trained staff being forced out of their speciality by the lack of available jobs at the next point in training, which is a disaster for the country which trained them, as well as for them personally. So
Who do we blame?
If you want to blame anyone, blame whoever keeps underfunding the entire healthcare service, so that each trust has to make cuts. Over those years those cuts have meant less doctors and nurses, dealing with more complicated patients, trying to give a more rapid turnover to deal with bed shortages. It has meant less support for doctors and nurses; with less phlebotomists, pharmacy working shorter hours, less admin staff, etc it means we shoulder more of that burden and making us even busier. Blame whoever forces hospitals to shut more A&Es, so that the remaining ones are overwhelmed. Blame those who allow hospitals to be shut down, or don’t expand services to cope with an ageing population, leading to increasing winter pressures year on year, with hospitals struggling to cope. Blame whoever decided that locum pay comes out of another pot than salaried staff pay, so that the same hospitals who can’t afford any more permanent staff can only afford to hire locums.
Blame a number of factors, but don’t pretend that NHS workers are the cause of all problems facing the NHS.
