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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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  • 1.38 is correct. Your fees should reflect the lack of benefits available to permanent roles.

    I am sympathetic to locums, but that sympathy has been tempered by the bile partners seem to get from out of work locums for cancelling shifts??

    We are not a charity? We are in a business relationship where locums offer work when it is needed?

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  • I find it incredible that some locum GPs prefer to seek state benefits rather than taking up a Partnership or salaried posts. Really? Are substantive posts THAT bad?

    And how long do you exactly plan to continue your LOCUM OR BUST path? Get real people. Remember you have a choice. But should you continue to choose the harder path then dont go looking for sympathy from people whose ranks you so despise to join.

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  • Whoaml at 12:50pm only locum on here that makes sense! Choose to be self employed with no fixed contracted work and take the risk. Surely some forward planning for a drought of work should be considered for those taking this path? Or in fact anyone relying on ad hoc work. The average locum rate is high enough that some £ put by for a rainy day is common sense, and some kind of insurance policy to protect income.
    I have little sympathy I’m afraid.
    I’m on my own and not part of a PCN and should I not be able to work for whatever reason and fulfil my contract delivery I run huge risks.
    Never had any interest in my ads for a salaried/ partner. Any takers now?

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  • Basic misunderstanding of markets by most here. Locums are simply the first to feel a lower demand ok General Practice. However if market demand remains low for General Practice then it is only a matter of time before salaried GPs and partners take a pay cut.

    The current state of the market should concern all GPs.

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  • If I return to locuming, I will certainly put my rates up to make sure I am able to put some money aside for times like these.

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  • 1.43 is absolutely right no bile should be directed to anyone practices are businesses, a point I had to make to fellow partners sometimes in my previous role
    1.46 I had to leave partnership for family relocate reasons I would love to return to partnership but I’m not seeing all these opportunities mentioned upthread I don’t disbelieve those who say they are offering them but if not being filled then the offer is not what the “market” wants
    Again been in the other side of this in what trainees always used to say was a desirable practice made what we thought was the best pitch we could afford and had no takers
    Maybe the whole model of primary care is dead business wise BMA could help I suppose but busy supporting the teachers right now who I think have their own union

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  • Guys stop in-fighting....... general practice has gone to s**t for all of us...... I left the UK as I considered it that bad, partnership, salaried, locum... it didnt matter.... it was ALL underpaid for the years of training and responsibilities..... you are ALL underpaid back in the UK. Wage stagnation has hit badly. Stop fight amongst each other and fight as one...... as a speciality we got very badly left behind and dont have the big compensation of private practice. Let me put it in perspective.... Ive never earned under £1000/day here in Australia.....never...... and my indemnity is a lot lower too..... £1500 for the year...even in Australia the specialists make a hell of a lot more..... General Practice is Dead...... until you ALL stand together and send in mass resignations all this talk all achieve nothing.... dont blame each other, look at the common enemy......... and FFS stop squabbling, you've ALL been done over......

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  • 6 sessions at £10K salaried
    20% superannuation
    13.8% employers NI contribution
    £500 indemnity
    A salaried 3days a week costs over £80K a year to the practice.
    6weeks A/L, 1 week study , 6 bank holidays is prorata if 8 sessions =FTE
    That's 9 weeks of the year when your salaried is not doing practice work.
    £80K over 43 weeks is £310 per session.
    If your salaried goes off sick or away for anything else that sessional rate goes up significantly.
    If you've got a decent locum who works a good session for you they are NOT expensive!!!

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  • I don’t think anyone is actually doing both ( ie partnership & Locum) hence the unbalanced or completely one sided views. Up until few years ago I was 100% Locum and phased myself through salaried into partnership and still locum here and there, I know colleagues who are 6 sessions partners and still do Locum sessions such as OOH. I’m presently at a more 80/20 split before COVID.

    1) Firstly as a Locum and utilising locums, is certainly a lifeline for practices. I have therefore continued to honour the work we offer our Locums as I know when times are tough ( both ways) such actions are remembered and reciprocated and not a feeling of abuse on both sides ie Locum ‘ raising rates’ or partners cancelling shifts with 24 hr notice .

    2) As a locum or partner if you don’t understand the concept of market forces, demand ( COVID aside) and how to minimise the financial risk of your chosen path then please take on a salaried role as the aforementioned is not for you.

    3) We advertised for a salaried GP/ ANP reply last year. We got zero replies, so we contracted a Locum and the model is financially viable for both parties temporarily at present.

