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Why would anyone want to be a locum GP?



The other day I found myself asking, ‘Why would anyone want to be a locum GP?’

In the current climate, this may sound naïve – there’s no doubt a cohort of partners and salaried GPs out there who long for locum-esque liberation.

But before I get a barrage from free-spirited locums waxing lyrical about the ready cash and ‘on my terms’ work ethic, or an aerial bombardment from peeved principals, give me a moment to justify the question.

One of the best things about our job is case follow-up. I see a doctor’s job as being like a detective’s. The patient presents with symptoms, a bit like a witness statement. Then you investigate further and gather clues – blood tests, imaging, trials of treatment. Then you bring it all together to diagnose and manage, or solve, the case.

And surely the most appealing aspect to any job, medical or not, is ‘solving the case’, whether you’re an officer in the Met, or a teacher with a challenging child, or a young parent managing a busy household with a stretched income. There is unquestionable satisfaction derived from catching the criminal, getting Archie to write his name, or ending another tight month in the black.

This morning I got another email from another cutting-edge, ‘by GPs, for GPs’ market-leading online locum agency (who, they point out, are not actually an agency, they just ‘match’ GPs to practices). The Head of GP Engagement had taken the time to write, though we’ve never met.

‘Head of GP Engagement’. Ouch, the irony burns. GPs are being proactively and cynically encouraged to disengage from the profession by this toxic industry that increasingly wants a slice of NHS pie. They are lured with promises of ‘unbeatable rates’ and seduced by insincere emails offering ‘an holistic approach to locuming’.

At my practice, we’ve use several locums to deal with winter pressures. Their abilities were worryingly variable: some have been excellent, many were not. They have their role, of course, and we stumbled through January thankful for their appointments.

But to return to my original question: who would want to be one? No case closure, no follow-up, no team to work with, no home.

It’s not so satisfying catching the criminal if you’ve not been involved with the case. Personally, I’ve had enough of filing pathology and imaging results I didn’t request. Often, I can’t even see how the investigations were justified. Perhaps the locum who ordered them felt more wary of litigation that day. Or perhaps they felt reassured by their cloak of anonymity, knowing a regular GP would follow it up.

And I don’t think politicians or practices help the issue, either. We all need more flexible work and better employment terms to re-patriate a generation of GPs whose needs now are very different to their predecessors’ 20 years ago.

Locum agencies don’t care about locums and their self-pronounced holism is hollow. They exploit a silent stand-off between ageing partners worried about practice profits, and younger or disenchanted GPs for whom agencies seem a flexible friend.

I’ve done a few locums myself (though never through an agency) and I enjoyed doing them (for a month or two) because the money seemed better, and the freedom was a treat.

But it didn’t take long for the gloss to wear off. A tax return in January and eight weeks’ work without solving a single case were two reminders that, as they’d say in Sheffield, ‘the riches offered to a locum are nowt but hokum’.

Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E.