Exclusive Around half of GP locums have reported a decrease in their sessions worked over the past year due to a lack of work available.
A Pulse survey, which included 426 locums who answered the question, also found that four in ten of 612 GP partners reported a reduction in the use of locums.
Around 48% of locums said that their shifts had decreased since November 2022 due to a lack of work available, the survey found, with a further 17% saying they had reduced shifts due to personal reasons.
Only 8% said they had increased their number of shifts over the past year.
As part of the same survey, Pulse revealed yesterday that the number of GP vacancies advertised had almost halved in a year.
GP partners responding to Pulse’s survey said financial reasons are behind the reduced use of locums, with the cost-of-living meaning that practices can’t afford to pay locum rates.
In recent months, there have been increasing reports around GP locums struggling to find work, with some putting this down to an increase in additional roles reimbursement scheme (ARRS) roles.
Under the ARRS, primary care networks in England are given funding to hire pharmacists, physiotherapists, physician assistants and advanced nurse practitioners among other professionals.
Recruitment expert Ash Higgs, who is MD at MCG Healthcare, said: ‘One thing that we have 100% seen is that locum work for GPs is extremely low – we don’t have much locum work available, we have some longer-term contracts in place but we are certainly not picking up new locum work.
‘From our point of view, it’s clear that surgeries are utilising the ARRS funding. There’s plenty of work for ARRS roles because of the funding, but in regards to locum GPs the market is extremely quiet.’
Dr Adrian Penney, GP partner in Shropshire and treasurer at Shropshire and Telford LMC, said: ‘The biggest change over the last three years, particularly since PCNs came along, is our bottom line – we’ve got no money. At a meeting this week with our PCN, every practice has got a cash flow crisis.
‘We want doctors but actually we can’t afford it. I haven’t taken a drawing over the last three months in order to support the practice.’
Dr Selvaseelan Selvarajah, GP partner in Tower Hamlets, said his practice hasn’t been replacing locums with ARRS roles, but added: ‘We’re just using less of them, because there isn’t the money. Especially with the pay uplift we’ve had to give, it means we’re thousands of pounds out of pocket between now and the next financial year. We don’t know what the new deal is going to be. So that means we’re going to have to really tighten our belts for the next few months.’
Dr Chaand Nagpaul, former BMA chair and a GP partner in North West London, said: ‘I think there’s real geographical variation in employment of locums. In my patch, we need locums. And many of them are doing regular sessions in several practices. One of the biggest limitations I found is estate, that we don’t have the rooms. Sometimes it’s more a case that we don’t have the space to employ locums more than the fact we don’t need them.’
Dr Richard Fieldhouse, chair of the National Association of Sessional GPs which runs the LocumDeck platform, said the NASGP estimates there are around 6,000 more locums practising in the UK than in 2017.
He added: ‘If we’re not employing these non-salaried, non-partner GPs, it becomes unsustainable for them to continue as GPs, then they’re going to leave, in big numbers. Once you’ve lost a GP, they don’t ever really come back, not in any useful way.
‘If we don’t do something urgently to retain these GPs, who we’ve invested so much in, then once their workload gets below a certain point, I think general practice as we know it could effectively crash overnight. Practices must be allowed to use ARRS funding to engage GP locums and appointment salaried GPs.’
Pulse’s special recruitment survey was open between 13 and 21 November 2023, collating responses using the SurveyMonkey tool. A total of 612 GP partners from across the UK responded to these questions. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £150 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the GP population
Additional reporting: Anna Colivicchi and Eliza Parr
HMG by design or accident ?
“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”
— Noam Chomsky
It’s happening before our eyes. Either be complicit with it, or remonstrate loudly. Or emigrate abroad!
Well, I suppose it is good news for the patients of english-speaking overseas countries who will benefit from all those experienced and newly qualified GPs leaving Britain.
But wait – won’t the patients here need GPs any more then? Not if they cannot afford to go private I suppose?
There is only one answer to this, and it is a HUGE change in both Government and population’s ideology about self-care and mutual support for the needy.
