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Independents' Day

A&E ‘streaming’ competition is causing locum shortages for quarter of GPs

Exclusive A quarter of GPs are finding it more difficult to employ locums due to competition from GP 'streaming' services in A&E departments.

Since last winter, acute trusts have had to ensure they have GPs on site at all times to divert and treat patients who do not need hospital care.

To date, researchers are undecided about the impact of the £100m scheme, with one study claiming GPs saw patients 'quicker' using 'fewer resources', while another failed to show any impact on overcrowding issues.

However, as predicted by GP leaders, Pulse can reveal that GP practices are feeling the impact on an already-stretched GP workforce.

In all, 24% of respondents to a Pulse survey of around 650 GPs said they - or the practice where they work - are finding it harder to get locums due to a related increase in competition for sought-after staff.

GPs responding anonymously to the Pulse survey suggested some A&E departments were paying more than they were able to and that GP locums were giving 'short-notice cancellations for more lucrative jobs'.

Meanwhile Dr Paul Evans, a GP partner from Newcastle and Gateshead, said: 'Several emergency departments have used GPs locally, in a region that already struggles to recruit GPs, thus offering yet another option for work for locum GPs - on top of walk-in centre, out of hours, hub and traditional GP -  often on an hourly rate above that which many surgeries can afford. 

'This means we have on occasions been unable to find locums to cover during a colleague’s maternity leave and have been faced with a choice of cancelling planned leave or running uncomfortably light on staff on some days.'

According to Dr Evans, the GP streaming services are yet 'another factor that has tipped the market in favour of the seller at the expense of the buyer'.

'Whilst some locums charge what we consider fair fees, the majority we deal with have put up their prices and increasingly attached conditions such as no visits/scripts/phone calls etc,' he added.

BMA GP Committee chair Dr Richard Vautrey said: 'The whole NHS system is under pressure and with a widespread workforce crisis the role of GP locums is crucially important in enabling the maintenance of services to patients.

'With limits on the number of GPs available, as the NHS in England expands the services in evenings, weekends and in A&E, it needs to take in to account the knock-on effect this can have on practices trying to maintain day-to-day activities.'

RCGP chair Professor Helen Stokes-Lampard said: 'We don't have enough GPs in the NHS, and we know that many practices are not only struggling to fill long-term vacancies, but to hire short-term locums as well. The reality is that there are only so many doctors to go around and demand is exceeding supply.

'It's essential that the forthcoming NHS long-term plan is underpinned by a coherent, properly-funded workforce strategy, and address the adverse impact workforce pressures are having on our profession and the care we are able to deliver to our patients in the community.' 


Readers' comments (11)

  • I work in A&E because I see a reasonable number of patients, feel part of a team and have start and finish times. I get involved in department and junior teaching and enjoy my work. If I wanted to earn a lot of money then I wouldn’t have done medicine. But on top of everything else it pays better too. I can honestly say if I wasn’t doing it I wouldn’t do anymore NHS GP locums. Locums are leaving practices because of the conditions, and finding alternatives- A&E departments aren’t dragging them away. In fact, I know it’s keeping some of my GP colleagues in the profession. Maybe the focus should be on making the conditions better rather than looking at ways GPs are finding to enjoy their work.

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  • jobs with poor pay and conditions are more difficult to fill - a puzzle requiring a College investigation?

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  • Interesting. What rates are they offering Emma123? (Feel free to tell me not to be so nosey :-) )

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  • won't be long before even partners will be approaching CCGs and NHSE requesting £200/ hour and being treated with respect for asking for such a reasonable wage

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  • I think Emma123 has hit the nail on the head: why should we work in worse conditions for less money?
    I left GP for work in A+E departments and GPWSI work for that very reason. I have had a very similar experience to Emma. I now head up a team of GPs in A+E who would probably not be working at all if it not for the A+E work. None of them want to work in General Practice as they've been worn down and abused for too long already.
    Make day-to-day GP more appealing and there will less of a recruitment problem. Don't blame jobs with better working conditions for causing the recruitment crisis.
    Unfortunately I believe it's not being done without a bigger purpose in mind: the gradual dismantlement of the GP profession as we know it.

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  • Shortage of GPs can't be blamed on A&E streaming. Some of us are leaving to work in A&E, however many more are just reducing their sessions or just simply leaving

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  • less GP practice appointments, more A^E visits, more GP A&E appointments, A^E GP paid more, better working conditions, GP will work in A^E. patients will go where the doctors are available. Just depends if the country can afford it or not. probably not though. general practice always ran on working far in excess of the amount paid for the work done. Guess the UK is now seeing the truth of how underpaid a service we were providing. should have just given up a proper pay rise each year like we asked in 2008 and thereafter. it was totally predictable, even then, that this would happen. you reap what you sow. or in this case you don't reap what you don't sow!!!!!

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  • a practice in my area has to employ locums as four of their new doctors are off on maternity leave at the same time.
    I hope this is not regarded as sexist......

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  • I’ve no issue with GPs working in ED/urgent care centres etc. As a GP partner in a small practice, but as part of an extended hour hub, I would hope that those 111 encounters that advise the patient to contact their primary care centre within 1 hour would be accommodated in that service but this doesn’t seem to be the case. Having seen the finances, for our hub compared with practice income, I hope the government are prepared for the huge bill when we all become salaried.

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  • Just Your Average Joe

    The GMC needs to step in and stop the non sense of Locum GP's refusing to do visits and other core work like signing scripts etc, especially when they are employed to cover small practices where they are the only GP presence for the session.

    Where is their duty of care and requirement to consider the needs of patients. Yes their working terms and conditions/demands are known up front, but where the alternative would be no GP at all, practices are being held to ransom, and patients are put at risk.

    GMC do something useful for once.

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