    However rather than blame the system ,we seriously start looking at how we work and I start reflecting back to why as a salaried I began to feel bitter about my day or actually what my concerns were as partner or the “ back in our day we had it tough “ from the senior partner ( refer to four Yorkshireman monty python sketch) way of doing thing. This effort is slowly coming to fruition with said Locums asking if they could have more permanent roles !

    4 ) Finally , I’m sure there is one thing which we can all agree a price on for £0..... Respect.

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  • And stop letting the specialists dictate what you can and cannot do.... the RCGP and its serial weak 'wont rock the boat' leadership has been part of the problem....thats let the government and other specialities walk all over us... seriously look at HSL and her social prescribing BS, too many cosy-ups in London.......if GPs stood together you'd have an organisation worth fighting for.... but most dont see it and are too busy rolling over and playing dead that those of us who are willing to fight realise we can't get the numbers up to make the difference..... thats why I left...... and I still dont regret that decision.... I am sad however to see the state of modern UK general practice.... it is a job unfulfilled and a lot of very talented people under-utilised..... when you start the revolution give me a call.......I'll sign up again...but not until theres fighting spirit..... Prof Martin if you could be a bit more Doc Martin, wear a pair, and give Hancock a good kick in the you know where...... then you might get the faith going again.....

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  • 11.48am Comment-GP Partner-I am not a Locum, but I find your Comment particularly distasteful and Vindictive. People are locums for different reason.
    Be careful of what you wish others,it may well turn out to 'bite' you.

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  • curious agree! .. p.s I’m sure you could retire in several years at those rates.

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  • To all Locum Doctors not working due to Covid:
    Check the HMRC website, if u are self employed, and have not worked youare eligible to claim via the Self employed Government Scheme up to 2,500 monthly.HMRC has sent several Doctors Letter.Only if income affected during Covid and earn less than 50000 yearly .

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  • i left a high earning, dispensing, single handed practice in south wales in 2007, after i had a haemoglobin of 5, and a dvt in mt right (dominant) arm. the LHB (same as PCT in england) declined to give me any help, saying "you're either working or you're not - get on with it".

    so i left.

    i now work doing two days a week as a locum, and i'm very happy. the pay is not so good, and the work is often unpredictable - but you don't have all the admin shit that partners do. no PCN's, no fishing trips from lawyers, no being told to work weekends or bank holidays because of the corvid crisis (partly man made by NHSE poor management), no staffing issues, holidays when i like, more time with family, no CQC, no interference from the nosey parkers or administrators etc etc etc etc.

    the money is not as good, but then the outgoings are much less. and we should all keep enough to one side for the unexpected - letter from the GMC (remember bawa garba ?), government confiscating your pension, tax hike (it's on the way to pay for corvid), MI or CVA, car accident, etc etc etc.

    ok - there is a downside, but i'm not complaining. swings and roundabouts. i can't work at present anyway (severe COPD), but i'm looking forward to going back when all this is over.

    meantime classic cars and bikes still need fixing, garden needs doing, house needs maintaining, wife needs servicing, etc etc etc.

    so stop squabbling amongst ourselves, and make the best of a bad lot.

    i doubt the government read this, or they would realise the fury they are are causing, but they must be falling about if they are !

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  • ex partner, salaried and locum - the job is just s##te whatever you do. we are underpaid and abused in the NHS. the fact that doctors have come back unpaid and put colleagues out of work says it all about GPs in the UK. No support and all in it for themselves. Thats why the whole system is being torn apart by NHSE and government. we don't stick together as one. easy pickings. Salaried GPs are abused - have tried a few of these and the crap loaded onto to you is incredible - don't stick to the contract, turn up to find you are on call, despite no contract for this and no overtime paid, expected to turn up for training and no time back, low rates of pay, harassment and bullying for taking time off for study leave or holiday, constant moaning from partners, yet they have double the pay but expect same level of working as them. if you cannot get your salaried or partnership posts filled or have constant turnover issues or struggle to get locums in general the problem really is you. Fortunately put money aside for such times and covering a locum with a good employer. only ever work for a bad employer once. lots of bad GP employers out there. if you haven't looked after your regular locums during this crises they are unlikely to work for you when things get really busy or just put up their rates because they know they can't trust you. being nasty will backfire on practices. be warned.

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  • David Banner

    I am eternally grateful to our fantastic regular locums who have kept us afloat in some rough seas recently.

