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GP locums asked to reduce rates ‘to compete with ARRS staff’

GP locums asked to reduce rates ‘to compete with ARRS staff’

GP locums have been asked to consider reductions in their expected hourly rate amid a reduction in available roles, in part due to the increase in ARRS staff.

One agency said that requests for GP locums within primary care settings ‘have reduced since the summer’ with ‘various new ARRS roles coming to the forefront at surgeries’, and asked GPs to consider reducing their rates to secure work.

In an email exchange posted on X, locums were reassured the request was no reflection on performance.

One email said: ‘I was wondering if you would consider a reduction in your expected hourly rate. This in no way reflects our thoughts on the quality of your work, it is simply trying to be the first agency our clients come to, should they need GP cover over the coming months.’

GPs and experts told Pulse that this is because practices are struggling to pay for locums due to insufficient funding, and that the use of GP locums in surgeries has significantly reduced.  

One GP told Pulse that locum work has ‘literally disappeared overnight’ and that after four years as full-time locum they have had to contact a charity for financial assistance.

They said they felt this is ‘because of the additional role recruitment scheme which has seen general practice flooded with ANP/ACP/PAs resulting in no need for highly qualified doctors’.

National Association of Sessional GPs chair Dr Richard Fieldhouse told Pulse: ‘There are definitely areas where locums are not being valued and instead, they are being supplanted by other types of roles.

‘We talk about continuity of care and the role of the GP, and how important that relationship is. And yet the profession is being undermined.

‘In places where locums are able to value themselves, it works great, but sadly there is a lot of places where the mindset is off.

‘GP practices need to think that when they are hiring a GP that is an investment in their future workforce.

‘It’s a combination of the locums being isolated and a lack of respect and investment in this really core part of the workforce.’

However, he said that normally in January and September there seems to be less demands for locums.

He added: ‘I think the agencies are suffering too because there’s actually not that much demand and practices are using other roles.’

Dr Steve Taylor, GP spokesperson for the Doctors’ Association, said that funding into primary care has been funnelled into PCNs and ARRS roles rather than to practices, resulting in less money to pay for locums.

He told Pulse: ‘I am hearing more reports of GP locums finding it harder to get work. This is at a time when the work in general practice is increasing and the number of GPs lower than ever.

‘The only conclusion is that there is not enough money in practices to pay for locums. Funding into primary care has been funnelled into PCNs and ARRS roles rather than to practices.

‘Costs are rising and practices haven’t got the funding. The UK needs GPs of all types and this together with falling numbers of partners, salaried GPs and now restricted work for locum GPs is a sad sign of the major issues.’

Ruth Hennessey, recruitment consultant at the GP Locum Agency, said that there has been a 60% drop in usage of locums by GP surgeries.

She said: ‘I suspect this agency feels they would encourage practices to book locums if they reduce their rates. In order to do so they will need their GPs working for them to reduce to keep their business afloat.

‘However, the bottom line is practices aren’t needing locums and haven’t seemed to for the last three months.

‘This year it’s been very quiet, worryingly quiet, and I would say there has been a 60% approximately drop in usage. So yes, locums are struggling to find work, as we are and probably every other agency out there.’

In June, a third of locum GPs said increasing their rates was a ‘top priority’ this year, according to the National Association of Sessional GPs (NASGP) 2023 survey.

Average GP locum day rates in England currently range from £600 to £850, latest data shows, with fees for 2023 rising by 2% compared with last year.


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Please note, only GPs are permitted to add comments to articles

Richard Brown 11 October, 2023 12:17 pm

Those poor locums. Years of increasingly exorbitant fees no longer so readily available. That was the gamble in not taking up a partnership / salaried role & contributing to the failure of the partnership model of Primary Care. For years any locum we could secure would insist starting after 9am, no scripts, no housecalls, no on call & fixed limited number of appointments. The partner, on less money, picking up the work.

Reply moderated
Anup Singh 11 October, 2023 12:31 pm

@Richard its not a race to the bottom, GPs should be paid £200 -£250 per hour for the work they do. Jealousy doesn’t drive up pay, what next- are you going to say plumbers are charging too much for £150 for call out fees?

