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Not enough GPs? Thousands of us are now unemployed

Not enough GPs? Thousands of us are now unemployed

As practices hire more and more ARRS staff, many GP locums can no longer find work. Dr Burnt Out says it’s time to shake up the partnership model

Dear Pulse,

Since I retired last year, I have been a GP locum at several practices near where I live. I have also got to know many other GP locums through a WhatsApp group that I have joined.

But something strange has happened recently: all of us are now unemployed.

Over the past few months, all locum work has completely dried up, and I have heard that this has happened across the entire country. As a result, there are now thousands of experienced, fully qualified GPs who can no longer find any work at GP practices.

We are constantly being told by the powers that be – LMCs, the RCGP, leading GPs, and (ahem) even Pulse – that there are ‘not enough GPs’. Not any more, it seems.

What has happened? Well, having been a GP partner for many years previously, I know exactly what has happened: profits are down or static for many GP partnerships due to large utility bills etc.

And how do you maintain or increase profits? You reduce salaries, which is the main expenditure for practices, and employ cheaper – but less qualified and experienced – staff members.

There are plenty of PAs, ACPs, ANPs, paramedics and nurse practitioners around who are much cheaper for practices and who are now commonly being used to see undifferentiated patient presentations; GP partners can presumably then act in a ‘supervisory’ capacity. I think this was the model that was outlined in a BBC Panorama episode some time ago.

So, who needs salaried GPs and GP locums? It seems we are now too expensive for many – but by no means all – GP partnerships, and the primary care model we are heading towards is: mostly ARRS staff as first contacts for patients with supervisory GP partner input and lots of unemployed fully qualified GPs.

What sort of warped distortion of general practice is this? Is this really the right model for our great profession and the general public – including our own families – as we move forward into the future?

The GP partnership model has gone very, very wrong for thousands and thousands of GPs.

Now it’s time for a change.

Yours faithfully,

Dr Burnt Out

Dr Burnt Out is a GP locum in London



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

Simmering Frog 6 November, 2023 4:22 pm

A big problem that will get a lot, lot worse. However, as a partner, I have no responsibility to make the life of a locum easier.

The solution is to become a GP partner but that will require moving for many.

A Non 6 November, 2023 6:29 pm

“I was just doing what I was told” GP partners have become self deluding banal cogs in a fundamentally dishonest and degraded system. The more I see what is going on the less respect I have for the people dutifully facilitating the destruction

Jp Fisher 6 November, 2023 6:32 pm

Put this together with “GPC calls for immediate pause on PA recruitment” headline… So we see that PAs are not good enough on one hand but cheaper than locums on the other. The government will see the mixed messages and rub their hands together in glee as we shoot ourselves in the foot.

Matthew Barton 6 November, 2023 6:54 pm

Unfortunately most partnerships cannot afford locums. We stopped employing them a few years ago.
We’ve been fully staffed for years, totally overwhelmed with work mind, and now unable to replace clinical staff to cover the inflationary costs, NI, utility, wage rises etc.
Primary care is massively underfunded and over whelmed. Please don’t blame the partners – without the the entire NHS system would collapse.

John Graham Munro 6 November, 2023 7:02 pm

Many Practices would rather have a locum pay them for the privilege

Ravi Mene 6 November, 2023 7:19 pm

To some extent this is a ‘Locum’ generated demand effect, when the market was buayant the locums raised their rates to as much as possible and now when the practices are facing a realtime financila squeeze, they are looking at cheaper options!! Try offering your services at a market acceptable rates? I know of several GPs who preferred to become ‘Locums’ rather than partners because the rewards were Hight with NO risks or responsibilities. Remember those demanding to see only 0ne patient every 10 minutes, no more than 12 appointments per 2 hous session, extra for visits, extra for paperwork, report sick at very short notice. It all ended on partners doing all the extra work. Welcome reality.

SUBHASH BHATT 6 November, 2023 7:29 pm

Loss of mpig and seniority allowances has impacted practice finances. Practices are employing staff which are cheaper and have no worries because they are covered by their insurances. Time will tell how this cheaper option works out. There are concerns expressed by patients and media. Only effective supervision you can offer is to be there to confirm everything done for additional staff which defeats the object..

