Rising demand from practices looking to cover GP absence but too few available locums is leading to unfilled sessions – and in some cases causing surgeries to offer only emergency appointments.
In Scotland’s East Kilbride a GP practice has stopped offering routine appointments for two weeks due to ‘short-term staff shortages’ and ongoing pressures.
The National Association of Sessional GPs said treble the number of GP practices posted requests on its locum booking portal in July, compared with the month before – with quadruple the number of vacant sessions on offer.
Locum GPs are being booked up ‘often within minutes’ of posting their availability with the service, which is used by over 2,000 GP practices and around 6,000 locums, said the NASGP.
GP leaders say they are aware of ‘widespread calls for locums to support unfilled shifts across primary care settings’ and that the ongoing problems in filling sessions is a sign of historic workforce shortages ‘coming back to bite’.
Kirkview Medical Practice in East Kilbride, serving around 7,500 patients, was forced to put routine appointments on hold on 26 July, with plans to offer emergency appointments only until 9 August.
A lack of locum cover at a time when many GPs are taking annual leave is to blame, according to local health board NHS Lanarkshire ,which is supporting the suspension of appointments. It is not clear how far Covid-related isolation is playing a role.
Dr Sharon Russell, associate medical director of South Lanarkshire Health and Social Care Partnership, a collaboration of local bodies including NHS Lanarkshire and South Lanarkshire Council, said GP practices in the region are seeing a 30% increase in activity compared with pre-pandemic levels.
She said: ‘Kirkview Medical Practice is operating an emergency only service for a temporary period as of Monday 26 July due to the aforementioned pressures as well as short-term staff shortages.’
She encouraged patients to ‘show patience’ and instead seek alternatives to the GP where clinically appropriate, citing self-care, pharmacy, minor injuries, opticians and dentists. She pointed them towards online guidance, and pointed out that the practice staff ‘continue to work tirelessly to provide a high level of care’ during these ‘challenging times’.
NASGP chair Dr Richard Fieldhouse said while there was a period last year when locum GPs took up salaried posts as practices limited their use of sessional cover, many have now returned but may also be on leave.
He said: ‘It’s very much a case of demand outstripping supply. A lot of locums certainly got very spooked last spring when so many were cancelled and so many took up salaried posts but our experience is that many of these have now returned back to being locums.
‘It is that time of year when lots of locums will be taking a holiday as well, as it’s just been ridiculously busy for the last six months already so a lot of us need a holiday.’
GP practices with staff shortages that have managed to keep service going say they have been able to do so due to GPs cancelling their leave or working overtime.
Dr Ros Lewis, a GP partner in Ealing, west London, said: ‘For the first time since I can remember in 30 plus years, we have been unable to fill a number of our sessions in the last month or so, even if we resort to trying agencies.’
She added: ‘This has resulted in GPs feeling obliged to support colleagues by working extra sessions or having to alter their leave dates.’
Dr Ben Molyneux, chair of the BMA’s sessional GP committee, said he expected the problems to continue for the next 18 months.
He said: ‘There is a definite shortage of workforce to fill the need for permanent staff to take leave, and this is multifactorial.’
In addition to locums needing to take leave, he said the workforce is also being spread across other parts of the NHS including vaccination centres and within 111 provider organisations.
He added: ‘The overall [whole-time- equivalent number] of GPs continues to flatline despite modest improvements in head count and so we are seeing the historic shortages in the workforce coming back to bite.’
GP leaders have warned practices face the ‘very real prospect’ of having to close temporarily or permanently this winter among rising workload and staffing issues.
LMCs also said they expect some practices to be operating ‘skeleton services’ this autumn as appointment levels rise during the traditionally busiest parts of the year.
They warned staff absence due to annual leave and Covid-related isolation is adding to the problems – despite new government guidance saying healthcare staff can continue working if identified as a Covid contact.
A BMA workforce study has found that each outgoing GP partner may need to be replaced by three new GPs due to shifting working patterns.