Sanna W Khawaja: What can we learn from the locum?

sanna_khawajaWhen recounting the tale of my first ever shift as a bona fide doctor, the line “I was on call with a locum SHO and a locum Reg” tends to get the perfect reaction: sympathy and kudos. I follow “The Locum Doctor” on Facebook and have made many a witty (some would disagree) joke with a “locum” punchline. The newspapers also love a bit of locum bashing. Yet here I am, taking a gap year for a number of reasons and I am “the emergency department (ED) locum.”

My foundation training experience of emergency medicine was terrifying. Based in a large city centre teaching hospital, trauma centre, as well as a tertiary referral centre for numerous specialties, I remember my winter stint in the ED as a combination of fun and fear (with fear overriding). But it doesn’t matter where or when your stint was—many remember it with similar emotions.

I have now spent the past month working in a number of different EDs and urgent care centres around the north west, as well as in the Midlands. It has been a refreshingly different type of learning. As headlines about A&E waiting times, GP failures, missed diagnoses, and hospital closures dominate the pre-election news, I am seeing firsthand, around the country, what the NHS is capable of and what it is doing well. We don’t often hear about that anymore, do we?

My ED as an FY2 did handovers properly, as should every department. There was a 30 minute overlap of night and day shift, allowing for a handover of the whole department. Despite being bleary eyed and desperate to get home, I look back now and understand the value of the consultant’s debriefing: “Any problems overnight? Any lessons learnt overnight? Could the shift have gone better?” But, as a weekend locum, I’m not sure where to take these suggestions.

In the Midlands, I saw how a well staffed rapid assessment unit phenomenally reduces time to referral—all the patients I saw had already had basic and relevant investigations. Moreover, having a doctor assigned to this area keeps it safe: ECGs were reviewed on arrival, and patients received adequate analgesia before being seen.

A custom made pro forma for minor road traffic collisions is a quick and safe way to see and adequately document this common presentation, which has the potential to lead to legal proceedings. This is being done well in urgent care centres in the Pennine Trust, why not in the A&E minor injuries unit at the same trust?

Despite my year long departure from the NHS, I am an NHS extremist at heart and find myself bursting with ideas that I think EDs could share with each other—all coming from the perspective of a clinician who knows firsthand what makes a difference on the shop floor. I just don’t know where to take these ideas. To my knowledge so far, there isn’t much of a platform available for the locum to feed back to the employer. I propose we create one.

The Francis Report highlighted the role of junior doctors as the eyes of the hospital. Rotating through specialties, a junior doctor is well placed to pick up areas that need improvement. I believe the same applies to the locum doctor, who can act as an impartial clinical observer, rotating through different organisations and seeing what works and what doesn’t. I can’t help but feel that the solution to many of the problems faced by EDs in the UK is akin to a large jigsaw puzzle—and through my work I have seen many departments holding different pieces. Now, more than ever, we need to start speaking to each other. This ED locum, for one, is keen to join the conversation.

Sanna W Khawaja has recently completed her foundation training in Manchester. Find her on Twitter: @SannaWaseem

I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.