Y oh Y 6 November, 2023 7:55 pm

Reality – GPs not committing to permanent jobs for variety of reasons that has made these less attractive resulting in high number doing Locums.
GP salaried posts then go unfilled.
Financially & for stability / continuity, GP practices employ other salaried staff. Funding does not cover £100/hr shifts, covers £100/patient for 12 months.
Solution: Partnership – the more who sign up, the more stable primary care will be & all GPs together can share the load and fight to improve the variety of reasons that GPs have left.

Ella Russell 6 November, 2023 8:15 pm

Sadly, a few of the contributors above have missed the point. A lot of us WERE partners so completely understand the financial implications of inflation within a business. But most of us who have ever employed locums, ANPs, pharmacists, receptionists, managers etc know that you also get what you pay for!
I know I am not the only one who has been involved in cases where life threatening pathology has been missed, patients have not received safe care or serious significant events are happening daily.
Most of us want to work as part of a safe, effective and well managed team when we are locuming and will help out and support other staff members when we can with admin, path reports and teaching/training if required. Anonymous comments like ‘I have no responsibility to make life easier for locums’ doesn’t encourage anyone working in the hell hole that is general practice at the moment and plays right into the hands of the politicians who want to salary us all or make patients feel they have no option to seek care privately!

Anthony Gould 6 November, 2023 8:34 pm

I looked at the number of family doctors in the USA a couple of years ago
I was expecting more per head of population as it is a private healthcare system primarily
There were the same or less numbers of family doctors compared to the UK
I assume they operate like GP practices are starting to as described above
Financial pressures forcing this change
Is it better for patients?
Access will be better but the service may be poorer
Patients value access – note the public anger and frustration around the 8 am tussle

Trefor roscoe 6 November, 2023 8:39 pm

The end result of this will be an increase in morbidity and sadly mortality, because the general public will be being assessed by people who are not fully qualified. The reasons for this are extremely subtle and will only become apparent over a few years. We will look back and realise that we have lost something irreplaceable but it will be too late.

a S 6 November, 2023 9:08 pm

Looks like many are blocked from all angles. Can’t be salaried as too long hours and get dumped on, can’t be partner as too much red tape and taking on responsibility for things that are beyond your control. Now there’s not locum work either. I was a locum for years. People says the money is good but when you take off the fact that there is no sick pay, no holiday pay, no payed leave and no pension contribution it’s really not that much. Maybe 3/4 of an electricians wage.
Looks like it’s time to open up that patisserie shop I always dreamed about. owning.

Mark Bloomfield 6 November, 2023 9:14 pm

NHS Networks let the cat out of the bag. This dire, dreary organisation routinely sets up polls on Twitter / website almost nobody bothers to complete, let alone read. Then NHS Networks published a poll asking ‘ Should general practice give up the independent contractor status and partnership model?’ Choice of Yes or No. Early yesterday, poll result heavily skewed towards ‘No’. Then in wee hours of last night, thousands of ‘Yes’ votes registered, skewing result completely the other way. Today, poll has been reset and now requires a log in. It’s a window into the mind of HMG: watch for the push to make all GPs salaried. ‘Nationalisation’ of Primary Care.

Matthew Barton 6 November, 2023 9:15 pm

Unfortunately the money in primary care in general has been cut.
If partners employ locums in the current market they are at risk of bankruptcy – spending more than is coming in.
Also the only thing that proves effective in medicine is prevention: public health and continuity of care in primary care. Locums offer neither of this.
Again don’t blame partners for not letting their livelihoods go bankrupt – blame the government for allowing us to become a sick nation.
I wouldn’t want to look to America for health care advise as mentioned above – health care now I’d their greatest contributor to gdp and are likely to be bankrupt as a nation within a generation without a turnaround in lifestyle behaviour…. we are not far behind!
Blame where blame is due – government, big food, big pharma….