The Locum 11 October, 2023 12:35 pm

As a regular locum, no agency involvment , I certainly have no shortage of work currently and after 6 weeks of no earnings (leave per annum) earn the same as a salaried GP approx.
I am very open about the fact that I am emigrating as I think the future for all GPs looks bleak in UK
I dont want be unemployed in 1-2 years time
I wish the UK public the best with their future noctor service

Reply moderated
Rukhsana Hussain 11 October, 2023 12:35 pm

This is a poor choice of headline for the issues at hand.

It is not about being asked to reduce rates to compete.
Experienced and Qualified GPs are being REPLACED by less qualified professionals. Pushed out of jobs.

No locum GP can compete with someone who is essentially free to the Practice via PCN funding!! Practices are not needing Locums or even salaried GPs because they can fill appointments with ARRS staff. The patient will think they are seeing a doctor anyway!! Anyone who will listen will do…

Sadly, the patients are the ones who will suffer due to delayed diagnoses and poor management by people who do not know any better! (How can they with only a few years of training?)

In a “GP shortage” and with unprecedented unmet patient needs, it is scandalous that ANY GP is without work.

Funding needs to be made available to get ALL GPs working to their maximum capacity immediately!!

If not, then the rest of the world and other organisations will be happy to benefit from the expertise of highly qualified UK GPs.

David Church 11 October, 2023 12:48 pm

it looks like government, through ARRS funding, is achieving destabilisation and downgrading of nHS general Practice!
I think Richard is wrong, or had bad luck. I am a locum, and whilst local surgeries’ booked appointments usually start at 9 am, I am usually there well before, and dealing with signing scripts, test results, and incoming correspondence, e-consults, or similar.
I am often the only doctor on site, so also am on-call, doing any HVs necessary, and also supervising any ARRS staff and Practice Nurses, and whilst in another Practice I may be supervising and doing hot reviews with GP Registrars, and Pre-Reg and SHOs (FY1-2) or medical students.
Richard undervalues Partner GPs, who, along with their Unions/Negotiators are responsible for allowing funding into General Practice to be reduced so badly by the Government/NHS that GPs have been leaving both Partnerships and locum work, for other places or specialties.
Partners should be looking to increase how they value themselves, towards the level they think locums get.
There also needs to be awareness that agency locums only get about 3/4 of what the Practice pays out.
Locum pay rates have increased over the last few years, and possibly by more than some Partners’ income, but other Partners are earing in excess of £ 180,000 a year (FTE), and bear in mind the rate of inflation over the last few years, the main probem is Partners incomes not keeping up. Use Locums as a baseline for what you are worth, and demand it from NHSE/Negotiators and DDRB. I think you will agree that a good locum is worth a lot more than an ARRS Noctor.
Some locums are only available at certain times, due to family responsibilities, and to fail to make allowance is unlawful discrimination. Is this why some have left Partnerships? Travelling distance/Time is another inhibitor of early starts, especially in winter, with flooded roads, etc.

Reply moderated
David jenkins 11 October, 2023 1:03 pm

David Church

agree 100%.

i, too, am a locum in rural wales. local shifts start at 9am – i am always there by 8.45 or earlier. i often have lunch on the hoof – while signing up to 400 scripts a day. i don’t moan about extras – i go to work, do the bis, then go home.

reduce fees ? not a prayer – especially with the LHB applying ir35 unlawfully !!

very sorry – you want heinz beans, you pay the heinz rate. if you’re not that fussed, and aldi beans will do, by all means pay the aldi rate – but don’t complain.

apples and oranges…………………

jayanth Peddi 11 October, 2023 1:37 pm

I don’t normally comment but feel like I have to.
Agree with all the comments except the first doctor.
GPS in UK feel they get very well paid from government for the actual work they do. Please go to another developed country just see what the GPS earn there for the work they do.
Atleast they get paid for the work they do..
Seriously considering specialist private practice or emigration.
Good luck for all GPS when you become old or I time of need, and see a noctor..
The partners have agreed to destabilise the general practice through pcns..
Just got dumped another additional work from pcn, unpaid work….
Good luck uk patients for future ..
This will be the same for hospital consultants soo. aswell with pa s and anps..
For god sake.. .. Soon Prescribing allowed from anyone with A levels..

