As large numbers of GPs struggle to find work, Jaimie Kaffash argues that the only way to solve the recruitment crisis is by increasing practice funding
I can’t quite believe that we are in this position. After a decade-long recruitment crisis, it has become very clear that there are large numbers of GPs struggling to find work.
Our special survey on recruitment showed that there are fewer GP vacancies than last year, and that there are many locums out there who are struggling to find work.
It’s not clear the exact reasons for this. Some are saying it is because of the additional roles reimbursement scheme, which funds practices to hire non-GP staff but not GPs. Others are saying it is because practices have given up trying to find staff, so fewer roles are being advertised. And others still are saying that there simply isn’t the physical space.
Yet these are linked by an underlying reason – a lack of funding. Practices are using ARRS staff, because that is what they are funded to do. They have given up trying to hire GPs partly because the cost of living is affecting their baselines, meaning they can’t afford to hire the increasing number of GPs that are open to permanent positions. And they haven’t the space to employ more staff, because capital budgets have been affected.
All of this has had the effect of creating the worst of all worlds – practices still desperately needing GPs, yet a number of GPs are needing work and finding themselves in a desperate position.
The answer is not for GP locums or prospective salaried to start lowering their rates. Apart from the human aspect of cutting pay during a cost-of-living crisis, there would be wider repercussions: if we start undervaluing any GP, then all GPs will suffer. Yet the pitiful increases in practice funding mean that they can’t afford GP pay – even if partners take huge pay cuts.
There are obvious solutions. I’ve already suggested including GPs in the ARRS. But there is an even more obvious one – to increase practice funding. But this won’t happen, especially with an election next year when the Government are likely to be voted out. Increasing funding would start having an effect after the election so even if the Conservatives weren’t ideologically opposed to funding public services, they certainly won’t do so now.
But without this increase in funding, we are in the midst of Schrödinger’s recruitment crisis – not enough GPs, but lots of GPs out of work. Only this Government could pull off that trick.
Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at editor@pulsetoday.co.uk
READERS' COMMENTS [7]
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Good article, but there is one more option. Force the funding in “rotten” GP practices be used to employ locums and open up appointments for patients, rather than being trousered. In this city (and there may be similar situations in other large cities), there are a few GP practices which are well known within the local GP community to be badly run. But nobody does anything about it; they should be forced to employ at least the average benchmarked doctors and nurses, or have their contract caretaken. And the GP partners running these practices are also among the highest earners. For example there is a GP practice of 3 principals for 20,000 patients (plus 2 salaried and previously adhoc locums), the principals earning around £200k pa. Or another 1 GP principal practice that “manages” 3 sites, again earning £200k. I know this situation is repeated in other large cities and the vast majority of good hardworking GP principals know which are the few rotten practices in their city. They’re usually in the deprived areas where the patient population struggles to have its voice heard.
So what I suggest is that, firstly the vast majority of good, hardworking GP principals no longer let rotten colleagues get away with this in their cities and that they expose these few rotten apples, otherwise everybody gets tainted with the rot. Name and shame them, for the self respect of the profession. And, secondly, get locums back working in these rotten practices so that at least more appointments and care is being provided, paid for by the funding that is already there but which is merely being pocketed by the few rotten principals as incomes of £200k.
Partner “income” and take home salary are two very different things. I have found this out the hard way over the years. It is even worse if you are paying business loans for buildings (so another mortgage equivalent or more than a house),
Are there fewer partner and salaried vacancies though, or is it just fewer locum vacancies?
If it’s only locum vacancies which have “dried up” then we’re really talking about a mismatch between what practices want from GPs (partner / salaried commitment) and what GPs want from practices (no-strings locum work)
Dylan, it’s some of what you say. But also a lot of it is GP partners falling in with the latest govt scam, I mean scheme, re taking ARRS funding even though the repercussions of employing ANPs, PAs etc to give first contact care for undifferentiated presentations has not been properly thought out (including who regulates them). Finally, there’s the usual small group of culprits (every large city has them, it’s the GP profession’s dirty little secret) who pocket the funding, take home high incomes (£200k around here, post-practice expenses but pre-personal tax and expenses) and direct their patients to 111 and a+e. When the NHS is more or less broken, that final group should be named.
the human aspect of cutting pay during a cost-of-living crisis – I take it partners aren’t human and our year on year pay cuts don’t matter then.
with regards rotten apples – they exist outside cities as well believe it or not, but suffer the same accountability from expensive ICBs who seem incompetent and clueless across the whole nation.
The disparity and decline in General Practice and reducing locum work is multifactorial but is in my opinion being spearheaded by PCNs led by PCN Clinical Directors who receive huge sums for promoting lower quality ARR staff within practices via PCNs and on occasion outside of their actual ARR competence. ARRs may have a role but certainly not to replace GPs and while PCN Clinical directors continue to receive payments to promote this process , then the situation for other GPs will continue to worsen.
We should not forget, PCN Clinical Directors had their payments quadrupled during the pandemic so this may well have been an additional possible £100,000 payment on top of other partnership/GP work payments and for certain, some of them were no where near the vaccine HUBs.
They operate groups of PCN Clinical directors with meetings often/sometimes to the exclusion of the wider GP frontline clusters and accountably to any reasonable extent is lost.
There is also an increasing number of private GP groups /enterprises being set up to take on GP contracts within certain areas , often involving the same names/ individuals or GPs and sometimes with no transparency as to the payments the GPs on these boards receive, despite these groups managing huge contracts.
In some locations, for years, the same names are appearing on different board positions over and over again and unless this relatively smaller GP group in different areas is held to account, the NHS will continue to face an inexorable steep decline to the demise of locum and eventually all other GP cohorts..
Well said Centregroundx2. Couldn’t have put it better myself..