Some Bloke 6 November, 2023 9:28 pm

Lots of various “specialist practitioners” in hospitals too. Not unique to primary care

Not on your Nelly 6 November, 2023 9:50 pm

You get what what you pay for. You reap what you sow. Locums asking for nothing less £150 an hour or 800 a day. Will only see 25 patients a day. No visits. Own self generated admin only. No flexibility. No desire to help out. All about self. I would rather just do the work myself thanks very much, rather than see all those patients you have requested a lot of investigations on (worst locum revently used to do a PSA and cholestrol on patients of any age even the 20 year olds and a bunch of ladies too), with no diagnosis and no management plan except see gp with results, which i will request but never care about or look at. What goes around comes around. Market forces.

Decorum Est 7 November, 2023 12:51 am

‘You can’t Buck the Market’ (apologies for quoting one of the ‘realisms’ of Mrs T’s philosophy).
Primary Care in the UK is basically finished/on-it’s-last-legs. It’s not being funded and the user/patient cadre have increasingly unrealistic expectations. No point whinging, just ‘call-it-a-day’.

MAHIPAL ALUMALLA 7 November, 2023 5:50 am

A few points contradicting other comments:
1) I can’t believe that GP partners are paying £150/hr for Locums. Most GP locums charge about £100/hr. NHS employer contribution is not a practice expense.
2) I qualified in 2006. My training practice offered me Locum the day after I got my CCT at £100/hr.

Bob Hodges 7 November, 2023 7:43 am

My practice has more GPs than at any point since we merged 5+ years ago. We are ‘fully doctored’ to historic ratios. We have fewer partners though because we have been unsuccessful in encouraging some of our salaried GPs to ‘step up’ as it’s just not the rich time for them (-no one partner have become salaried) for family reasons.

We still employ locum GPs and ANPs.

Our ARRS colleagues mostly do specialised roles like medicines management, frailty and mental health with some doing ‘minor illness’.

There is a limit to how many locums we can operate with because how high prevalence area needs a LOT of continuity follow up appointments.

To provide continuity of care, you need continuity of colleagues.

Barry Sullman 7 November, 2023 7:50 am

Locums bled me dry and provided a junk service to boot. They never resolved anything – patients would come back. They would order blood tests on everyone knowing that I would be responsible for the result. On Sundays I would process several hundred results – and sob. I would call it sobbing on Sunday. So I asked a locum to review the bloods – He gave every patient an appointment. When crown indemnity came into force I asked them to pass on the benefits by reducing the charge by £5 an hour. They refused. Sessions could be booked weeks in advance. The locum would cancel on the day. Who managed the crises? Me. ARRS role staff provide a better clinical service to locums in every respect. I have no sympathy for locums – they are risk averse, push the burden on others and do their best to avoid doing any real work. Locums did this to themselves.

David Banner 7 November, 2023 7:54 am

The single life always looks more attractive …..flitting from partner to partner never making a commitment, creating your own rules, enjoying new experiences ….far better than your boring married mates stuck with the same partner in the same place for eternity.

Trouble is, you often end up older, lonely, isolated, childless and bitter, undervalued by everyone, impotently shaking your wine-soaked fist at an uncaring world that has now rejected you.

John Graham Munro 7 November, 2023 9:16 am

what about those partners who cancel their holiday at the last minute?——–or those who hang around the surgery when supposed to be on holiday?——or even off sick?——-and don’t forget those who can’t find the cheque book when it comes to coughing up?—–I could go on

Barry Sullman 7 November, 2023 9:25 am

Cheque book? Locums were always paid on time. They mercilessly bled me dry whilst cheerfully providing a next to useless service.

Richard Greenway 7 November, 2023 9:51 am

Its tricky – but locums have increased charges by 50%+ over recent years, and GP practice incomes haven’t gone up to match, most have dropped. There are partnership and salaried roles available -many practices are desparate. Practices are often responding to lack of applications by doing what they can- its not their plan A. Any new funding is coming through ARRS scheme which prohibit spending on doctors and nurses, including locums.

Karen Ling 7 November, 2023 10:27 am

The reality is that many of us found salaried or partnership jobs too overwhelming and had to leave the regular day job to recover from burn out, either moving to locum jobs or working in the private sector. It’s not that we are lazy or want to deplete practice finances!

