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The waiting game

Locum GPs forced to claim benefits as work dries up

Exclusive Locum GPs have been forced to claim state benefits after struggles to find work during the pandemic, Pulse has learned.

Locum GPs say that the reduction in patient demand for GP services during the pandemic has meant practices are less willing to use them.

At the same time, locum GPs told Pulse they are facing bureaucratic hurdles to join NHS 111's Covid Clinical Assessment Service, and retired GPs have offered to work for free for GP practices.

This has particularly hit locum GPs who have been ‘shielding’, and the lack of sickness benefits means that the self-employed GPs are having to decide whether to take the risk of exposure or not working.

Sessional GP leaders said they have been ‘cast aside’ since the pandemic started.

Dr Saumya Jha, a locum GP based in North London, told Pulse that she had to claim benefits having been unable to find lower-risk shifts such as remote triage and patient letters. She hasn’t worked since March, when she contracted Covid-19, she added.

Dr Jha told Pulse: ‘Things are just cancelled last minute and the shifts that are available are very hard to come by and are high-risk shifts with very limited PPE.

‘So people are really struggling to find employment because either you take the risk of high viral load exposure or you don’t work at all.’

One locum colleague has gone from earning £130,000 working 10 sessions last year to nothing over the last two and a half months because he is ‘scared’ to work in the high-risk shifts available, she added.

Another GP told the National Association of Sessional GPs (NASGP) that they too have looked at claiming for state benefits after six weeks earning no money as a locum.

The anonymous GP said: ‘It has been hard as locums cancelled at short notice and it has been six weeks trying to get on the onboarding for CCAS to earn minimum wage.

‘I have looked at claiming state benefit honestly but [am] hopeful the CCAS onboarding will come through and I might not need to.’

‘Honestly speaking, [I‘m] living from hand to mouth - very depressing as I feel underutilised and very insignificant.’’

NASGP chair Dr Richard Fieldhouse told Pulse that locums are being ‘cast aside’, particularly over the CCAS service that initially targeted retired GPs.

He said: ‘People feel really let down because retired GPs and medical students have been prioritised ahead of the existing locum workforce.

‘Locums are saying they’ve come across retired GPs who aren’t going to even ask for payment, they just want to do it to help out. [But] there are people desperate to pay the mortgage here.’

Meanwhile, locums - many of whom are more recently qualified and have not yet ‘built up financial resilience’ - are left with ‘absolutely no income protection scheme or sick leave scheme’, he added.

Nottinghamshire LMC wrote to locums last month to offer its support and reassure sessional GPs that they are ‘not forgotten’.

LMC GP retention lead Dr Sonali Kinra and chief executive Michael Wright wrote: ‘We acknowledge that there are limited locum opportunities currently.

‘The reasons are multiple - cancellation of annual leave amongst doctors and fear among patients thereby not accessing care, to highlight a few.’

GPs were encouraged to join an LMC GP ‘roving scheme’ that matches staff to areas of need ‘with appropriate PPE and IT equipment’ and to consider a fixed term contract modelled by the BMA.

It comes as Pulse revealed last week that locums were facing six-week long waits to access work at NHS 111’s Covid clinical assessment service (CCAS) - while NHS England said that it ‘still needs clinicians’ to staff the service.

Earlier this month, the BMA told Pulse it had provided an ‘off-the-shelf template contract’ for local areas to offer to locums while they still lack full death-in-service benefits.

Readers' comments (144)

  • I thought there was a shortage of GPs - I am sure there are many unfilled salaried posts still advertised. Maybe a steady job rather than the uncertainty of being a locum has its advantages?

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  • I agree with above, there are many Salaried GP jobs available. We have had multiple applications recently for a Salaried post when we had almost none last year. I understand the flexibility with locum jobs but Salaried posts can also offer similar flexibility as required.

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  • Been waiting for this bleating.
    Tough. Its called Karma.
    Should have taken partnership when offered.
    Welcome to the real world of risk and reward.

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  • I am in the same position no work for 4 weeks as a locum and struggling to get the CCAS registration through. No luck so far but I keep trying.

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  • where do i begin on this one.......

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  • People are locums for different reasons. I’ve been a partner and it chewed me up and spat me out. I nearly lost my house. No one could of foreseen this happening. I am lucky that I have a CCG job with a regular income so not dependent on locum GP income. I don’t feel that comments such as it’s karma or bleating are helpful. No wonder we can’t improve our working conditions if we can’t pull together and support each other!

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  • National Hopeless Service

    Unemployed?? Plenty of partnership and salaried jobs out there.

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  • Been waiting for unpleasant comments like 11:48am. Anonymity to add to the unpleasantness, too.

    I don’t think using out of date over up to date doctors is good for patients.
    I don’t think doctors working for free is good for the profession (the Government may think otherwise...)
    I don’t think the CCAS shambles is good for anyone.

    I don’t think asking for sympathy is helpful - or reasonable, in my opinion.
    I do think we should all be angry that medical skills are being under-utilised in a pandemic - and we should reflect on the myriad reasons the locum workforce is needed in “normal” times.

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  • It's called market forces. We would far prefer the certainty of salaried GP colleagues/partners, but these have been virtually non-existent for the last few years and a readjustment has been inevitable for a while.

