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GPs go forth

Are locums paid too much? Yes

When partners cut their drawings and salaried GPs buckle under their workload, locums must make a case for themselves in the newly-harsh climate of general practice, argues Dr Dean Eggitt

The arrival of a good locum on a bad day is like having Wyatt Earp by your side at the OK Corral. But whilst Wyatt walks away at the end of the day largely unscathed, you are left behind to tidy the mess. It is easy to see why there appears to be a divide between partners and locums and it has led some partners – including myself – to wonder whether locums are paid too much.

Partners are expensive, but they run the surgery as well as seeing patients. Salaried doctors are usually paid less than partners because they don’t bear the financial, physical and mental burden of running the practice but should they fail in their duties, they are held to contract reviews.  Locum GPs, on the other hand, are not expected to contribute to the duties of a partner nor uphold the same strict contractual arrangements that a salaried doctor would do.

Partners understand that locums have the same professional bills as the rest of us, and that if they don’t work, they don’t get paid.  Taking parental leave or sick/compassionate leave is difficult as a locum, but arguably this is offset by the flexibility and freedom they experience.  Indeed, GP partners also find taking time off difficult to plan for and usually take out insurance to protect their practice in case of extended periods of illness. 

Unfortunately for us all, as practice expenses, patient expectations and list sizes grow, many smaller practices will not afford to use locums. In an ideal world, locum GPs would acknowledge the economic climate and reduce their fees. As it is, I fear they may become another victim of efficiency savings, with locum vacancies paving the way for extended use of the nurse practitioner role.  Currently, locum GPs are paid too much, and unsustainably so.

Dr Dean Eggitt is a partner in Doncaster and medical secretary of Doncaster LMC.

The other side of the debate: Read why Dr Vicky Weeks thinks that locums are not paid too much

Readers' comments (18)

  • Locum fees are an example of a free market for medical wages.
    Their fees, price, are what the market will bear.
    Unpopular surgeries with greater demands (perhaps where it's like being in a gunfight at the OK Corral) may lead to higher fees.
    If Dr Eggitt fears market failure, it may be worth examining this.

    DoI - once and future GP locum.

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  • The above inference being to examine for market failure, not the popularity of one's surgery...

    (same author)

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  • Greedy GP partners who e been stuffing their podkets since 2004 ofr any and every readon and wanting to exploit similar or better quailfied and capablee slave sorty saladied GPs will have to pay ofr Locum GPs. Many sincere and hard forking GPs have been theated so badly as saladied GPs with false promises of being made partners. If the locus GP is exponsive, so be it. You can't have ur cake and ............

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  • Anonymous 12:17
    Anyone is capable of greed , including a salaried GP , I don't share a word you've said , if you feel exploited then quit ( i was also a salaried GP myself and never felt exploited as i would never allow it ). Everyone will be hit financially partners , locums and salaried all alike. Even though it might feel like a locum's paradise at the moment , this will change quickly as market forces re adjusts. If you feel we are not paying your worth (whatever that is!! and you seem to have a very inflated opion of yourself ) then please become a greedy partner yourself (there are plenty of opportunities) and stop moaning !!

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  • At this point in time - I am a full time locum . I have no intention of applying for partnership given the workload and the responsibilities. I would never ever want to be salaried doctor - I would rather drive a taxi... (consider the workload, partners attitude and amount of tax one would pay in a PAYE situation ) .

    Having spent a brief time in NZ I am comfortable with the idea of not having a regular JOB or an industrial age pension. I am a qualified professional and I could choose to go down the employment path anytime I wanted and in any country I wanted....
    I will not be abused as a salaried GP (or as a locum) .
    The only reason I see myself doing a salaried position is if my health takes a hit !!
    I have adequate insurance to protect any loss for now.

    I am not against partners and there are a lot of lovley people working as partners and I can understand your frustration regarding the fees.

    But I am not going to spend all my day doing surgery lists (that are as long as the partner decides) + oncall (that should have been done by a partner but decided to offload this) + prescription (unlimited) + telephone triage + home visit.

    On one occasion a partner asked me to do a list of case summaries as I had 2 empty slot . this was work designated and labelled for the practice nurse. I did do it but never went back there. That partner was a chronic abuser of locums.

    All professionals should stand up for themselves - irrespective of their status being locum, partner or salaried. I certainly do and I charge my way . I charge for what I do and not a blanket sessional rate for doing an all inclusive . I am not prepared to spend all my day for 400 pounds doing all what the partner wants to offload.

    My stategy is simple. Here is the menu - choose what you like and the bill be accordingly. You will be surprised that no one now asks me to be oncall....

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  • Locum GPs are paid higher because they are available to cover the surgery sessions at short notice. The cost locum GPs pay is that they cannot plan their days in long term/ have to deal with the uncertainties and variations in practice rules like referral pathways, local services, stress of planning trip to a different place every day and higher indemnity fees. So local GPs have stress of different sort. Therefore slightly high earning is offset by the above factors. At the end of the day most surgeries prefer to have a good locum GP and are happy to pay them a reasonable rate, if not high.

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  • If I work 8 sessions per week with 6 weeks annual leave and one week study leave as a locum I will earn, 92,000 per year. This assumes that every day is filled. Partners earn £100k plus for the same sessional number.
    If you want me to reduce my wage, then I ask the partners to show me their accounts. If they can prove that they are earning less than 90k pro rats then I will agree to reduce my wage.

    Failing that, can you please explain why I should suffer for your sake? The reality is that you need to take a holiday. You could not get a locum, and cover within the practice or use nurse practitioner but this will lead to a compromise in patient care and more stress for your business.

    I advise people to reduce your stress an enjoy your time off. You work hard and you really do deserve it. If you use sub standard things, you will have it at the back of your mind. please accept that there is a cost. I would not walk into Asda and negotiate on the weekly shop.

    - anonymous salaried!

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  • I wonder at which point non partners will become wise to the real partner drawings. You guys know the published figures in the papers include all the on costs right?

    What people need to remember is the risks partners are having to take. We could be sued by our employees and we will be personally liable. If an employee is off sick, we'd have to cover it. If the boiler breaks, we'd have to cover it. If there is a serious issue which cannot be discussed in working time, we'd have to find time outside of work to cover it. If there is a complaint made against the practice, we'd be responsible and we'd have to find a solution. If the practice alarm goes off in middle of the night guess who'll be contacted - me.

    My real take home now is pittence above when I was a locum 3 years ago, even adjusting for holidays - and I was working >10hrs/week less. Per hour income is 2/3 of when I was a locum.

    I'm not complaining and I fully agree with market forces - which is why we hardly ever employ locums in my surgery and we'll do everything to cross cover. I enjoy the ability to re-shape my practice to what I believe should do and that's the real priviledge of being a partner. The money is hardly worth it, as I can earn a lot more as a locum. But the non principles should broaden their vision a little more then they can see and try and understand why partners command seemingly higher income.

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  • Locums don't have to make any case for themselves.
    If Dr Eggitt feels locums have to 'make a case for themselves' as independent contractors then surely GP partners need to make a similar case for their own role and not being salaried under NHS managers?
    GP partners run a business, and the supply and demand for locum GPs actually one of the areas of the NHS less affected by monopoly of supply or demand.
    coi - GP partner

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  • Drachula

    We use locums as little as possible as they do not do the whole job, work shorter hours and do not have the local knowledge. They are expensive, and if we can manage without, we will. We would certainly use more locums if they were cheaper. Market forces may force this, but I am concerned that it may not as there will be a recruitment crisis pretty soon. The choice will be either a pay cut to pay for the locums, or a service cut as we manage without.

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