Matt Greenwood 7 November, 2023 11:29 am

Dispute the claims here every LMC jobs page has lots of job options and vacancies for GPs
The difficulty is funding to practices has been cut and as responsible people for the running of a surgery you have to make the best use of the funds that are there. Unfortunatly now that there is compertition from a MDT and the expenential growth of people choosing to locum over regular work we now have a market implosion the exclucive position of the last few years has gone and we all must adapt to no winter pressures funding and the toll of unfunded goverment promices

please lets not attack each other but help each other please see your local LMC jobs pages there are lots of options

the list is easily avalible search google LMC *your area Jobs

Matt Greenwood 7 November, 2023 11:29 am

Dispute the claims here every LMC jobs page has lots of job options and vacancies for GPs
The difficulty is funding to practices has been cut and as responsible people for the running of a surgery you have to make the best use of the funds that are there. Unfortunatly now that there is compertition from a MDT and the expenential growth of people choosing to locum over regular work we now have a market implosion the exclucive position of the last few years has gone and we all must adapt to no winter pressures funding and the toll of unfunded goverment promices

please lets not attack each other but help each other please see your local LMC jobs pages there are lots of options

the list is easily avalible search google LMC *your area Jobs

Mr Marvellous 7 November, 2023 12:32 pm

We saw a similar issue during the pandemic. I have, in my career, been a Partner, a Locum, and Salaried.

As a Locum, you must accept that your bookings and your income will depend on you working at the rate that the market is willing to accept. When demand was high and practices were willing to pay rates went up.

Recent years have seen GP Partners take a hit from nearly every direction (unfunded staff salary increases, increased mortgage costs, inflation, utility bills) and so practices will see what they can (or more accurately are willing to) afford.

If you’re not getting enough work at your current rates, you need to drop them or hold out for the same rate but appreciate that you’ll get less work. And yes, you are competing with less qualified staff that won’t do as good a job but will tick the “patient seen” box and these are funded centrally. You and I know it’s suboptimal and sometimes poor medicine but NHS England like it and are willing to pay for it.

You can’t have it both ways when you operate in the market.

Fox Mulder 7 November, 2023 2:45 pm

How many GP posts can people find across Leeds? Salaried or Partnership? The answer is ZERO. The same goes for Bradford and it is a similar story across the North West. Leeds is the 6th or 7th largest city in the UK and not a single GP vacancy – this is shocking. Across the Leeds-Bradford area there are hundreds of GP locums now effectively unemployed, probably 500+. It is not even about locum work anymore. It costs up to half a million pounds to train ONE GP! Where are these thousands of UK trained GP’s supposed to go now?

Fox Mulder 7 November, 2023 3:03 pm

Profit making should never come before quality of care. Patient safety should similarly never be compromised. If practice profits are truly being squeezed (debatable given even pre-ARRS we were hearing of partners making £250,000+) and GP locums/salaried are no longer ‘affordable’ this needs to be made clear to the public and the misleading statements about there being a ‘shortage of GP’s’ in this country retracted. Either way having thousands of GPs sat at home unemployed is an untenable situation. As highlighted above it is not even about lack of locum work anymore – there are large parts of the country where there are simply no posts of any kind for GPs. These people will have mortgages to pay, bills, school fees etc, all in a high inflation environment. What a waste after decades of training and rigorous exams. Among this group there will be GPs who suffer with ill health and those returning from maternity leave. Many are already leaving this country; hundreds and probably thousands more will follow. What a travesty.

A Non 7 November, 2023 3:59 pm

Hey Mr Marvellous enough already with ‘the market’ bullshit. You, I and everyone knows there is no market in UK healthcare. You my friend do exactly as you are told and if you don’t like it tough. The minute anything approaching a real market genuinely gets going (i.e. the explosion of locums over the last several years) the government steps in and does all it can to destroy it. To the extent they appear to have decided to get rid of GPs all together. You think its not happening? Open your eyes ..its happening and its happening right now and you and your like are carry out the dirty work. Keep on doing what your told but please don’t patronise the rest of us who see this for what it actually is.

