Exclusive There has been a 44% reduction in the number of GP vacancies advertised since November 2022, a Pulse survey of 612 GP partners has revealed.
Pulse has reported in recent months 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 locums have been asked to consider reducing their rates to secure work.
The survey, which was carried out last week and included partners from across the UK, found that alongside a reduction from last November, there has also been a 23% reduction in the number of vacancies since May this year.
GP leaders attributed this reduction in vacancies to a number of factors, including an increase in the ARRS success in hiring staff and a lack of resources and space to house GPs.
The survey also showed that 62% of partners reported an increase in the use of pharmacists by their practice, and an increase in the use of other roles.
This comes at a time when GP numbers are remaining stable, with October 2023 NHS Digital figures in England revealing a 0.4% year-on-year decrease in fully qualified full-time equivalent (FTE) GPs.
Dr Malinga Ratwatte, chair of the BMA’s GP registrars committee, said: ‘The sentiment that we are hearing from the ground from senior registrars, as well as recently qualified GPs who have just finished their training, is that they are finding it more and more difficult to find work – salaried jobs as well as locum work.
‘In the last few years GPs have recognised that the intensity of the work means that they find it difficult to work “full time” – the definition of that is variable.
‘I think GPs have sought to mitigate this by taking up different roles as part of a portfolio career, and that has been a way to retain the workforce to some extent.
‘But with the increase in the ARRS , the amount of work available as well as salaried jobs has actually decreased.
‘Our fear is that because those opportunities are no longer available, it’s probably going to drive an exodus of GPs out the profession and out of the country potentially.
‘We are worried that the expansion of ARRS roles is going to exacerbate the workforce crisis, and we are worried we are travelling in the wrong direction.’
Vacancies by numbers
Total number of vacancies reported by 612 GP partners who responded to the survey
November 2023: 347
May 2023: 449
November 2022: 619
Professor Kamila Hawthorne, chair of the RCGP, said: ‘These figures are surprising as what we hear from many members is that they are finding it very difficult to recruit GPs, even after several months. What I hope isn’t the case is that practices are giving up and making do without enough GPs to deliver the care and services their patient population really needs.
‘As a College, we’re very supportive of general practice working as GP-led, multi-disciplinary teams – and it isn’t surprising to see increased recruitment of many roles, given funding for ARRS roles practices have received. We want our patients to receive safe, timely and appropriate care, and often that doesn’t have to be delivered by a GP – but practice nurses, pharmacists and physios, for example, whilst excellent in their own fields are not substitutes for GPs. We continue to desperately need more GPs, but figures show that whilst workload in general practice is increasing, numbers of fully-qualified, full time equivalent GPs continue to fall.
‘Our manifesto sets out seven steps to safeguard general practice, and ensure patients can receive the care they need, in the future, and includes a call for a national retention scheme, to keep GPs working in general practice longer, as well as ramped up efforts to train more GPs.’
Dr Steve Taylor, GP spokesperson for Doctors’ Association UK, said: ‘There is clearly a reduction in the ability for GP practices to offer work for GPs based on these figures. A conclusion could be made that practices are using alternative direct patient care staff to fill vacancies.
‘Yet it is more likely that increasing costs are making it harder. With overall funding for GPs falling in real terms, many practices are having to ration the limited financial resources but also cope with a huge increase in demand. Some are choosing to use this limited funding differently. Practices should be financed for both more GPs and more clinical support staff. Currently they are not.’
Percentage of GP partners who said they have increased the use of the following health care professionals since November 2022
Physician associate 21% Paramedic 33% First-contact physiotherapist 47% Pharmacist 62% Mental health practitioner 41% Advanced clinical practitioner nurses 36% None of the above 12%
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 yet we are being told that ARRS staff are NOT replacing GPs?! And that the solution for locums out of work is to find a salaried or partnership role…
It would be useful if the Pulse could analyse the GP: patient ratios (not including trainees) in Practices now compared to a year ago too.
The scary part about the direction in which we have already headed is that despite huge numbers of staff within primary care, patients lives are increasingly at risk. The phrase “Too many cooks spoil the broth” comes to mind!
It isn’t the huge increase in ARRS staff that has caused this.
It is the fact that all new funding for 5 years has gone to PCNs and to employ a very restricted range of ARRS staff.
GMS has been allowed to wither, and so practices cannot afford the staff they *really* want and need (doctors, nurses, receptionists, managers) because all the money has to be spent on ARRS staff.
It is a disgraceful situation – bad for practices, bad for sessional GPs/locums, bad for the profession as a whole and bad for patients – but we shouldn’t be surprised as it has been clear that this has been the government and NHSE’s plan all along.
