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Has the recruitment crisis come full circle?

Has the recruitment crisis come full circle?

As GP locums struggle to find work, Jaimie Kaffash reflects on whether the recruitment crisis has returned to where it was a decade ago when younger GPs were left unemployed

As you may have seen, after 64 years, Pulse will be printing its final ever issue in January and concentrating our efforts on digital. This has given me a chance for reflection. Having been at Pulse since 2012, one story (other than Covid) has dominated my time – the GP recruitment crisis.

When I first started as a reporter, I remember going to a briefing after a BMA GP Committee meeting back in the days when they did that sort of thing. One of the big themes was how impossible it was for younger GPs to find partnerships, but also struggle to find jobs at all.

That changed pretty much overnight. Soon, we were hearing stories of practices being unable to fill vacancies, and it has stayed that way ever since.

I can reel the stats off the top of my head: in England, promises of 5,000 and 6,000 new GPs by various health secretaries, with the result being a loss of thousands.

So there is something poignant about this issue potentially going full circle. We are hearing more and more reports of locums struggling to find work. And perhaps even salaried jobs not being available.

This is by no means universal. We know some practices are still looking for GPs and struggling. But it does feel as though – at least in some areas – this recruitment crisis has come full circle.

The reason behind this in England, it seems, is that underfunded practices are having to rely on the cheaper options paid for by the additional roles reimbursement scheme (ARRS). At the moment, the focus is on physician associates.

There are ethical issues around this, of course. I reject the idea that PAs are straight out of school, with no training etc – and I absolutely agree that any personal abuse towards them is wrong (though those who do insult personally are few and far between).

But – just like pharmacists, paramedics or first contact physios – they aren’t GPs. They are all great when given task-specific work compatible with their training and capabilities but are a threat to patient safety if filling in the role of GP.

However, them filling in for GPs was the always the logical conclusion of the ARRS. If you fund practices to employ one sort of professional, the chances are that that is what they will employ. Especially when you are effectively reducing their funding during a cost-of-living crisis. This gives the illusion that enough appointments are being offered while also requiring space that stops GPs from being employed.

There is a really easy way out of this, of course: allow practices and primary care networks to use ARRS money to employ locums. This will improve patient safety, which has to be the priority for the NHS and the Government. And putting the trust in GPs to spend this funding on the right roles is a much better approach than the current ‘NHS knows best’ attitude that would have made a 1960s GP blush.

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



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

Pangaean Soup 8 November, 2023 5:11 pm

Good solution offered. But will this government listen to sense? It can’t be right, when winter is coming, that ?1000s of locum GPs are sitting at home when they could be usefully employed to alleviate the pressures and waiting lists..

Simon Gilbert 8 November, 2023 5:44 pm

NHS Commissioners hold Quantum GP views – simultaneously believing that the answer to all health challenges is ‘GP to sort’ whilst also sticking to the credence that GPs cannot be trusted to rationally allocate more funding themselves.

Jonathan Gregson 8 November, 2023 6:35 pm

I find it difficult not to feel schadenfreude for the locums’ situation.
For years, GP principals endured locums and salaried doctors gloating about them earning as much as partners without the responsibility. They waved bye to the practice and didn’t take work. We carried on minding the shop, ensuring there was primary care infrastructure to support the very jobs they enjoyed.
However, with responsibility comes agency, because now as we attempt to maintain profitability in the face of rising costs and reduce real term rises in income. we are choosing to use ARRS monies to staff our practices
PCNs are not able to employ GPs en mass because finite ARRS budgets will not stretch to that far.

David Church 8 November, 2023 8:53 pm

@ Jonathan : I never gloated, I did the work well, often the least popular shifts, and often the most inconvenient ones to family, etc. Then I worked hard for partnerships, but was abused by dishonest partners, but still I worked hard. Being unable to recruit during the recruitment crisis, I had to give up the partnership, and did salaried work for a while, but found some Partners tried to abuse the goodwill again, whilst raking in profits and trying to avoid paying employed staff fairly (although others were better!), so went back to locum work: I always work hard and try to provide a good service. I have never charged as much as locum agencies were charging during the recruitment crisis, but I do feel that part of the funding problem in GP now is because of Partners forever agreeing to do more work for less money, and then try to avoid actually doing it. Partners have caused the low incomes by undervaluing employed doctors, and going overboard on trying to get quality work for peanuts. Locums (but not agencies, generally), have been fairly valuing the work they do, unlike business Partners, and now DoH is looking at this and saying Partners don’t deserve as much as they say they are worth.

Rehman Ata Tung 8 November, 2023 10:59 pm

Young GPs should just leave the country. The whole system is designed to work agains them.

Dr No 8 November, 2023 11:26 pm

@Rehman… yes, agreed, and older GPs should leave, this isn’t a job I recognise any more and I see the direction of travel from all political colours.

John Graham Munro 9 November, 2023 5:02 am

@ David Church——–my profile exactly——except that I impress upon the Practices, that they need me more than I (as a ”high class” locum} need them.

David Coleman 9 November, 2023 8:24 am

> allow practices and primary care networks to use ARRS money to employ locums

I don’t think this is a great solution either. Most PCNs will have already maxed out their ARRS budget. We haven’t been able to recruit beyond one or two replacement roles this year because we hit our limit long ago. We have 70,000 patients, 1 PA, and no budget left. But at current locum rates, that full time PA salary would only cover around 50-60 days of locum work which if you spread it around our ten practices would give on average 5-6 days each.

As a network, we recommend practices use IIF money for locums to boost access, but the best answer- as it always is – would be more money through the core contract.

Turn out The Lights 9 November, 2023 10:58 am

The ARRSE money is a short term solution, with short term positions.once staff realise they are not on agenda for change and their money doesnt go up yearly as in secondary care and trusts(not funded) they will be off.Primary care as been defunded and the Tories are practicing a scorched earth policy for the next administraion.Their will be no money.The NHS is finished and the BMA have not provided a plan B (yet they will have to soon).The NHS is sunk.

Nicholas Sharvill 9 November, 2023 11:13 am

What should a locum be paid? There are those partners who do their very best to provide a service for their patients in an underfunded service. There are also a few Partners who perhaps provide a very poor service to their patients but draw a high income that nobody checks. There are hard working locums and there are the who think they are worth more than they are in terms of sorting problems for patients . In the very old days it was normal for new GP to earn very little and old ones to get seniority payments, the most productive time I have read for being GP being in ones early 40’a. So those just starting and those past their best as ex partners drawing their pension perhaps should earn less?

Arun Perumpallil 13 November, 2023 3:31 am

Is all the reactions a bit too late. What will the thousands of Physicians Associates who were trained do? It’s poor planning that has left the workforce in such a bad situation. In spite of all these PLAB continues and IMGs who pass PLAB find themselves to be one of the 500 odd applicants for a single post. Human resource do not like to appoint them due to the hassle of applying for sponsorship. Practices do not have the physical space to appoint more clinicians or take on more trainees or ARRS staff. The reforms are aimed at reducing primary care relying on locums as during the golden period they were charging a lot for very little work leaving partners to do many more hours than they wanted to keep the practice running. ARRS stuff may cause less and may not have the skills of a GP but with effective triaging they can be a very good workforce. I’d there is a bottleneck should the training post increase be reconsidered and the invitation for IMGs as well.