It is inevitable that locum pay rates will fall
The reason for this apparently contradictory state of affairs is simple. This was caused by Covid as a rapidly deteriorating GP practice system was falling apart It was thrown a serendipitous lifeline. GPS took over control of access and this allowed for a pause in the decline. GPS decided who was seen when and where therefore no need for any more docs and open season to fill the surgery with noctors Who knows how long this can last but unless government imposes access targets or rights returned to patients to decide on getting an appointment GPs should make hay while the sun shines
This may be an unpopular opinion, but surely reduced locum usage is a good thing for the profession? I opted for a salaried role as a new GP because I wanted that support / patience from colleagues and continuity of care with patients whilst learning the trade. I’ve experienced the locum life previously (A&E) and it was great for that stage in my life, but with that extra pay and flexibility comes risk and lack of stability – when the works there great, but when it dries up and there’s still bills to pay that’s something that has to be accepted as part of the locum game. Ultimately a scenario where salaried posts get filled, including in maybe traditionally less desirable areas, and the patients and practices get continuity of GP for results/follow ups, is better for patients and fairer for the wider workforce. Yes some will go abroad, but I think the potential mass exodus is overplayed with the family/friend/cultural ties many of our gps will have.
You’re newly qualified Angus so the ‘support/patience from colleagues’ may make up for the crap salary, which is way below hospital consultants and our job is far harder without the study pay, admin time etc they get. My sister is a consultant anaesthetist and all she ever says I don’t know why you do or how you do what you do but I could not bear it. Well I can bear it but not for shit pay and shit conditions as a salaried. I would be partner but I won’t buy into a business where you can’t control either your workload or what you get paid for it while retaining full financial liability; its mental wellbeing and financial suicide in my opinion. Kinda worked when government were generous but relies on good faith. this govt and 13 yrs of Tories have proved to have no good faith. I would become partner once the above conditions are sorted. In meantime working back in A&E as GP, thanked personally on every shift from consultants to managers as they cannot believe how quickly and efficiently we work and how many unnecessary admissions are prevented. I will locum and move around until income failing and then I will get out of medicine. Simple. Not up for being taken for a ride by this government. Too demoralising. If I was younger I would emigrate, but I’ll just diversify. WE have transferrable skills and I think we could work well in most fields. We shall see.
If “It is inevitable that locum pay rates will fall” then, according to this Adam Smith interpretation of the value of GPs, sooner or later so will GP partners’ funding and income fall. That is, if a locum’s work is only worth, say, £60 per hour, then why should a GP principal’s be worth a lot more (around here, it works out as £160 ph, for some)..
That’s after their practice expenses, and before their personal tax and expenses..
@ so the bird flew away. I’d love to know how you arrived at a figure of £160/hr for GP partners. The majority of GP partners earn less per hour than the locums they employ. This is due to responsibility for the admin work (eg dealing with test results and queries generated by locums), HR and premises responsibilities, NHS contract planning, monitoring and performance audit, estates management and covering colleagues on unexpected absence. The list goes on and on. On our practice locums have earned more per hour than anyone else.
Having more permanent staff is undoubtedly better foe patient care and team morale bur locums are still an essential part of the workforce. They will always ben needed for parental leave and sickness etc.
However, we have had a massive problem where locum work was far more favourable than a permanent post for about 10 years.
The government should have improved they terms and conditions of permanent staff to make that a more favourable option. Instead, I suspect they are trying to increase permanent staff by making locum work an unviable, financially unstable option for many. I doubt locums will ever be included in ARRS funding for this reason.
Sure, North London gp. “around here, it works out as £160 ph, FOR SOME”. Some = the rotten apples ie those GP principals that trouser funding rather than provide an acceptable service to their patients, a minority of around 10-15% of principals.
So £200,000 ÷ 52 ÷ 24 (number of hours actually worked by “rotten apples”, as opposed to sitting in PMs office drinking coffee and looking at spreadsheets,) = £160 ph. And that’s being generous re number of hours worked – if it was patient contact hours, the number would be < 24, and the hourly income nearer £200 ph. Hope the maths helps.