David Taylor 7 November, 2023 4:05 pm

Blaming GP Partners for the current situation of tight practice finances due to static funding with high bills and wage inflation is frankly absurd and is no doubt exactly what the powers that be want to see. We can’t give any healthcare to anyone if we all go bust and are no longer financially viable so yes making a profit is fairly important as a GP Practice as I don’t fancy getting evicted any time soon.

Mr Marvellous 7 November, 2023 4:14 pm

A Non

I know exactly what the situation is, I have no doubts about the direction of GP in general and have planned accordingly.

“You and your like” are the ones squealing about the lack of work. If you want work, drop your rates. If you don’t, that’s up to you. I don’t particularly care either way.

GP Partners don’t owe you a living.

Omer Jan 7 November, 2023 4:42 pm

Our practice has the same number of doctors as we always have had (no massive change in patient numbers either) – we now have two new PA’s (about 1.5 FTE) who do a great job, debriefs and doing their scripts is a bit of a headache but they are a massive help with seeing patients and I have no doubt in saying that they operate at good ST3 level.
We still get locums but honestly, where are these experienced amazing locum GPs, I dread having locums because the number of pathology results coming back the next few days is just unreal – request every investigation for every patient and let the partner deal with it.

Fox Mulder 7 November, 2023 5:06 pm

What no one is answering is the key question – where are THOUSANDS of fully qualified GPs (NASGP estimates there are 17,200 GP locums in the UK) expected to go now? 4,000 GP registrars are qualifying every year on top of this.
Hang on, I thought we had a severe GP shortage?

Some Bloke 7 November, 2023 8:10 pm

Fox, why don’t you answer your key question yourself? Guess you know the answer.
My key question is different – why do I not have funds to staff my practice to a desired level? And to that question – I have an answer. Because past 13 years we’ve been led by a bunch of self serving liars and dimwits, quick to throw promises of unfunded better than to be expected care and dreamt up efficiencies. What is even worse- they were elected three times, admittedly last elected failure of a PM was an anti- Corbin thing.

David Jenner 7 November, 2023 8:28 pm

Dear Fox Mulder
I have just looked on Leeds LMc website and found five salaried GP posts available.
Another contributor has shared a link to other websites desperate for GPs and we are advertising too for a salaried post amongst many others in Devon .
So the answer to your question is they can apply for those posts , and only when the adverts are truly non existent should GPs genuinely interested in working as a GP in a role requiring some
Commitment look to go abroad or retrain .
Lets think about patients too, they often value continuity and a regular GP either partner or sessional.
Locums have a right to seek flexible work but then they must accept flexible employment ( or not) .
I think there will always be a demand for them , especially to cover parental leave .

Ian Pidgeon 8 November, 2023 8:33 am

I understand your concerns… But… You can’t have your cake and eat it..
When living were in VERY high demand, your prices went up, and your demands were challenging (no paperwork, £60 extra per visit etc). You have the freedom to take days/weeks/months off at your will…
This was the luxury of being a locum, and not under the “restraint and protection” if being employed by a practice, or being a partner.
Now the situation has changed, and your “luxury of choices” is no longer favorable.. you DON’T get sick pay or COVID pay.. But you CHOOSE THIS. you don’t get offered employment when practices don’t need you.. But you CHOOSE THIS..
When locums were reaping the joy and financial benefit of being in high demand, where were the articles in pulse with the headlines “dear partner..I know you desperately need me, so I’ll work longer hours, do more work, and charge you less….”.

As a partner I CHOSE to have the red tape, responsibility of staff, and carry the “final buck”.. but with that comes stability and regularity of income etc…

Fox Mulder 8 November, 2023 11:20 am

10 posts across the whole Yorkshire County some of which may already be filled given the situation.
1000 GPs (probably more) into 10 does not go!

Fox Mulder 8 November, 2023 11:33 am

Ultimately by hiring non-doctors instead of GPs (whether that be salaried or locum) to hold GP surgeries and perform visits we have devalued the profession and made a mockery of our degree and all the rigorous training and examinations we have had to endure over a 10-11 year period.

