In message <[log in to unmask]>, Jeremy Rogers
<[log in to unmask]> writes
>> 1.If you are(or are thinking of going )paperless,what do you do if you
>> need a locum - especially one not conversant either with your system or
>> with the way you use your system?
>
>Some practices I've seen ask the locum to record on paper, then someone
>else transcribes it into the computer. Not ideal, but if the information
>has to be recorded 'your' way, I see no other option.

Wonder what that does to the audit trail? any ideas? I agree options
seem limited... 'my' way just makes sure everyone in the practice codes
the same things in the same codes.. but it isn't very intuitive! ;-)
>
>> 2.If you are a locum(either temporary or permanently and proffesionally)
>> is it either reasonable or practcal to expect you to be able or willing
>> to enter all your consultations on the practice computer - asssuming
>> that every system is diffferent - and usage of the same systems is
>> probably very different as well?
>> (are there any locums on GP-UK? *please* either reply or email me
>> privately.. thgis problem must concern you..)

small snip
> I for one would be quite concerned
>about such a requirement: I have no control over what you choose to do
>with the computer record after I have gone. I have no way of knowing
>how secure your system is, or how carefully you look after the information
>it contains. I prefer to use the paper-based record in locum land, because
>the legal situation surrounding them is at least well understood.

Very valid points - especially if locums are legally responsible -
whether or not on a principal list. My feeling was that it would be both
unreasonable and impractical to expect any locum to use the
computer.There is another problem - do you create a new password for
every locum? and if not, how would you identify the doctor responsible?
On the other hand, if the medical records are only held on computer, a
locum would need to be able to view the record.
Are there any systems which would allow a locum to see the record
without altering it?
>
>> 3.If you are dependant on your computer - paperless or linked - what do
>> you do about IOS claims and statistics etc if you have a locum?
>
>At the end of the day it is inevitably the case that all doctors will
>record things differently (if at all!). When we all used to scribble
>our own notes on bits of paper, and nobody bothered really to try and
>analyse the collective set of notes, it wasn't a problem. Computers
>offer the chance to do the analysis much more quickly than wading through
>piles of Lloyd-George folders, but any analysis will be more or less
>suspect depending on how consistent the computer record is between users -
>both in the rate at which they record, and the degree to which they agree
>on how to use the terminology.

Have you ever been in partnership? This is a real problem! :-)
We're IOS linked .. and I wouldn't want to miss IOS claims..
>
>I don't see how you can expect itinerant locums to be familiar with all
>the systems they might encounter.

Agree - most unreasonable.
> Even if they were, it is unlikely that
>they could mimic how you actually use it. If you want that degree of
>familiarity with your particular practice system and style, then you will
>need to try to cultivate 'regular' locums and pay to train them in your
>particular view of the world. Similarly, if you are employing a locum
>for a longer period of time - a week or more - then you might consider
>a more formal training in your system than the five minutes on day one
>from one of the practice staff which seems to be the norm.

Certianly would - if we were paperless - or could afford a locum for a
week..... As we're not paperless, I wondered how paperless practices
dealt with this type of situation? Does it stop them employing locums?
> Since most
>locums are doctors recently off the VTS, you will need to repeat this
>training regularly.

Sorry,missed this! Are you saying that being a locum tends to be a
temporary stage - i.e.that the individuals acting as locums change
rapidly? or that GPs just off the VTS are not computer trained? or that
they are likely to be familiar with only one computer system - or even
that the VTS doesn't cover computerisation?!? ;-)
>
>As an aside, practices which are in the habit of employing itinerant locums
>at very short notice, then giving them a surgery of 24 five minute, late
>booked appointments (most of whom will be acutes) plus five extras can not
>really be suprised if the locum chooses not to bother wrestling with the
>practice computer.

No arguements with that. There are diffferent situations in different
practices . There are planned locums - holidays, meetings etc, when e
know in advance that we'll need a locum.In other situations,such as
sudden illness, we *have* to find a locum at very short notice .. and it
makes sense to give a locum the emergencies! We do 5 minute slot
emergency surgeries (and refuse to discuss any other problems " while
I'm here , doctor")
Mary

--
Mary Hawking
Kingsbury Court Surgery
Church Street
Dunstable
Beds LU5 4RS
tel:01582 601289 (home)
    01582 663218 (surgery)
fax:01582 476488 (surgery)


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