With the GP shortage sending locum bills spiralling, the Government must rethink its workforce strategy, says Dr Andy Sant
For many English GPs, the progression of the health bill continues to occupy our thoughts.
Despite not yet being passed into law, the development of clinical commissioning groups (CCGs) is happening at some pace, alongside the clustering of PCTs and SHAs.
I work for Devon LMC, and on our large patch we have heard increasing concerns about significant calls on the time of jobbing GPs.
People have warned this is having a detrimental impact on the availability of GP locums.
While these opinions were leavened with some anecdotes, we felt it would be beneficial to try and acquire some quantitative evidence.
During August we ran a survey on our website to encourage practice managers to report their feelings regarding locum availability.
The response was excellent. Some 58 practice managers posted a response, representing over 30% of practices in the county.
While the survey was mostly qualitative, it has given us some tangible information on the practicalities of covering absent clinicians with locum staff.
The results conclusively showed that booking locums this year is much harder than last year – and practice managers were also asked to make some comments regarding their experience.
‘Booking locums is a particular problem unless booking some three months plus in advance,' said one practice manager. ‘Short-notice cover is a particular problem now.'
Another warned: ‘Last-minute booking for emergency cover such as sickness is pretty much impossible.'
And a third said: ‘I have been working in general practice for seven and a half years and this is the hardest it has ever been.'
The unifying theme appears to be the difficulties in booking locums without significant advanced notice.
Meetings and leave that are planned long in advance appeared the easiest to cover, while short-term sickness absence was the hardest.
It is perhaps hard to give a definitive answer for the reasons behind such a change. Clinical commissioning in all its forms appears to be mopping up huge numbers of locum sessions. This has been a massive growth industry from virtually nowhere.
For example, one of our local commissioning groups offers two days a week for its chair and half a day a week for each of its six board members. This removes a full-time equivalent GP for a CCG covering a population of only 100,000 patients.
This means that within six months of starting, the CCG has removed 2% of the GPs from its area.
At the risk of having an American discussion around salary, there may also be financial reasons for the behaviour change in GPs who undertake locum sessions.
The tapered tax relief on earnings above £100,000 is an incentive for people to stop doing work above this threshold.
A similar argument applies to the increased NHS pension contributions above £100,000, and there is another pinch point at £68,000.
Perhaps for a lucky select few, the 50% tax rate on earnings above £150,000 is relevant.
Are locums making a conscious choice to limit their income to minimise personal taxation and maximise their work/life balance?
The changing demographics of our profession may also have a part to play, although this argument has been used for decades.
The increased feminisation of our workforce is a fact – but perhaps even men prefer to work part-time these days.
Planning for the future
The health bill has been a long time in coming, but within a short space of time it has mopped up a surprising amount of surplus GP time. Given the long lag in training up a new generation of GPs, it is a shame that those responsible for central workforce planning didn't apply sufficient diligence in working out a response to this in advance. Their failure to do so has left our profession, and the patients we serve, with a real issue for the foreseeable future.
Given that our problems may be compounded by the proposed pension changes and the ongoing actions of a Government struggling with mounting national debt, perhaps we should ask ministers to consider a response with some urgency.
Dr Andy Sant is a GP in Plymouth and executive vice chair of Devon LMC
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