Therun Nassa 8 November, 2023 12:26 pm

GPs prefer to become locums to retain some control of their life and sanity. All GPs should understand this! I don’t know why there’s so much resentment for locums. If you’re not happy with your lot, try being a locum instead yourself. Quite rightly no doctor should see a patient in less than 10 mins !, not because they’re lazy but because it’s not safe or reasonable. I challenge the notion that a truly thorough and safe job can be done. even in 10 mins, let alone less. Of course a locum should charge for extra time spent on visits or admin – I don’t know why this is considered strange ?? Incidentally where I work locum rates have never been £100 per hour. Also I’m not sure how some of you believe that locums operate with no risk or responsibility ?? – every clinician has risk/responsibility. It is also certainly true that factoring in no sick pay/holiday pay and NHS pension for many – there are financial sacrifices to make if anything, it’s not winning the lottery. Everyone (as many have said) needs to understand the real problems in GP, the reason why so many choose to be locums in the first place !

A Non 8 November, 2023 1:11 pm

Mr Marvellous
Nobody is squealing, but your use of a word associated with pigs to describe colleagues says it all. Personally am fully employed thanks. If you cant find peers willing to do as you say I suspect theres more to it than what you want to pay them. Carry on doing whatever you want but don’t kid yourself your anything other than part of the problem.

Ian Pidgeon 8 November, 2023 1:46 pm

“GPs prefer to become locums to retain some control of their life and sanity”

I completely get this. But that control and freedom come at a cost. It just so happens that cost is lack of support when you’re not needed.

I’m a partner… This comes at a cost; I have less freedom than a locum (to a degree.. I work many half days to fit with child care) but I have much more financial/employment safety. Plus, I REALLY like my job and my practice.

I don’t resent locums at all.. we use a great bunch when we need them. But when we don’t need them, I’m not responsible for their financial well-being …

Ray Shrouder 8 November, 2023 4:37 pm

Wow, I hadn’t realised how divided our profession has become.

Camaraderie is dead 🙁

Pangaean Soup 8 November, 2023 4:46 pm

Well said, Ray Shrouder. It’s sad that some GP principals have taken the effort to write in to slag off GP locums instead of staying united against the common enemy of low quality politicians and capitalist oligarchs. In the last 13 years these politicians have mismanaged the beloved NHS forcing GPs to work under ever-worsening t&cs, such that increasing numbers turned to being GP locums, instead of choosing to prop up the service that was being impoverished and strangled.
Show support for your GP locum colleagues – you wouldn’t slag off your hospital colleagues taking action over their woes.

James Bulltard 8 November, 2023 4:51 pm

The author and 90% of comments missing the crucial point:

Any funding beyond shrunken-inflation-ravaged core funding is all tied into the PCN DES so we are contractually unable to hire GPs.

Scottish GP 8 November, 2023 5:45 pm

Partners and locums not to blame, we need to step back sadly and watch it fail. Then invest in 3 piece suits and carnations for our buttonholes. They need us but sadly don’t realise it. The sooner the better. Running round like headless chickens doing a half decent job just prolongs the agony.

Ian Pidgeon 8 November, 2023 7:01 pm

“It’s sad that some GP principals have taken the effort to write in to slag off GP locums”

I would challenge this by highlighting most comments aren’t “slagging off” the locum employment model…
My office heavily retires on locums at certain times, and they provide great clinical care.
It’s just highlighting that by choosing this model of employment, you have chosen a mix of luxuries and risks…
When the times are great, locums reap the luxuries in their bounds (a few years ago we were begging locums to cover clinics..paying £££)..
But in a time of partners/principles choosing to spend their finances in a way that isn’t in the locum favour (bearing in mind, partners have significant personal financial investment in their business that they run), you can’t be angry at the partner..


christine harvey 8 November, 2023 7:46 pm

Many locum’s were in the same position when Covid started which for me was about 3 months into a new locum career after 19 years as a partner and burning out in that scenario . I managed to make it work and I’m sure I will again.
What really scares me is the poor care that some of the ARRS roles provide – often with the patients thinking they are seeing a doctor. In certain roles they are fine – in an undiagnosed population they can be dangerous and I have seen this time and time again with GP’s having to pick up the pieces or avert disaster at the last moment.
Are GP principals really happy with the care being provided? I’m pretty sure I would have some concerns about the set up I was putting my good name to.