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  • Contractors are contractors in any market - being a doctor is irrelevant. Locum doctors are a necessary flex in the system but for some it seems to be a permanent state lasting years. Something needs doing - I wonder if HMRC took a detailed look at the sector and re-clarified the definition of locum - we might lose some but it might precipitate a change of status towards more substantive posts. Wont be popular but something needs doing centrally to balance the workforce.

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  • Locums might think twice in future about exploiting practices who need doctors and the excessive fees they were charging before this all started. Sorry, but I have little sympathy!

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  • Well said Claire Hooper.
    The partners on this post need to open their eyes and smell the coffee.....
    The lack of proper incentive for many partnership/salaried posts is a problem to the whole profession and one engineered by government.
    Rather than gorging on a mixed grill of fat dripping shadenfreude, they could offer constructive advice and proper critique in the direction in which it is needed??
    I very much feel for my fellow Locum’s right now.... I’m luck enough to have ‘some’ shifts at a practice where the leadership understands that partnership is a ‘crap franchise’ at best..... wake up.... everyone!!!!! You’re smarter and better than this.....

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  • Peter Swinyard

    For many years, locum GPs accepted that their freedom to pick and choose work meant that they were not always fully occupied - and their reaonable fees gave them an income less than the partners, who invest heavily of their own money into a practice - and accept the risk involved of joint and several liabiity for practice debts, should they occur. There was no real market for salaried doctors before the 2004 contract, as a GP Assistant (as they ere then) could only be engaged uner the Red Book in particular circumstances, did not attract the Basic Practice Allowance and was seldom used.
    After 2004, salaried models became very much more common. With the increasing stresses and strains of partnership, many made a perfectly reasonable decision to work only as a locum and supply and demand meant that high fees could be charged - one of the commentators above made £130,000 last year - no doubt hard earned, but higher than many partners' incomes.
    The pendulum is swinging again and more doctors are choosing substantive roles - in Wessex recruitment for partners and salaried doctors is buoyant. I think this will pan out as far fewer locums, genuinely providing the cover for holidays and sickness as it always used to be, and more substantive doctors working in practices in various roles to the benefit of continuity of care and job satisfaction.
    There will be a transition painful to many but the end reault should, I think, be better.

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  • Well said Peter very eloquently put

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  • As a locum who left my partnership a short time ago, I can completely see why some partners feel very little sympathy or even some quiet satisfaction ( not implying any malice just that its nice to be on the better side for once) for the situation some locums are in. When you're cutting into very hard earned profit and personal take home wage to pay for someone who walks in and walks out for a good hourly rate without taking the background grinding down that a partner suffers from endless dumping from every angle, those people having 3-4 months of a harder life financially doesn't tug on your heart strings. Nor on your wallet. Expecting practices to call in locums when the work load is manageable is ludicrous. GP practices in the majority of cases are severely underfunded for the work they do and having a few months of reduced outgoings cannot be resented. The practice I'm locuming in are seeing a nearly day on day increase back up in demand for GP appointments phone/ video F2F - this was purely a lull and the deluge of untreated/ delayed patient demand is coming...

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  • Interesting points peter and I agree DrS

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  • I’m a locum and I agree- live by the sword die by the sword. No one forced me I chose to because the economics of salaried/partnership didn’t add up. Now I’m lucky to have OOH work and some special interest to fall back on but I can’t complain about market forces when I chose originally to take advantage of them.

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  • I retired at 55 five years ago but have been working as a locum/ salaried GP 3 days a week since . Due to the Covid situation my hours have been cut to just one day a week. I get it , the F2F work has reduced so not the need for expensive Locum/ salaried GP’s . I am lucky as I get my reduced pension but other Locums are in dire straights . There will be a need for us again as the work seems to be ramping up . I did my day yesterday and was totally exhausted after a 12 hour stint . We all want to do our bit , and do not want to deskill . I would still not want to be a partner again . That nearly killed me

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  • As my name says seen both sides of this back in locum land after 15 years as a partner
    Some work cancelled on a rolling basis I understand that other clients still using my services
    What I don’t get is why yet again GPs turn on each other?
    Some partners on here seem very angry that locums make or made more than they do - yep market forces. So adjust your business model if it doesn’t pay what you think it should or walk away if you believe in market forces - can’t have it both ways!
    I get some older partners are “heavily invested” in their practices especially if they own premises - flip side of course is rent reimbursed by NHS and over time big rise in property values - again swings and roundabouts. Most younger partners have never owned premises of course.
    Any partner suggesting a centrally planned workforce as earlier in thread is wanting their cake and to eat it surely? Fine for them to be free market entrepreneurs but other colleagues have their careers decided for them at a centrally agreed wage? USSR collapsed years ago!
    Yep schardenfrude I’m on a cancelled day today sitting in the garden in the sun I’ll take in on the chin free market and all but very busy yesterday at another practice as demand returns to normal. As GPPartner upthread said no sympathy for locums now I am comfortable with that but likewise in a few months time as demand surges and partners want time off for practices like that my rates will reflect his attitudes no sympathy

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  • My understanding as a locum is the higher fees are there so that when things like this happen you can still survive without sick pay, annual leave, study leave etc...?

    Not to mention the fact that I have almost never spoken to well-treated, contented salaried GP. I have been actively advised against it by all that I have spoken to.

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