Will the locum bubble burst?
Locums used to be an underclass of the profession but can now pick and choose and command high rates. Will it last? Amanda Elliot reports
A locum's lot is a lucrative one or so it is commonly believed. But it was not always a seller's market and some predict the scales may once again tip in favour of GP principals under the new contract.
There is little doubt many of the UK's 7,000 GP locums are riding high. Rates range from less than £280 a day in Northern Ireland to £550 in under-doctored areas like London.
All agree the recent BMA decision to end its four-year fight to publish suggested locum rates and the GP contract will affect the market but there is little consensus on how.
Life without BMA suggested rates
Dr Robbie Coull, an Inverness-based locum since 1994, saw his net annual earnings rise from £30,000 in 1998 to around £75,000-£100,000 after the BMA stopped publishing its rates. He believes BMA advice 'traditionally suppressed rates'.
He says: 'Market forces dictate rates of pay for medical practitioners should be about double current levels. Principals are unable to take advantage of this situation, but locums can increase their rates of pay to reflect their market worth.'
Dr Coull, who runs the locum messaging service locum123.com, believes leaving rates to market forces will benefit non-locum as well as locum GPs in the medium- to long-term.
'As locum rates rise, more GPs will leave principal posts to do locum work. Rates of pay for principals will need to rise to prevent this exodus,' he adds.
Dr Richard Fieldhouse, chair of the National Association of Non-Principals (NANP) and a locum in Chichester, West Sussex, expects rates to 'waver up and down' depending individual locums' negotiating skills and their location.
Not all locums have seized the chance to increase their fees massively. Glasgow locum group decided against backing a
10 per cent increase in rates for fear of 'appearing greedy'. Instead, they supported a 5 per cent increase this year resulting in rates of £141-£161 for half a day. After one-and-a-half years as a locum, group member Dr Saeed Pourghazi says he is now seriously tempted to become a principal. 'On paper it might seem like we earn a lot but I'm quite sure we do not when you take our expenses and insecurity into account,' he adds.
Dr Martin Breach, a founder member of NANP, earned just £60 for a half-day when he worked as a locum in Northern Ireland in the early 1990s.
Now a full-time principal in St Helen's, Merseyside, he argues that the suggested BMA rates protected principals and locums from the extreme effects of market forces.
'Back then we were treated like a
sub-species a resource to be exploited. It was patently unjust. Now locums
are treated with professional respect
like another GP but with different employment status,' he says. 'I have seen it from both sides and feel the rates are appropriate. Locums have defined GPs' worth as a whole. We can now go to PCTs with our heads held high and say we are worth X pounds. They have pulled us up by our bootstraps.'
Effects of the new GP contract
Dr Fieldhouse, a locum of eight years, dismisses the idea that rates will plummet because the market will become saturated under the new contract.
'It is ludicrous to suggest practices won't need locums.
'There will be fewer and fewer GPs doing full-time work and more and more women GPs coming through from medical school seeking part-time
options. Patients are not suddenly going to get less ill because of the new GP contract.'
Dr Vicky Weeks, chair of the GPC's non-principal sub-committee, agrees. 'There will always be a demand for locums. You will always need someone to cover for you. Under the contract GPs will look for more flexible options,' she says.
Dr Coull predicts little if any impact on locum rates if non-principals rushed to take up partnerships under the new contract. Any fall in locum demand would be matched by the reduction in the locum pool.
He says: 'Some will run practices and others will work in them. GPs running the practice will want to maximise their profits by keeping locum and salaried rates down but will find they are competing to attract staff to run their service.'
He adds: 'They will also be competing against out-of-hours providers for staff. I expect salaried posts to run at about £75,000 for eight sessions a week and £100,000-£140,000 per year for 36 hours a week of out-of-hours cover.'
Dr Breach also does not expect the market to suddenly become awash with locums. 'We are a long, long way from that. The system has been bled dry. The well is so empty we have a long way to go before it is overflowing again,' he says.
Dr Greg Carter, another founder member of NANP and now a principal in Marple, Cheshire, believes the current locum bonanza will only last another five years until the Government's recruitment drive starts to yield results.
'There will be a sharp backlash against locums. There are more GPs in training and soon there will be more around. We may need fewer locums. They will be easier to recruit and prices will fall accordingly,' he says.
'GPs will start to ask themselves whether they really need a locum. If the rates remain ridiculous or locums are too inflexible GPs will simply say ''bugger it'' and do the work themselves,' he adds.
Dr Carter said he helped to set up NANP because he felt locums were badly exploited by principals who 'used the excuse of the market for low pay'.
But now he says locums are using the same argument now to justify 'ridiculous rates'. There are many times he has regretted making the switch, he admits. 'The pendulum has swung too far in the other direction.'
Dr Coull, also expects rates to fall in the 'very long-term'. He says: 'Few of us believe that in such circumstances the BMA would try to artificially inflate rates of pay to protect us.'
Dr Fieldhouse is more optimistic. He expects the GP contract will open up 'exciting new areas of work' for locums as PCOs try to set up more services run by GPs with special interests.
He is currently looking at the legal and practical implications of launching a 'locum partnership' to better target locum work generated by PCTs under the new contract.
Under his plan a handful of locums would come together and hire a business manager to handle all non-clinical work. 'Being a locum is now a positive career choice for GPs. There are more of us than ever, pay is better than ever and we are better organised,' he says.
· National Association of Non-Principals' guidance on pay rates and downloadable booking forms
· Automated free messaging service for locums practices pay a small fee
· BMA's 'frequently asked questions' page on locums with links to pension guidance
· NHS Pensions Agency advice for locums
· Doctors-only discussion forum where GP locums swap advice and information on rates