At best, RCGP has been weak, at worst, it has been complicit in this.
Stop flogging the dead NHS horse. Let’s be honest, GP principals are as much the cause of this problem as the government or NHSE. They choose to collaborate with every scheme foisted on them, while pretending to grumble. In my neck of the woods, many of them pay themselves earnings of around £150 to £200k while cutting down on staff employment expenses and locum GP use. They offer poor partnership terms (parity in 5 years anyone??) or no safety of a written agreement so who would want to risk joining them, and they screw down salaried GP earnings. They are, after all, businessmen first. If they were really on the side of their locum GP and salaried GP colleagues, they should be shouting out about the iniquitous ARRS, going on strike/withdrawing services, or flooding mainstream media highlighting what’s really happening in primary care. Time to get rid of the partnership model methinks, and no doubt we’ll hear the howls of GP partners’ anger when it’s no longer necessary for the government to stuff their mouths with gold.
Today a lady said to me , my chances of getting a date with Tom cruise are better than seeing a Gp. This is public perception of general practice.
The uplift for secondary care doctors is another blow to general practitioners. Very thankful I’m leaving UK next year.
My personal experience, plus a significant amount of anecdotal evidence, is that the bottom has completely fallen out of the locum market over the last 3 months. I have worked as a locum for over a decade, and never seen anything like it, even during the early part of the pandemic.
The bottom line is that there are GPs, but no money to pay them. I have seen stats over the last few days that indicate there are approaching double the number of doctors on the GMC GP register as there are known to be working in NHS GP posts. I think it would be fair to suggest that at least some of these doctors, like me, would be working as NHS GPs if the work was available.
And I don’t think the issue is that I charge too much (I know I don’t!), it’s that practice income is massively down, and the funding there is for staffing (ARRS) cannot be spent on GPs. When I ask partner colleagues how they would feel about £xxxxx that they absolutely had to spend on appointments delivered by GPs and only fully trained GPs – not advanced practitioners, extended scope practitioners, specialist associates etc – the reaction is absolute delight. Even the most enthusiastic teachers and trainers feel that all they do is supervise and soak up queries from other practitioners.
We need a wide acknowledgement of the value of GPs, and funding to match. I’m not holding my breath.
From a politician’s perspective this is great news. Vacancies down, other (cheaper) people doing what expensive Drs used to do – whats not to like?! The sad reality, even though nobody in a strategic capacity dares to actually say it, is we are going through a process of getting rid of a primary care service delivered by Drs. Its being re-engineered into a “para-medic” staffed service, using the word in a generic sense. Much like the bulk of legal work is done by para legals. This makes absolute sense to politicians and parliament given they’re all basically lawyers – and para legals are cheap and make everyone lots of money. Wonderful. Its painful. Nobody in receipt of health care would suggest this is a good idea, but the people who benefit most from primary care are the very people with the least political influence and as our society gets more and more divided between rich and poor, powerful and weak – the distance between the weak and the powerful people tasked with deciding their fate, grows larger and larger. What would someone like Jeremy Hunt know , deep down? Thats why they ask surgeons what they think. And here we are. In this mess. What we are seeing here is the future unfolding. Its nuts and its happening and I don’t see a single politician of any persuasion suggesting we should be doing anything different. In fact they are all proposing more of the same. RIP
Post Brexit, our politicians are fundamentally caught in the ideological battle between the libertarian right’s view of small government and cutting spending and the majority public’s “Scandinavian” view of paying a bit more tax for spending on their NHS. Unfortunately the rich libertarian right, funding think tanks and lobby groups, appear to have all political classes, both centre-left and centre-right, in their grasp so don’t expect big changes when Labour gets in.
GP principals just hide behind the excuse that they’re only actioning whatever management tell them to do, even selling out their GP colleagues, salaried and locum. Isn’t that true? It seems not all GPs are equal, some are more equal than others. Protecting their excellent incomes and pensions, GP principals are no longer advocates for their patients. Unless a well-informed movement gets going, then watch as the corporate vultures soon start picking over the bones of the NHS.
GPs have never understood why they should not have a locum for free
Until harm occurs to patients , ARRS are seen as the solution to managing patient demand. There is a role for ARRs but not at the expense of GP s not being employed.
The solution to this is simple. Allow ARSS funding to recruit and use locum or salaried GPs. This is the real issue. Most practices I know would without a doubt use a highly trained autonomously working GP if the funding was available. They would find a relief from tedious supervision and GPs deal with more uncertainty and complexity within a short time frame leading to less return consultation and comeback. This decision has been a NHSE political decision but I can’t see the BMA looking in any ways to reverse or renegotiate it. I wonder why?