Centreground Centreground 11 October, 2023 1:54 pm

This decline, again led by Clinical Directors who are overpaid, unnecessary positions motivated by self-interest and do little of any real benefit that could not have been done by the practices themselves in my opinion have misused the ARR system.
Combined with underperforming, wasteful PCNs, they have led to the ongoing destruction of the NHS and again have steadily brought General practice to its knees combined with this decline in the locum market.
ARRs have their place but we as a practice do not use these far less qualified and less experienced to replace locums who work faster at 3-4 times the rate (taking into account the standard ARR notes entry –‘ could not contact patient and rebooked’ or ‘needs further ‘30min appointment’ that we often see x4 and in the locums in whom as partners we have greater trust to correctly diagnose and manage patients in more cost effective time spans.
Locums also tend to resolve the problem far more often and do not rebook into other GP slots.
Locums as I have done in the past serve a useful purpose for doctors at differing periods in their life as an option.
Clinical Directors of PCNs have promoted the introduction of a third tier low quality service into the NHS being motivated by avoiding frontline work through incessant pointless meeting attendance and the carrot of greed via clinical director payments. They are the same bunch who normally hop from one board position to another.
Patients, GPs, locums, and nurses etc. etc will all suffer the consequences of the irreparable damage caused by Clinical Directors and PCNs to the standards and infrastructure of the NHS and until the time the BMA manages to stop this relentless Clinical Director/PCN gravy train, the problems for all NHS primary care staff will continue.

Sandeep Kampani 11 October, 2023 2:17 pm

Sad situations. If pharmacist become GP then there will be shortage there.If Nurses become GP then there will be shortage there etc.So plumber will become electrician, electrician can become builder -of course without any regulation and do not worry if any house on fire..
@Richard something called Vicarious responsibility can come into play in unregulated roles and also workload with come your way and the A&E way. after deflection Good thing you do not worry about antibiotics resistance.
My advised get a private health insurance with private GP access

John Graham Munro 11 October, 2023 2:43 pm

I’m indispensable to a practice—- —worth my weight in gold———and make sure they bloody know it

Left Back 11 October, 2023 3:35 pm

In the absence GPs willing to take up substantive posts whether Salaried or Partnerships, so called independent prescribers are the only way to fill the gaps. And locum GPs straight from GPVTS can often seem as risk averse as “noctors”, and at face value are more expensive.
Experienced locums, especially ex GP partners, may be worth their weight in gold, but are increasingly thin on the ground.
Its definitely the patients who will ultimately pay the price for the decline of the Partnership model of General Practice.

Simon Braybrook 11 October, 2023 3:54 pm

We tried in vain to get new partners. We tried in vain to get salaries GPs. We barely got even one or two to even look round. So we sought paramedics and were flooded with applications. We’ve employed three and they’ve done advance practice and independent prescribing and are absolutely fantastic.

It wasn’t my first choice. I would have taken doctors if they had applied, but I have no regrets.

Keith M Laycock 11 October, 2023 6:10 pm

Interesting comments along with the possible £180,000 GP income, although healthcareers.nhs quote average from £70,000 – £104,000. I don’t know which is correct.

For comparison and for those with itchy-feet, a new (optional) contract for Full Time Equivalent (FTE) GP’s in B.C Canada is quoted as $385,000 (£230,000).

FTE is defined as providing 1680 hrs of service per year and 5,000 appointments with a patient panel of 1,250.

There is no obligation to provide out-of-hours service, e.g. after the clinic has closed or on weekends. On an 8 hrs per day and a Mon- Fri work week that equals 42 weeks per year and 119 pts visits per week.

There are lot of details and provisos in the contract, still?

