You are the Boss – The Locum Psychiatrist’s Manual

by TheEditor

Categories: Management

This post is constructed from a manual that I constructed some time ago. It summarises a book that I am publishing.

The summary constitutes opinion on how a locum business ought to be run. It is not advice even though it may appear to be directive and refers to ‘you’. The author owes you no duty of care. That’s why my opinion is not advice! No liabilities accepted. Sue yourself if you follow any of this and you suffer damage or loss.

My opinions are based on 20 years of locum experience, and lessons learned. This summary will not explain each line of text in great detail. You take it or leave it – and you are free to make your own choices and mistakes. This summary is not a prescription for how any individual should run their business. Pick, choose, add to, and delete as you wish – to serve your needs.

You are the boss!!

  1. Be self-driven i.e. self-motivated. Consider yourself not as an employee as such even if you are under PAYE. Many locums are self-employed. Treat yourself as if self-employed.
  2. You are in charge of your income, investment, expenses, taxation, and health.
  3. Assume that no one is coming to arrange transport or accommodation for you. You are the boss – take control of your business.
  4. Treat your company or self-employment like it’s truly your own business. [Personal Service Companies have effectively been banned in the UK. But some locums work in the Republic of Ireland as a company. Nonetheless self-employment outside of a company structure workable.]
  5. As the chief exec (director) of your own business you decide how you run it.
  6. The integrity and reliability of your performance is your business!! If you mess up, then you mess up your own business.

Quality:

  1. Quality of your services depends almost entirely on you!
  2. Live quality: in your education, knowledge, accountability, services you deliver, self-management, and business management.
  3. GMC standards are your rule book in the first instance – know them inside out an apply them.
  4. Know all standards from NICE and MHRA that apply to your practice. Apply them.
  5. Reference the standards in your correspondence and decision-making.
  6. Get the knowledge and skills to run your business. No excuses. Being self-driven you find the means to gain the knowledge. No one will ‘send you on a course’.
  7. Do not cut corners in delivering care. Well, you could and if the boss gets sacked and sent to the GMC – that’s fine by you! Locums have a beeline to the GMC but you don’t have to believe me.

Money management:

  1. You have to know everything about how your business works. Why? Because you are the boss!!
  2. There are costs to being a locum. Some are claimable in tax claims reliefs. If you don’t spend money you don’t make money.
  3. As the director you are individually responsible. You can’t say – ‘it wasn’t me who faltered’ in this department and blame somebody else.
  4. Think of costs differently from how you would if you were employed.
  5. Nobody is going to come along and put money in your pocket.
  6. Your hourly rate of pay is there to cover your expenses.
  7. Keep records of all spending so you can claim expenses where appropriate in your self-assessment to HMRC.

Health:

  1. Eat well, sleep well, do not contract a transmissible disease.
  2. Do not break a leg, arm, or neck.
  3. Do not drive like a moron or take chances.
  4. Do not fall asleep at the wheel.
  5. Do not operate a mobile device when driving and cause an accident.
  6. Do not get blinded in one or both eyes (if you already have the gift of sight, obviously).
  7. If you consume alcohol – manage it carefully. Never appear at work with any odour that may be construed as alcohol (unless it is approved for prevention of infection).

Taxation:

  1. Get a top-class accountant or accountancy firm that you can communicate with easily and freely.
  2. Cheap or mediocre accountancy is no good.
  3. You are accountable, not your accountant.
  4. Know all your claimable expenses and equipment.
  5. Get Driversnote app at https://www.driversnote.co.uk/ – or be a cheapskate and groan if it costs you £100. I like it because I think the amount of time I would spend filling in mileage claims is worth more than £100/yr. Cost of the app may be claimable as an expense at HMRC – check with your accountant.

Technology (this is big):

I found technology to be a big part of my operation as a locum. It is the means for communication. I cover a range of technology I found useful. But as this is not advice you are free to pick and choose as you wish. You do not have to buy all this stuff upfront. You can purchase as the need arises.

As you are the boss, you have to educate yourself on how to use the technology. You’re not an employee in my model, so don’t expect to be cajoled to learn – no one is there to cajole you for anything.

Hardware:

  1. You can expect to be working well away from your home.
    1. Invest in the right equipment to have high-quality communications:
    1. Sound and reliable computer (laptop), with extended warranty and accidental damage/theft cover.
  2. Get a top of the range dual sim mobile phone with unlimited internet access included (or at least 50GB per month bandwidth allowance).
    1. Your phone camera will function sometimes as your portable photocopier.Always ensure that you the battery capacity of your phone can go for at least 2 days without charging. (See: Doogee S89 Pro).
    1. Always carry one or more good chargers and cables.
  3. Understand how to connect your laptop to your mobile phone to share internet access i.e. do not rely on public or hotel Wi-Fi.
  4. Get a good Satnav. If you have a good mobile phone, Google Maps or Waze, will work as free Satnav, to get you around tons of traffic. Alternatively there is TomTom Mobile that is a paid app that lives on your mobile phone (it navigates around traffic pile-ups automatically saving much valuable time. These things work with an internet connected phone – that’s why a good phone and internet are essential).
  5. Get a Bluetooth connection to built-in car speakers or Bluetooth add-on car speakers (which you can buy), for when you are travelling. The latter allows you to speak freely and lawfully while you drive. You will find that on long journeys you need to be in contact with home, friends, and agencies. Never miss an important call. Voicemails are nonsense and often too late in important matters.
  6. Consider getting a portable printer, and a portable scanner such the Fujitsu ScanSnap iX1300 (new version). It will often be the case that the boss needs to print or send scanned documents (by email), when on his own in accommodation. Avoid using equipment at places of work for personal/business matters. It could be a breach of their policies.