Oh dear. We are in a pickle
The government want to divide and rule
I have a little sympathy for my locum colleagues, but not lots.
1. The government actively took money out of practices to form the pcns. They then stipulated that they can get funding for specific roles not others. That’s not the fault of partners.
2. Due to the above it is not financially viable to have locums..there is no money there.
3. Locums lived a great life…choosing what to see when to see it and holding all the cards. They had great salaries as a result and enjoyed it.
Now that the situation is different I cannot tolerate the attack on partnets’ salaries….when the jobs were three you didn’t want them, now the funding has vanished you complain.
I am most shocked that locums didn’t learn lessons from COVID when locum shifts reduced significantly…if it was me I would have actively looked for a proper post…you didn’t.
So decide what you are going to do about it instead of shitting on partners that have held the can right through your golden locum years.
Oh dear! But these comments just underline the point that GPs are a divided profession. GP principals only care for their £150k+ incomes and building up their pensions. Most locums, many of them women or BAME and choosing to be a locum for multiple work and family reasons, only earn £30k to £80k and definitely don’t “shit” on GP colleagues. Don’t believe the Daily Mail rubbish about them charging £1000 per hour. Around here it’s £85 ph.
Anyway, all GP principals will be salaried soon, then perhaps they will direct their ire at managers and politicians, rather than undermining their locum colleagues.
Curious that article header says the number of GP advertised jobs has reduced. That doesn’t appear to be the picture here in the South West, with a glut of salaried jobs advertised on our local LMC website. Locum work on the otherhand has virtually dried up, which would in turn mean many locums potentially available for salaried jobs.
Trouble is- do locums they want these salaried jobs?
In my year of locum work, I’ve seen many a new GP actively avoid face to face classic GP’ing with one reason (not ever mentioned here) being that they don’t care for the classic GP role of being in your room/ silo all day and would rather have a job that is like the old firm of hospital work. Remote locum jobs have been very popular, but these have dried up too. Portfolio GP’ing in medical education seems very popular too.
Why waste money advertising when no-one applies? Give up trying and adjust to the new set of rules. We have been lucky enough to be fully staffed with GP’s and rarely used locums anyway. I suspect the high use of locums is small practices for holidays or those with longer term recruitment problems. Partners have had to adapt to the current reality and as money comes tagged we can’t use it for locums even if we wanted to. Practice profits are down so despite higher workload the money is not being trousered by us. Sorry locums but you will need to make a new plan.
Some of the partners on here talk as if locum(s) were an actually real unchanging person. Static. Always a locum yesterday, today, tomorrow. This isn’t the way it works fellas. Todays locum was yesterday’s partner/salaried GP. Someone even suggested this locum (person) was foolish for not getting a job when covid struck, I think they even said “like i would”??. Urrr excuse me but some almost certainly did, the thing is, some of those jobs will be doing stuff that doesn’t involve being a GP (urr like I did) and increasingly, I suspect, that direction is a one way street. There are indeed a lot of locums around but today’s locum is not the same individual as yesterday’s and what ever these people are, they aren’t stupid. There are some fairly unappealing themes regularly expressed by a subgroup of those currently carry the partner label. Taking a look at whats going on on the current groups “watch” I am not impressed. The one dimensional analysis offered up by some of these guys will only serves to encourage previous peers and colleagues to continue their one way stroll to the exit. Once a GP has gone they rarely come back. But dont worry hey you’ll have a nice cheap pseudo GP to supervise instead.
So when the governments doubling ( ?) of the numbers of medical students results in a flood of new doctors, where will the jobs be??
Not in GP surgeries !
Great comments “A non” drawing attention to the fact that some principals peddle the usual mistaken and hackneyed tropes about our GP colleagues known as the “the locum”, like shorthand for “all things wrong with general practice”.
But to put the shoe on the other foot, there are also “rotten” GP practices. In this city (and also quite likely in other large cities), everybody knows the small minority of GP practices that trouser their funding rather than spend it on expenses such as staffing, including locums. These GP partners are among the highest earners taking incomes of around £200k pa whereas the average GP partner income around here is £120k. They operate in the deprived areas where patient power is poor.
Whenever a principal comments negatively on GP locums, the first thing I ask myself is “I wonder how much they earn; I wonder what’s the vested interest they’re trying to protect that would explain their antipathy to their GP locum colleagues; couldn’t be just their own incomes?”
I never know why the vast majority of the good, hardworking GP principals don’t out these sub-standard GPs pocketing the funding. Good people staying silent, I suppose. Or easier to let the blame fall on powerless locums. Get rid of the sub-standard GPs and get locums back working in these badly run practices.