    And I don’t blame them for turning down our repeated offers of salaried/partnership posts.

    They have all accepted with good grace that we currently don’t need them.

    The offers of a permanent post remain on the table, but all have politely refused, despite their current difficulties. Again, I totally respect this.

    Hopefully they will still be available when we need them again. If not, c’est la vie. But we have treated each other with respect during both feast and famine, and see our relationship as symbiotic, not parasitic. Maybe that’s why they prefer to work for us, not elsewhere.

    Yes, they are expensive, probably too expensive (but that’s market forces for you), but as medical professionals and colleagues I have rhe utmost respect for them.

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  • It was Market Forces that pushed up locum prices, especially in London, especially from the agencies that charge 30% fees.

    No the market might be pointing in another direction....

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  • Dr Alpha... there are technically excellent, hard working GPs earning much more than I am with good skin cancer and occupational health practices built up. At least in Oz if you are industrious, you can create the opportunities for yourself in a way the UK denies....

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  • People are getting far too personal on here.

    Locums have to realise that their position inherently means there is no job security.

    Partners have to realise that locums were well paid with less work and of course they would stick with that.

    What I dislike is the entitled that some locums have that somehow the system owes them work. And the partners who feel that locums were taking advantage of partners. We're all adults here.

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  • "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"...

    Sounds to me that he made a personal choice?

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  • Difficult time for locums. Try and support them. Especially the ones who helped you out in the past. We will need them again.

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  • Never seen so many comments before on one subject so quickly. Furlough should apply I think as they are self employed and no locums available due to corona??

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  • Former partner now locum | Salaried GP21 May 2020 2:03pm

    Whatever the reason one may have doing locums in the past, one has to accept the landscape has changed dramatically.

    Only the trees that bend can wither the storm, so adapt my friends.

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  • I could t agree more with Curious.
    Stop in fighting. Start asking for what you are all worth.
    Another pay freeze is on its way for a long long time

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  • Vinci Ho

    Don’t really want to be judgemental in here . This is another phenomenon which demonstrates how devastating Covid 19 is in terms of impacts in medical, economic and social terms . The ramifications are far reaching and could have been even worse if the government did not pay off the 80% salary in those being furloughed . For those with non-contractual employment i.e. our locum colleagues , lack of realistic job security has led to this plight of no income tragically . Equally , I am not convinced that we should blame those retired colleagues volunteering to work for free in the middle of a human disaster .
    Truth is , a locum life is entirely determined by demand and supply in the market . Making the choice to be whether partner , salaried or locum always carries pros and cons . Perhaps , some people might not have thought through about their choices in the first place ,given their individual circumstances. For partners and salaried ones , what our workload will become post Covid 19 remains an uncertainty especially against the backdrop of the PCN DES(yes, one can choose not to sign it). Once the level of workload becomes unbearable again , locums are in need once more ?
    All I would say is our profession has been in a crisis prior to Covid 19 and it simply turns it into a double-crisis .

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  • Hi, I'm a locum and have met few GP partners who seemed to actually enjoy their work (often overworked, burnt out, point of breakdown), bar the ones who ran exploitative practices where they had a lack of involvement in patient care (and I they didn't seem very happy either) or I would describe them as dysfunctional characters (again not happy people !). The salaried doctors weren't far behind. I've financially prepared myself for a potential downturn like this (more for illness rather than once in a 100 year pandemic) but that is because I've done this for a while and feel sorry for newer locum GPs or those with serious health issues who need help. I will probably have to change the way I work, but will not give up on preserving mental health !

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  • Locums have helped practices in past but they have charged practices current rates as well. In current scenario when there is not much work or should i say not much face to face interactions, I cannot see how practices will employ locums.
    I personally offered salried job to my long term locum 6 months before pandemic hit UK. He politely refused saying he makes more money doing Locum. Fair enough. Now practice doesnot need Locum. We poliety replied when he enquired for shift that at present we dont need locums when we need we will contact you.
    Frankly We all will change the way we practice and in future I see lot less demand for locums than before

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  • The floodgates will soon open again soon. Surgeries will be crying out for locums again as they are inundated with hundreds of calls a day from angry taxpayers wanting overdue referrals and letters demanding that their bunion surgery be expedited on a 2ww pathway.

    Not to mention the huge number of sick note requests now that the UK has off the scale unemployment contributing to the ever-growing mental health/addiction time bomb.

    Partners on here saying this is all karma are treading on thin ice. By July the workload will be far higher than usual for the summer months.

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