Despite this, 20% (approx 1,000,000) of the BC population are said to be unable to register with a GP – they are referred to as ‘unattached’.

neo 99 11 October, 2023 8:17 pm

This was all inevitable after the BMA agreed to the 5 year deal with the ARRS funding being limited to healthcare professionals other than GPs. It was an own goal to the detriment of its membership paying GPs. The BMAs shortsightedness has caused this and has dumbed down the role of the profession. I can however as an ex-partner and Current locum understand the partners point of view as they are looking for cheap access to bums on seats. However I feel this doesn’t always work out to be most cost effective or safe for patients. I have often seen allied health professionals make diagnostic errors, over investigate inappropriately and have noted a high follow up rate and a low completion rate due to lack of experience and skills especially when dealing with undifferentiated illnesses and this is not cost effective or safe. There is a role for them within certain defined areas however feel when dealing with undifferentiated illness, they should be fully supervised. I have often seen 3 or 4 prior consults with AHPs when a competent experienced GP could have managed and completed the episode of care in 1 consult. What we need in the current climate is a safe mix rather than a race to the bottom. I would suggest the BMA should be advocating to include GPs into the ARRS funding fold. There really is no reason not too unless the political agenda is to have non GP led primary care in the future whixh would be very unsafe and not in the interests of GPs.

Adam Crowther 11 October, 2023 8:41 pm

General practice to work well requires a mix of skilled committed and consistent team players regardless of professional background or employment status. We are all responsible for creating attractive safe working environments for ourselves and others

Pejman Zoroufchian Moghadam 12 October, 2023 11:22 am

This approach was taken by my surgery as well and most patients will come back one way or another when there is a wrong diagnosis, like always the main approach is here to make people happy to be given earlier appointments than quality GP work. No wonder why many people are leaving the country where their job as a doctor is valued. If this condition are continued many would consider leaving and more migration from Primary care would be expected , I think.

Some Bloke 12 October, 2023 6:40 pm

Ha ha ha ha… oh…. this is precious…. asking locums to consider reducing rates.. why would anyone do that? I just don’t employ them, unless reasonably priced and genuinely helpful and willing to engage with how the practice works.
Employed paramedic, PA, ANP far more valuable to the Practice than most locums.

Turn out The Lights 13 October, 2023 7:32 am

Its a market you can’t fix a free market or manage it supply and demand.Note as the number of experience /trained people that can do Arrs roles reduces, their demands will increase as well.Its called a market.You cannot fix a market.

Paul Burgess 13 October, 2023 11:34 am

As a former partner I’m locuming, not through an agency, and have as much work as I want. But at £80/hour I’m not chomping at the bit..

Alexis Manning 13 October, 2023 8:36 pm

As a (likely career) locum, those who charge silly fees are finding that they are not so in demand when practices are not over a barrel.

Jaideep Israel 14 October, 2023 10:35 am

One must never under appreciate locums. They are invaluable at times of great need (annual leave, sickness) and can help with providing appointments for people that need to be seen when the practice is short of GPs. On the other hand they can create more admin work for the permanent GPs particularly if they order excessive tests that need viewing or do poor quality referrals that get rejected and need re-doing. Practices vary but they have to find the right balance that works for them and many practices feel they are better off with minimal locum use.

The Socialist 14 October, 2023 3:19 pm

This is what happens when true socialism thrives under the guise of conservatism, liberalism etc- the states turns institutional subjugation, surveillance, over-regulation, and a false sense of free-market economy & individual freedom. The result? Race to the bottom.

If only every British GP knew what they are worth in a true free market – there will be none left in the country. But then they have turned into a Woke animal farm (boy how true George Orwell was).

The Socialist 14 October, 2023 3:29 pm

For those of you asking for more money from the government or for more staff, think again- “The problems with Socialist is that, at some point your run out if other people’s money” (These are Maggie T’s words, not mine)

So, by extension, The definition of socialism should be “asking a professional with 6-year degree and 8 years of training, to lower their salary expectation to compete with those with 6 weeks of training”

This is not the government; it’s our woke leaders. This is what unchecked socialism begets.

The Socialist 14 October, 2023 9:47 pm

In any other part of the western world; an Independent Doctor (Consultant or GP) still earns at least twice as much as those on “Top Management post “, (reflects their skills, experience & training duration). UK doctors (GPs and consultants) get paid peanuts (yes, even high-earning GP partners). Yet, our Woke leaders in the BMA, LMCs ICBs and RCGPs keep asking fore ARRS staff, more money and more regulation (remember the reaction after Lucy Letby case- asking for regulation of managers?). By extension, you are asking for more subjugation from the state-controlled quangos (just like, you all wished for the CQC pre-2012). The keep complaining that there is too much bureaucracy and red-tape etc.