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Independents' Day

Stop denigrating GP locums, 'livid' GP leader tells NHS England

Exclusive The Government's negative attitude to locum doctors is harming efforts to retain GPs, the BMA's GP locum representative has warned.

Dr Zoe Norris, chair of the GPC's sessionals subcommittee, told Pulse that she was 'livid' upon reading NHS England's Five Year Forward View delivery plan last week and has demanded a response from NHS England.

The document suggested that locums 'are individuals who are actually available to work and are doing so - but in a way that is unfair to their permanent colleagues and is placing an unacceptable burden on the rest of the NHS'.

It also said that NHS England would discuss with unions 'new options to encourage individuals who are currently choosing agency or locum work back into substantive NHS employment'.

Dr Norris said that although the specific section referred to hospital locums, she thinks it 'reflects generally the way that locums are viewed', suggesting that 'there is a persisting view that the problem is locums rather than the underlying issues'.

'As an individual locum it makes me feel devalued, and like I want to quit now. And I’ve got to say that as chair of the sessionals, it makes me despair,' said Dr Norris, who has written to NHS England's primary care director Arvind Madan about the phrasing, and will also call a meeting with junior doctor and consultant leaders in the BMA to discuss how they can improve NHS England's understanding of the locum workforce.

She said: 'I am staggered to be honest, that that is their view and also that that has made it into an official document that is in a public domain - that that is how they view a significant part of the workforce.'

She added that this has come as she was already due to meet NHS England chief executive Simon Stevens to talk about 'unfair' comments he made while addressing doctors at a previous event, suggesting locums only practise for money.

She said: 'That was actually going on prior to this because of comments that Simon Stevens made at one of the workforce conferences at the BMA House about locums.'

'He said - I paraphrase - we don't want partners working themselves to death, but equally we don't want locums who work somewhere for a week and then leave the next week because they get a better offer and more money.'

Dr Norris said that the current policy was 'vilifying' locum GPs, affecting their morale.

She said: 'When you look at the Facebook forums today, locum GPs are saying "why am I bothering then, if they are going to push me?"'

According to Dr Norris, the policy also risks destabilising NHS England's own plans aimed at boosting retention of GPs considering retiring altogether from the profession.

She said: 'Some of them are former partners who have retired, who have stepped back from the partnership but are still working in the workforce, and they are staying because they can choose to locum.

'If that is gone, if you're forced, then they will just leave, and that will only worsen the situation.

'You can’t dictate to the medical workforce how they work, you have to improve the environment.'

An NHS England spokesperson said: 'Locums provide a very important service, particularly during staff shortages and surges in demand. However patients value continuity of care and we have heard from many practices that want to see ways of making general practice a more attractive career choice for GPs.

'That is why the General Practice Forward View is delivering a range of ways to boost the number of partner and salaried GP positions.'

Can the Government retain GPs while disincentivising locum work?

The news comes as NHS England's GP retainer scheme, aimed at encouraging GPs who are thinking of leaving to stay in work, was extended as part of the 2017/18 contract deal.

Under NHS England's own scheme, GPs are encouraged to take on sessoinal work rather than leaving the profession.

But last year's GP Forward View said locum GPs were ‘undermining service continuity and stable team working’ and raised the prospect of ‘new measures’ to create an alternative for those who ‘can commit to working in a practice or an area over a period of time’.

It also comes as NHS England has set a cap on what they think should be the maximum GP practices should pay locums.

Under the policy, any practice that pays a locum more than £80 per hour has to report this to NHS England.

Readers' comments (28)

  • It seems like some of our profession has swallowed this sour grapes attitude. I have heard several GP principals who moan about their own situation but then refer to themselves as "proper" GPs, i.e. implying that non-principals are somehow second rate. This is clearly untrue and there is plenty of vibrant talent, dead wood and everything in between, in both groups. I gave up partnership because I refused to be exploited and because I had, had enough of living, breathing and dreaming the stresses of general practice 24/7. This is classic divide and rule.
    The reality is that general practice has always been a market provider because no government has ever nationalised and owned it. What we are experiencing are market forces which, according to tory ethos is a good thing...or is it?
    And if continuity is so important, why create super-practices opening for longer hours, which by their very nature, offer fragmented care? Similarly, why encourage patients to go to UCCs for GP care?
    Desperate measures and contradictory, flawed strategy, driven by illogical dogma.
    Is it too much to want a government that actually delivers something to its people instead of just bossing us all about and blaming a few individuals when its policy fails? Must be hard to achieve if you have six jobs like George Osbourne I guess.

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  • This is a political action to divert blame away from NHSE to someone else; in this case Locums.
    You are right to complain and push back, as, unchallenged, this sort of thing sows a seed in people's mind, and they start to believe it.

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  • I have chronic health issues and in 2011, my contract as a salaried GP was not renewed because of the number of days off sick I had had to take. I felt pressurised to go to work when I was not well enough, which was neither good for me nor in the best interests of patients. Since this salaried post ended, I have been working as a GP locum. I can manage my workload around fluctuations in my health. There are practices where I work fairly regularly so get to follow up some patients. If I didn't have the option of working as a GP locum, I probably would have quit medicine altogether and struggled to support my family. I certainly don't locum so that I can make loads of money. As a locum, I can ensure that I am fit enough to do a good job for my patients when I do go into work.

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  • Cobblers

    John Pike 10:47am. With one eye on the governments cartel laws on pay rates might I suggest a 25% pay rise? £100+ per hour is going rate here in South East.

    Other rates are available. Your house may be at risk if you fail to keep up with payments blah blah blah. (TIC)

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  • Wouldn't a better headline be "Tell government to stop criticising ALL NHS staff"

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  • Caring for someone is very much a human activity
    To be a good GP it is essential to be human first
    Whether a Locum, a partner, a salaried a registrar this is essential
    To denigrate any element of the profession is to denude this quality

    What our patients value the most is a human compassionate professional

    Do not dehumanise the profession. Do so at your peril
    Time to wake up…

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  • End of the line?

    IR35 is another assault on all locums
    Personal services company routes can no longer be used for those providing services to the NHS..
    So now all locums are on PAYE With nic deducted at source
    without sick leave annual leave or indemnity support
    no continuing education support
    kept in the dark about local events meetings
    NHSengland no help or support at all
    The current climate will not cause us to come back
    rather it will cause us to leave

    Leaving seems an attractive option just to get NHS England, GMC, CQC Appraisal micromanagement off ones back

    Smart enough to be a doctor
    Smart enough to run a private business

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  • "Only the paranoid survive." They really are out to get us, you know.

    Look up - monopsony, stir in some moral rectitude a la Bevin, wait 40+ years and you'll get what we've got.

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  • @anon2016
    Thank you. Monopsony - great word and a new addition to my lexicon. But fortunately for the liberated, it doesn't really apply to freelance GPs as every practice is a single business entity. Unless practices breach cartel/competition law they remain very vulnerable to market forces and increasing workforce costs. GP partners are paying for the government induced workforce crisis and rectitude is not a valid currency anymore.

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  • these are comments from a frustrated chief who has no real solution to the problem so now NHSE has changed its stance from bashing the full timers to the locum-i wish his dreams come true-his boss is even more worried so he is offerring incentives of thousands of pounds to the new and retired GPs-in some parts of world its called bribe-still we will always be there when the NHS needs our expet help

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