The amount of GP locum work in the NHS in England stayed stable between 2018 and 2020, despite ‘widespread perceptions’ that numbers of locum GPs have risen, researchers have claimed.
The paper by researchers from the University of Manchester, published in the British Journal of General Practice, also found there were ‘substantial geographical variation in locum use between and within regions’, with this ‘suggesting differences in the distribution of locums’.
But GP locum leaders warned that this study ‘barely scratches the surface’ in terms of actual locum use in England.
The study used routinely collected NHS Digital workforce data between December 2017 and September 2020 from 95% of all general practices.
The analysis, done at the population level, quantified and inspected the scale and qualities of the locum workforce compared with other types of GPs ‘for the first time’.
The study found that ‘aggregate reported locum use in England ranged from 3.15% [of the GP workforce] in December 2017, to 3.08% in December 2018, to 3.58% in December 2019, to 3.31% in September 2020’.
But ‘the use of locums seems to vary substantially across different practice types and areas of the country,’ the paper said, with practices in London having the highest locum use (7.5%), and practices in the North East the lowest (2.5%).
According to the study, ‘practice characteristics such as rurality, CQC ratings, and whether the practice was single-handed were stronger predictors of higher locum FTE than population characteristics’.
The study also found that:
- Locums were ‘more mobile’, tending to be ‘younger males of whom most had qualified in the UK, though a large percentage had qualified elsewhere;
- The proportion of practices using locums ‘varied from 37.4% and 40.8% in 2018 and 2019, respectively’;
- CQC ‘ratings appeared to be a strong predictor of locum FTE, where practices rated as having inadequate and good services had higher locum FTE than practices that were rated as having outstanding services’;
- Patient satisfaction was ‘very weakly associated with locum FTE while deprivation, QOF quality of care, practice performance, QOF morbidity burden, and practice workload did not appear to have any discerning effect on practice locum FTE’;
- ‘Single-handed practices had substantially higher locum FTE compared with group practices’, and in rural practices, locum FTE was ‘25% higher than for practices located in urban areas’.
The paper said: ‘These types of practices may face substantial challenges in recruiting and retaining permanent GPs, and it may be hypothesised that relatively high and sustained levels of locum use may be indicators of wider problems affecting recruitment and retention.’
‘This is likely to reflect recruitment or high turnover challenges in these practices/areas and can provide a greater understanding of general practice workforce challenges in England,’ the researchers added.
It comes as the latest data released by NHS Digital showed the headcount of GP regular locums has dropped by 155 between September and November 2021.
But the study found that locum headcount could be overestimated, as ‘other databases on workforce report different estimates on the numbers of locum GPs’.
Locum headcounts in general may ‘overestimate locum use’ because ‘some GPs may also be simultaneously permanently employed’, the study said.
However, National Association of Sessional GPs (NASGP) chair Dr Richard Fieldhouse said the study was ‘not a true reflection’ of the locum workforce and is ‘barely scratching the surface’, as it is based on NHS Digital voluntary reported data.
Dr Fieldhouse said: ‘It’s like basing the total number of the UK’s woodpeckers on the actual number reported by bird spotters.’
He said: ‘We shouldn’t be basing any workforce planning on FTEs, because that’s like saying the average family has 2.4 kids. There’s no such thing as 0.4 of a kid – we need to talk about actual people, and locums are people.
‘We also shouldn’t be basing numbers on voluntarily reported data. By definition, the practices that have the time to count locums and then report the numbers are not the practices that need locums as much as the ones who are spending so much time finding locums.’
Dr David Coleman, GP and clinical director of Doncaster South PCN, said: ‘Locums are a valued and vital component of the GP workforce. The study emphasises how they often fulfil an important role in supporting primary care services in rural and under-doctored areas.
‘My practice has received valuable support from locum GPs throughout the pandemic and our patients have benefitted from continuity of care from one of our regular locums. I think it’s vital that GPs are all roles and backgrounds recognise the common ground and challenges we share, rather than being drawn into squabbles over the relative merits of different employment models.’
He added: ‘I tend to think more and more about good people rather than roles nowadays. If a salaried doctor left, I’d just be looking for a good clinician of any role and any contract model – the job market is too tight to be restrictive.’
It comes as Winter Access Fund guidance issued by NHS England in October encouraged local commissioners to use the cash to pay for extra sessions from existing staff or by hiring locums to help clear the backlog of appointments and meet demand for face-to-face consultations.
The guidance said that the money could fund ‘full use of the digital locum pool framework’, with all parts of the country expected to have established a digital locum bank model or equivalent by December.
In some areas, remote GPs have been sourced via digital GP companies but some GPs warned Pulse this could worsen problems in under-doctored areas by taking resources away from local practices.