Bernie Hunt 8 November, 2023 9:31 pm

ARRS staff are fully funded by nhse at pcn level. PCN’s are part of nhse strategy, the way forward. It is a deliberate policy to cut GP funding ad have patients seen by non medics, like ANP’s, PA, pharmacists, paramedics, who now regularly see and diagnose(up to their very limited ability as medical technicians) undifferentiated cases.
When pts die, the press pick up on the patient not knowing it wasnt a doctor the patient saw. What really matters is the government are moving to a situation when it usually wont be a gp you see in GP. The same happens at LAS. Few patients speak with a doctor. They think a senior clinician(ARRS staff) is a senior consultant, and they listen to very imperfect advice which will, as in GP cost lives. Its cheaper medicine from non doctors, brought in by the current government for people relying on a previously doctor led NHS. ARRS staff are only responsible up to the level of skill they hold. Patients will suffer, Gp’s will go abroad. Gp’s should think twice before we train ARRS staff, to be ‘clinicians’, a better term is medical technicians. And GMC shouldnt regulate non Doctors.

Bernie Hunt 8 November, 2023 9:44 pm

Ps as a Locum, I dont blame partners, I dont blame ARRS staff, but I do blame DOH/NHSE strategy to deliberately offer low cost, lower standard health care to the UK population, for no other reason than it makes the state smaller.
There is massive savings that could fund front line GP’s nurses, hosp doctors and AHP’s, and thats in management costs, trusts, CCG’s NHSE etc. The massive admin manager costs that go with the NHS structure, thats ineffective, inefficient, and and a barrier to best patient care. Its not how big banks run. The admin managers support the bankers who are best placed to make decisions on finance. Lucy Letby case illustrates the obstructive effect of executive admin management on patient safety. It has the same negative effect on patient care as delivered, and drains the system of much needed front line expenditure on health workers of all grades and types.

Pangaean Soup 8 November, 2023 11:14 pm

Instead of collaborating with every ‘bright idea’ the politicians/NHSE come up with, latest being ARRS, GP principals need to take positive action by”striking” and withdrawing their services and so drawing national attention to the dire situation that NHSE is forcing upon them and their patients. Stick up for your patients – you know they deserve better. What sort of country and healthcare system do we want going forwards, now that we have our sovereignty back. This will be a bad winter for the NHS.

T :) 9 November, 2023 7:16 am

As a GP partner I would employ a locum over an ARRS anytime. Obviously at a reasonable rate which in my area is about £75 and hour, no visits and actioning self generated paperwork. ARRS if you add the supervision needed and the rate of patients they see compared to a doctor, actually work out more expensive not just in financial terms but in stress of supervision and risk taking on behalf of the partner. Each have there roles. A good locum wins everytime. Honestly they get paid very similar to the GP partner at this rate anyhow and even the trainees earn a similar wage. 😦.

David Coleman 9 November, 2023 12:18 pm

At our practice we’ve got more doctors than ever before and still use locums every week. Another factor may be expansion of GP training numbers and greater focus on GP placements for registrars. As a result, we have 9 GP registrars currently – even when supervision is accounted for, this provides a boost in capacity and negates the need for locum capacity somewhat.

We’ve had no change in number of ARRS staff in last two years – these roles were generally recruited early. I think the big tipping point has been partners getting last year’s accounts, experiencing a significant drop in income, and then facing further rises in expenses this year (and likely next). Locum costs are the only real variable expense and with no firm requirements for access, it’s the one think we can cut/stop to keep the ship afloat. I don’t think many are making an ARRS>locum decision, as I don’t think there’s much of an overlap between what these roles do, it’s more a case of having to make so with what we have.

