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What is the NHS’s problem with GP locums?

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Perhaps it is just me, but have you noticed that NHS England seems to have an almighty problem with GP locums?

First it was the locum ‘indicative rate’ where NHS bosses told GP practices to report annually all the instances where they paid over a certain amount for replacement cover. This ham-fisted initiative was included in the GP contract for 2016/17 against the wishes of the GPC and to the bemusement of practices everywhere.

Persecuting locums is not a solution

In contrast to the cap in hospitals, GPs are independent businesses and so the whole thing was a bit like ordering them to not pay so much for loo roll (come on, do you really need the ultra-soft cushioned variety?).  We are still waiting for the actual rate to see the light of day (I suspect because they have no idea where to set it).

Next, the GP Forward View. This accused locums of ‘undermining service continuity and stable team working’ and - rather threateningly - it 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’. What this could mean, we still have no idea, but there was a sign in the recent announcement of reimbursement for indemnity costs.

These will be given to practices as a single payment, based on their unweighted list size, with NHS England saying that it expected practices to provide an ‘appropriate share to their salaried GPs and locum GPs’. But let’s be realistic, this is hardly likely to happen. GPC lead on indemnity, Dr Charlotte Jones, had a rather different take saying on Twitter: ‘The view of NHSE is that sessional GPs who are not salaried can increase their fees.’ Hmm that is rather ironic as then they will presumably breach the ‘indicative rate’. Spot that? It is called a pincer movement.

I suspect is the start of a mini campaign to make life that bit more uncomfortable for freelance GPs. NHS England chief executive Simon Stevens is a big fan of the independent contractor model, and why wouldn’t he be? It is cheap, popular among patients and there are no limits on the work you can pile on.

The rationale is that locums have been freewheeling around the NHS for too long and I am sure some GP partners would agree that locum fees are out of control and that they are being held to ransom in what has become a seller’s market.

But for many GPs this is the only way they will stay in the profession. I have been given sight of a poll from the National Association of Sessional GPs which found 92% of the 77 GPs who answered agreed or strongly agreed that entering a locum chamber was crucial to them remaining a GP and 86% to preventing them from burning out.

Now, the poll is very small (and those in chambers may be happier than most) but it is still significant that so many say this is the only way for them to remain practising. A Pulse poll also supported this trend, with half of GP partners saying they would go salaried if the right deal was offered.

The truth is there is no magic bullet that will prevent the current drift away from partnerships and it has been NHS England’s own policies over the past few years have fuelled this drive towards locuming.

Persecuting locums is not a solution. It has been said many times, but is worth repeating: make the day job as a partner more bearable, and then the tide will turn the other way.

Nigel Praities is editor of Pulse

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Readers' comments (15)

  • The NHS can't have it both ways re continuity of care, either. The attitude from the centre has over previous years implied that any one doctor is as good as another and there is no need for patients to see the same one each time -- hence shift work for GPs who supply primary care services through big organisations is quite acceptable.

    It is quite obvious that the NHS's concerns about locums are based around the cost (funny how they don't want the market when they see what it does)-- but we need to be sure that no manager ever spouts the 'continuity of care' argument as a reason for not allowing practices to engage locums.

    Having said this, personally, I'm very much in favour of continuity of care, and the efficiencies (and better medicine) likely to occur when the same doctor (or a small group of them) see the patient most of the time is very attractive.

    But the reality is that fewer doctors want to be partners now, and so practices will simply have to rely on locums. Trying to dissuade locums, or discriminate against them, will only hasten the collapse of primary care -- and with it, the NHS, because of the loss of the all-too-important gatekeeper role.

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  • GP's must share the burden of the austerity pain like the rest of the NHS or so I was told by NHSE. The problem for partners is it directly hits profits and therefor take home pay. In the salaried world there is no cut in salaries (except if you are a junior doctor and they impose a new contract on you!)Locums are just using market forces which the Government has tried using in the NHS since the late 80's. This is all to soften up the whole NHS to hand over to accountable care organisations who will offer a way out of partnerships and a salaried role, which will be very attractive to doctors who just want to practice medicine, and not worry about running the business.

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  • Just to add to the confusing messages and illogical workings of NHSE this is a response to an enquiry as to why our payments are going down despite our list growing...

    "Both the PMS contract and GMS contract are paid based on your weighted list size and this has reduced. The fact that your actual list has increased does not have any bearing on your payments – it is the weighted list that counts for this. The reduction in weighted list size and increase in actual is to do with the ages and mix of patients on your list. We cannot access the calculations behind how the actual list becomes ‘normalised’/weighted. This calculation is done nationally across all GP practices. You may be able to compare the change in the make up of your list yourself."

    So NHSE can't access how the payments are calculated what hope is there that any of it is right?

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  • GP locums do not live in a bubble. We see all types of practices and all types of patients. Small isolated islands/practices are less likely to change with the times and yet not many seek a locums opinion/input. Bed...sleep...make

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  • Oh Cmon, you need to ask? They have us by the short and curlies, they are totally self interested, for now locums have the advantage, and don't they know it. I don't mind paying 700 quid a day for a GP but we pay for a GP and get practice nurse level work and teenager level whining. There are good locums but they are few and far between the worry is that too many are mediocre unregulated unaccountable and have given up being GPs. At the moment HMRC is turning a blind eye to the tax implications of a regular locum in one place ut for how long. The trick -- do without them they work at or below the level of nurse practitioners so get a nurse practitioner and pharmacist instead.

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  • Locums are the most honestly priced part of the NHS! No collective bargaining, just pure £ per defined work, with the cost and availability of a locum to a particular practice taking into account the working environment and workload.
    They represent the marginal rate of GP time and, as such, are a good marker of the state of UK General Practice supply and demand.

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  • Of course the government hate locums. It is because they are rebelling against the exploitation of the contract which sees the piling of work for less money. If Partners behaved more like locums and actually valued themselves, maybe we wouldn't be in the mess we are in.

    In an era of massive recruitment issues, locums are out life line.

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  • People moan about locum rates but forget the huge factor driving costs are the extortionate indemnity fees locums have to pay up front with no guarantee of filling all sessions.

    Locums are as accountable as anyone and have to be on performers lists and answer to the GMC. Partners like locums should also find a way to charge market rates to the government, instead they have been let down by the GPC and accepted both reduced pay and reduced pensions.

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  • The fact of the matter is that we need GP locums and cannot function without them to cover OOH and same day emergency appts.
    I work in an urgent GP clinic and am the only salaried Dr in a team, of at least 12 locums who are not interested in becoming salaried .
    That says it all!

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  • You can't argue with market forces . Unless of course you are a tory interfering with something that is state run.

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