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Practice open for emergencies only as widespread GP shortages ‘bite’


GP turnover increase


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.

READERS' COMMENTS [10]

terry sullivan 9 August, 2021 10:57 am

govt would like to get rid of gps?

John Graham Munro 9 August, 2021 1:01 pm

As I predicted months ago—–”do not despair locums—-the time will come to get your own back” after being shabbily treated by the very same practices which are now short staffed—–toss aside the ”altruism and ”all in this together business”——-hit those G.Ps where it hurts—in their pockets——after all, they’ve now had to pay out for their holidays abroad—– this will stress the poor loves out even further—–do what you’ve agreed to do (like seeing patients) then go home—–unfortunately when the partners return they will pick holes in everything you’ve tried to do to keep their miserable practices afloat——I’ve been a locum for many many many years

Robert James Andrew Mackenzie Koefman 9 August, 2021 1:17 pm

pure and simple supply and demand, partenrs need holidays as much as locums do as well

David jenkins 9 August, 2021 2:30 pm

in wales we have different problems. front page of last monday’s “western mail” informs us that the welsh nhs is on it’s arse. this is not, apparently, due to bad management, or incompetent, overpaid, managers with no nhs experience (our local health board appointed a manager to a “managed” practice with no nhs experience at all (she used to manage a housing association !). the cause of all the ills in the welsh nhs ? you’ve guessed correctly – agency, bank, and locum workers !!

the solution ? – simples, cancel almost all locum and agency work with immediate effect – problem solved !!

unfortunately, not so – the same four man practice this week has an advert for three doctors to cover their patch for the same day this week !!

and what, you will ask, is the reason for all this apparent discontent in the locum workforce ?

i’ll tell you – IR35 !

HMRC’s own advice is to treat all locum and agency staff on an individual case-by-case basis, and NOT apply a blanket IR35 policy.

but no – all locums treated as employees, but “for tax purposes only”. so no sick pay, holiday pay, paternity/maternity pay, and no contract either, hence the hike in locum fees.

i have offered to work in the above local practice, which is less than 15 minutes drive away. my fees are less than other locums, and they would save on pension contribution too as i already have my pension !

but no – no can do. instead they told a patient who rang this morning there were no doctors available !!

you couldn’t make it up !!

Patrufini Duffy 9 August, 2021 3:03 pm

80% of UK General Practice is trivial. It’s ok if you don’t fill the slot. The world will be absolutely fine.

David jenkins 9 August, 2021 5:23 pm

Patrufini Duffy

the problem is that 20% of gp work is NOT triviatrix.

unfortunately, you can’t tell which 20% without someone seeing them !

Patrufini Duffy 9 August, 2021 10:13 pm

DJ : agree and therein lies this problem. Leadership doesn’t support you in distilling and focussing your purpose and meaning in an indefinable state of social and counselling driven defensive General Practice. It is all a dilute cordial and you’re being set up to fail finding the wheat from the chaff. I recommend this podcast: saviour vs. helper. It is enlightening.

https://youarenotafrog.com/episode-88/

A non 10 August, 2021 1:39 pm

I absolutely agree 80% of GP is trivial crap and I absolutely agree the other 20% most definitely isn’t. The unsolved problem is the relentless escalation in the trivial crap..the serious stuff is still there bit it’s getting totally drowned out. We are literally drowning in drivel. As for ‘not enough locums’ …the locum market was almost asphyxiated by the long covid shut down..to the persistent idiots who continually moan locums are too expensive and cause of everyone’s woes..stick your empty rota up your jacksie

A non 10 August, 2021 1:45 pm

..without aquagel – its too expensive

John Graham Munro 10 August, 2021 3:31 pm

A non——–well said—-re. locums