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Boom and bust

GMC Arora

Around this time last year, Pulse ran a series of stories on locums who were left without work, and in some cases left in a position where they had to claim benefits.

A year on and we are in a very different position. Locum leaders say that locums are being snapped up within minutes of declaring their availability. One practice in Kilbride, Scotland, has taken the drastic step of putting routine appointments on hold and only accepting emergency appointments because of staffing problems.

I have noticed a bit of antagonism between locums and partners around this boom and bust cycle, with some locums feeling aggrieved about practices halting their use last year. Partners, on the other hand, have felt they have been taken for a ride by locums charging higher rates. I can understand why both parties feel like that, even if I suspect that there is no malice on either side.

But my main feeling is that this is two sides of the same coin – the coin being the recruitment crisis that has not gone away. The instable nature of GP recruitment means that when partners do get the chance to rein back locum costs they will; conversely, locums always know this is a possibility due to unstable supply and demand.

I can’t see much respite from this boom and bust. LMC leaders are fearing winter, with pressure already mounting, and no doubt locums will be in even more demand. And no alternative counting of GP numbers will change this.

Maybe the only way out is to rip it up and start again.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at


Richard Fieldhouse 11 August, 2021 11:15 am

I agree Jaimie, we’re all in this together, and the more us GP locums can be enabled to redeem a sense of purpose through supporting local practices, the better.
In my experience, I feel practices have every right to feel aggrieved by the cost of some locums, but where this happens this is nearly always because it’s a locum agency that is charging its additional fee to the practices, not what locums are paid themselves.
And where practices/places imbue an inclusive culture towards locums, locums are happy charging less; where practices/places are dismissive of locums, the locums simply charge more for those practices as it’s simply harder/riskier to work there.
Let’s work together.

John Graham Munro 11 August, 2021 2:38 pm

I told locums way back not to despair—–their time will come—–well it’s here.——to the uninitiated——join an Agency——you will regret going into a private arrangement——I’ve been a full Partner on three occasions—- a salaried Partner—–and an Assistant——-I’ve also been a locum for many many many years——–believe me I know how each species thinks

Vinci Ho 12 August, 2021 12:16 pm

The reality always bites :
(1) The fact is, general practice in NHS is , by default , a hybrid model of small to medium sized business and government service . While GP partners are remunerated directly by the government as the biggest client in this business , they are also bound by NHS rules and regulations. When it comes down to employment or employees which include salaried GPs and locums , their decisions are subjected to the reality of a free market governed by demand and supply . Animosity , or even confrontation, only happens when sensible negotiations fail to materialise .
(2) Jaimie , as your recent ,interesting study/survey on how GP colleagues feel about the future model of general practice showed , partnership was still popular among your respondents . In fact, according to your report article, ‘’analysing based on age, the younger generations were in fact a little more in favour of a partnership-style model than the older ones.’’. 🧐
This resonates what I wrote previously that my gut feeling is , GP partnership is yet to disappear completely. But there are many modifications we need to take on the drawing board , once again . And I suppose the relationship between GP partners and salaried GPs/locums , is one existential consideration for all GP colleagues.
(3) Perhaps the two parties are frenemies , perhaps not . But one thing for sure , we cannot afford to be enemies against each other under the current circumstances where our common enemy is a government ,yet to understand and recognise the true position of general practice in this system ,but treating us as political expediency . The forthcoming Integrared Care System (ICS) alongside a new version of Health and Social Care Bill (bestowing the health secretary full power on executive decisions ) can be an existential threat to all of us(GPs) .
(4)You probably by now know how I feel about what our younger generations would like to choose in this realm of general practice. I have only one word , Respect .
Nobody should be treated as a means to just fulfil some immediate , urgent needs . This ridiculous ‘dystopia’ delineated by a retention/recruitment crisis can only be down to the past and present misdeeds of successive governments. 👿
(5) When the lips die , the teeth are exposed to threat of chilliness(唇亡齒寒) . This is a well known Chinese well known saying .
I can only plead for some soul searching in a historic time like this ……….😑

David Church 13 August, 2021 1:30 pm

Causes of locum rate rises :
1) inflation – supermarket food prices suggest 10-25% over last 2 years
2) have to make up for lower earnings last year
3) higher expenses costs due to price rises
4) additional costs for PPE, taking longer, extra laundry, etc
5) having to cover higher risks of periods of isolation and sickness – without any sick-pay arrangeemnts
6) higher pension costs due to ‘annualisation’
7) higher indemnity costs due to risks of GMPI failing to cover, or failing to record shifts worked
8) costs of needing to organise to counter ‘monopolising’ activities of DHSC/employers aiming to eradicate independent locums
Please support locums against government impositions, and help them to help Practices, and please, Partners, properly value yourselves and your time and work, against the income of NHS executives, football players, TV stars, Tech and financial Execs, and MPs !

Vinci Ho 13 August, 2021 5:55 pm

Many thanks for the information 😃