07 February
GP Locums; an essential service, or a potential impediment to the long-term and future stability of General Practice?
Continuity of care
At Menlo Park, we pride ourselves on being the only consultancy in the UK to focus purely on permanent clinical recruitment within primary care. Our mission to support the NHS by advocating continuity of care and providing long-term solutions, has seen us win back-to-back General Practice Awards for Best Primary Care Staffing Agency (Dec 2021). We were also voted winners of the 2021 Global Excellence Awards for ‘Most Outstanding Primary Care Recruitment Company’ and have a 5-star rating on Practice Index.
First, let me start by stressing that this article is not about the condemnation of locums. The ability to tap into the locum market to cover short term needs like holiday cover, sickness and MAT leave will always be crucial, however, what happens if locum GPs begin to outnumber permanent salaried GPs? What impact will this have on our Primary Care services, and the patient experience?
Locum GPs
The National Association of sessional GPs (NASGP) have said that ‘nobody knows the exact figure of GP Locums working in the UK; however, the GMC publishes the total number of GPs registered on their database and arrives at a figure of approximately 60,630. All data pertaining to the number of GPs in the UK states “excluding locums”, a figure of approximately 43,440. The difference between the two suggests the total number of locum GPs, as being approximately 17,190; circa 28% of the UK GP workforce,’ (nasgp, 2021) and apparently this figure is growing.
As you can imagine, in my line of work, I speak to many Practice Managers and GP Partners, and yes, some do only tap into the locum market for short term cover, however, many have had no choice but to rely on long-term locums because they’re unable to recruit a permanent salaried doctor. In fact, out of all the practice managers who I approached about their locum use, only one confirmed that their locum usage was for temporary purposes only.
I asked some of my clients if the locums they have used, do the same workload as their salaried doctors? Unanimously everybody said no. Although some were very happy with the patient care offered, there were comments across the board which included how most will not do admin or prescribing and most refuse to do house visits. One practice manager commented that they actually generate work for the team as they have to do the follow ups, while another went as far as suggesting that some locums seem to be losing their GP skill to deal with anything complex.
Benefits of locums
Again, please let me stress that I know there are some very good GP Locums out there providing a much in demand and valuable service, some of which combine a salaried or partnership role with locum work for that flexibility in their working week and even a change of scenery. All my clients were unanimous in understanding why GPs choose the locum life, benefits recently highlighted in my colleague Kirsty Morris’s article ‘Salaried Vs Locum’ dated January 24th, 2022, covering desirable advantages like flexibility in hours and days, workload and pay. When considering the pressure Primary Care is under, GP burn out etc who can blame doctors for choosing this line of work? Especially when you’re able to command daily rates of circa £750.00 as opposed to a sessional rate of circa £9,500 – £10,500 annually.
I asked my clients, what can be done to encourage more locum GPs to re-join the permanent workforce? Many hoped that the assurance of job security, being part of a team and having a voice within the practice would be appealing, not to mention holiday and sick pay. However, one practice manager said ‘I have tried! It never works!’ Others suggested more partnership opportunities, Golden Handshakes, and flexible working hours, maybe being able to offer more child friendly hours for example? The concern with being overly flexible as stated by a Practice manager in Tayside is the fear that Partners will leave as obviously all these benefits are what they want too! Achieving a balance is very difficult, especially with the demands on General Practice.
NHS Pension
One controversial topic raised was the fact Locum GPs are entitled to an NHS pension. When I raised this subject with practices, I had mixed responses. While a couple agreed they should be entitled, the majority didn’t agree. One client explained that “Locum GPs should not receive an NHS pension as they aren’t committed to solving workforce issues which benefit the patient by offering continuity of care. Its more about earning money from the NHS without giving back.” Another client said ‘no, they are not employed, and it is an employment benefit. The system needs Salaried GP’s, so to make this less attractive makes no sense!’
Many of the practices I work with blame the fact that locum GPs benefiting from an NHS Pension has at least in part, contributed to their difficulties in securing a permanent and stable workforce.
The future stability of General practice
So, where does all of this leave the long-term and future stability of General practice? If practices are already struggling to secure permanent GPs with circa 28% of GPs in locum roles, then how will this impact the quality of Primary Care services and the patient experience if this figure continues to grow? What can be done to mitigate this issue? Based on the feedback I have had from practices across the northwest and Scotland, currently, for many locums the benefits outweigh the negatives. Flexible working hours, a lower workload, and a higher income are more desirable than the security of a salaried role which inevitably entails a higher workload at a lower rate of pay.
It has been suggested that capping the daily locum rate and having minimum workload expectations which include admin and home visits might help, but let’s face facts, when if ever will that happen? Consequently, while many practices continue to struggle with staff shortages and subsequently more intense workloads, more and more doctors will seek a better work-life balance, and who would blame them? Therefore, unless the role of a Salaried GP can be improved in terms of hours, workload and pay, it is inevitable that the locum workforce will continue to grow which inexorably will have a damaging impact on continuity of care and the quality of our Primary Care services.
Sources
NASGP (2021). How many locum GPs work in the UK? https://www.nasgp.org.uk/faq/locums-how-many-gp-locums-in-the-uk/#:~:text=The%20GMC%20publishes%20the%20total,this%20figure%20is%20approximately%2017%2C190.
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