Software

  1. Get your own licence for Microsoft Office 365 (aka O365).
  2. Teach yourself how to use MS Word from O365 using YouTube vids.
  3. Learn to use all common features of MS OneDrive.
  4. Lean to use speech recognition features in Windows 10 or 11, or on Apple devices. Alternative consider a licence to Dragon Naturally Speaking.

Logistics

Transport

  1. Public transport is not a great idea because you’re usually traversing large distances.
  2. Most locums are drivers. Get a large vehicle e.g 7 seater MPV type. Absolutely crucial for most locums is a reliable, comfortable, and good-sised vehicle.
  3. Larger vehicles are better for those who will be working hundreds of miles away from home.
  4. Ideally have a car with cruise control and speed limiter. Speed limiter is important to avoid accidentally being caught by a speed-camera. Your livelihood depends on your ability to drive. A clean driver’s licence is always best.

Accommodation, Services & Equipment:

  1. Good worry-free breakdown cover for your vehicle. The boss’s vehicle can’t just break down and he is left stranded! Right?
  2. Avoid the cheapest hotels or accommodation such as AirBnb. The boss must sleep soundly for optimal performance.
  3. Good suitcases with wheels.
  4. Good attire, suits, shirts, socks etc.

Planning:

  1. Learn to efficiently use Google maps, Microsoft Word and Excel. The boss needs to:
    1. Plan his journeys
    1. Know his travelling times in advance.
    1. Work with documents
  2. Record important information such as travel and expenses using Excel, or a cloud-based calendar e.g. Google or Microsoft calendar.

Optional other things:

  1. Portable generator and or DC inverter.
  2. Portable large power bank to supply AC current (see: Bluetti EB70). This will not only charge your phone, but it will run the portable fridge/freezer below in your car boot, usually on a Friday when you’ve check out of a hotel or AirBnb.
  3. Portable fridge/freezer that plugs into car 12-volt socket and can use AC. Good idea as most hotels do not have fridges where you can store food/drink. (See: Alpicool T50). This enables you to bring home cooked food.
  4. Food warmer such as this unless you like cold food in a hotel type accommodation or enjoy eating fast food most of the time. You can use this to boil an egg without water and heat up home cooked food.
  5. Containers of sufficient size so stuff doesn’t fly around your vehicle. Makes packing and unpacking ‘packaged’ and easier.
  6. Small travel kettle.
  7. Small travel blow-dryer – some hotels do not provide.
  8. Blankets – important if you need to stop in services in the cold of winter to take a nap.
  9. Warm winter gloves and a blanket – for those times when you’re taking a snooze in cold weather at a services carpark.
  10. Fluorescent jacket, in case of a breakdown.
  11. Good inflatable pillow, so that the boss can take a comfortable snooze in motorway services if he has a long journey. Never risk tiredness on the roads!! If the boss is seriously injured or dies in a car accident due to tiredness, it’s all over!
  12. Good LED flashlights – just in case the boss finds himself in the dark (See: Imalent RC30)
  13. Audible or Scribd ebooks – played from phone or SatNav through car speakers or add-on Bluetooth speakers. The boss must stay alert and avoid boredom on long journeys.
  14. A supply of A4 paper and notepads.
  15. A good personal travel bag – which contains all toiletries, shaving equipment, toothbrushes, toothpaste, cologne etc. This avoids having to pack all this separately. Your personal travel bag is always ready to go.
  16. A Flextel number :
    1. Avoids your true mobile phone number being accidentally released by Hospitals. This tends to happen due to ‘human error’ even though they all claim Data Protection.
      1. One number connects to your mobile, home, or any other number in the world you want it to connect to. (Most of these numbers are free of charge).
      1. You can block whoever you want – permanently.
  17. A second sim in a dual-sim mobile phone. This can be had for £15/month at time of publication with unlimited texts and standard mobiles/landlines. This affords protection of your private and personal mobile numbers. Your number will leak from a health service -guaranteed.

Other posts that may interest you...

The biopsychosocial assessment

The biopsychosocial model is a comprehensive approach to understanding mental health that integrates biological, psychological, and social factors. This model recognises that mental health and illness are the result of ...

Read more

Functional assessment in psychiatry

Functional assessments in psychiatry refer to a systematic evaluation of an individual’s cognitive, emotional, and behavioural abilities in the context of their daily living and social environment. The primary aim ...

Read more

Systemic disempowerment in care-delivery organisations

Today I explore the term ‘systemic disempowerment‘ (SD) as pertains to large health and social care services. Health services are without doubt inseparably intertwined with social care services. The concept ...

Read more