Adam Crowther 9 November, 2023 9:42 pm

In our region ARRS roles have been superb particularly when placed into specific appropriate roles. I don’t buy the “other HCPs are dangerous” narrative at all. We employ regular GP locums too. Generally former salaried or partner GPs and of course they are excellent but would rather they took up permanent employment with us so they can enjoy the additional benefits this brings. It is sad that GPs don’t feel able to work in permanent roles but completely understand why they don’t. Sadly all the additional funding into general practice is funnelled into the restricted PCN DES and so the “spare” money in the GMS contract has been lost to inflation on the other elements of providing a practice such as other staffing costs and consumable and utility expenditure. This is not the fault of any GP or other HCP. If HMG resource the GP contract appropriately for the needs of patients and staff and make a commitment to the wholesale investment in the general practice estate only then this situation will resolve sadly 😢

Karim Adab 11 November, 2023 1:31 pm

Edit – posted without finishing – makes no sense at all to say “The GP partnership model has gone very, very wrong for thousands and thousands of GPs” – it has always been individual choice how one wants to be a GP, to then blame the system because you don’t like your choice is perhaps a position requiring some further reflection.

Pangaean Soup 11 November, 2023 7:04 pm

The multiple factors that lead a GP locum to making an *individual choice* include whether one wants to collaborate with propping up the underfunded and dying GP partnership model, and selling out by pretending one can provide a “world class” service given the funding and time constraints, never mind the increasing complexities of clinical care and patients’ wants. In my experience (partner, salaried and locum), the golden time to have been a GP was in the 1990s. The vast majority of locum GPs I’ve come across are admirable and excellent clinical doctors, earning between £30k to £80k, while managing life and work. This is significantly less than GP principals’ incomes. Anyhow, all GPs will be soon salaried.

Mr Marvellous 12 November, 2023 9:18 am

I find the entire concept of this article bizarre.

“Unemployed” should be “I’ve set my rates at a level at which people don’t want to or can’t afford to employ me”.

Seraj Anwer 27 November, 2023 9:01 am

Absolutely, agree with this comment. Locums have sucked the system dry – charging obnoxious rates because “they could” – most (not all) providing a wash your hands of service at the of the day – letting the partners pick up the pieces and follow up the patients.
Now that the money has dried up in the system – it’s time to “shake up” – because you cannot get locum work! Oh come on!
You left your partnership for an easier life – because you thought you would be able to seeing all the £££ without much work. Now you should accept it!
I have no sympathy I am afraid.

NHS terminal 27 November, 2023 7:40 pm

In my neck of the woods, GP principals 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 and locum pay rates. Around here, average GP salaries are £85k full-time and locum pay rates £85 per hour proving that GP principals are, after all, first and foremost businessmen.
GP principals always hide behind the excuse that they’re only actioning whatever management tell them to do, even selling out their GP colleagues, salaried and locum. The GP profession is divided – there are GP principals and the rest. Most patient-oriented work is done by the “rest”. Isn’t that true? To paraphrase Orwell, it seems not all GPs are equal, some are more equal than others. Spending huge energy protecting their excellent incomes and pensions, GP principals are no longer advocates for their patients. Time to get rid of the partnership model methinks, and no doubt we’ll hear the howls of GP partners’ anger when the government no longer needs to stuff their mouths with gold. And then sit back and watch as the corporate vultures start picking over the bones of the NHS.

Barry Sullman 28 November, 2023 12:24 pm

What a load of nonsense. Have you any idea how tough it is to be a Principal? Yes the pay is more, but for that forget having a family. Forget late mornings in bed over weekends. Forget parties. Principals live and breathe the practice. I work 12 hours a day continuously, often 7 days a week. My children have to make an appointment to see me. If I had a time machine I would never have become a principal. Salaried GP with no care about the practice running is a much better place to be in.

NHS terminal 28 November, 2023 1:43 pm

Aaaah the crocodile tears of the rich sitting on their golden hoard of monopolised income and super pensions! And yes, I’ve been both a principal and a locum. My prescription is that you take your own advice, and get a salaried job stat and hopefully rediscover the joys of general practice. Good luck with getting some quality sleep, going to parties and seeing more of your kids 😉