How much employing locums costs

GP's latest survey shows fees have changed little and many locums are unhappy. By Carole Slingsby

Dr Fieldhouse: 'Locums are simply fully qualified GPs, yet are clearly suffering and their voice isn’t being heard loudly enough' (Photograph: Solent News)
Dr Fieldhouse: 'Locums are simply fully qualified GPs, yet are clearly suffering and their voice isn’t being heard loudly enough' (Photograph: Solent News)

Stagnant fee levels, falling demand, being treated unfairly by practices, having to freelance because salaried jobs are badly paid and revalidation worries all featured in the list of woes revealed by GP's joint survey with the National Association of Sessional GPs (NASGP) on locums' pay rates in May and June 2010.

A total of 398 GP locums from across the UK took part.

Click here for the full results of the GP Locum Survey 2010

Commenting on the results, NASGP chief executive Dr Richard Fieldhouse, also a GP locum, says: 'It really is quite disgraceful that these same complaints are being repeated year on year, yet the scale of the angst is deepening and the volume of locums is increasing.

'Locums are simply fully qualified GPs, the same as every other GP, yet are clearly suffering and their voice isn't being heard loudly enough.'

Some locums prefer the freelance life while many respondents combined locum sessions with other commitments such as part-time salaried GP posts. Only 32 per cent of respondents received their entire annual earnings from locum work.

Click here for a breakdown of the survey respondents

Fee rates
One respondent from South East Coast SHA (earning £80,000 a year from locum sessions) says: 'I was a GP principal for 25 years. Nothing would induce me to go back to it.'

As can be seen from the table, fee rates have not changed significantly since GP's last survey in February 2009. Of the respondents doing locum work a year ago, 78 per cent said that their fee rates were about the same as then. Another 8 per cent claimed that their fees had dropped.

With 17 per cent claiming that demand for their services had fallen, compared with 56 per cent who said this in GP's previous survey, there seems to be more work in 2010.

However, an East Midlands respondent said: 'Local NHS GP locums are being undercut by agencies that employ lots of doctors from Europe who are prepared to work for a lot less, and some of them can't speak English properly.'

All respondents to this survey were UK-based and just 17 per cent obtained work via locum agencies. Because there were so few, it was not possible to ascertain whether rates they were paid differed significantly from fees earned by locums booking work directly with practices.

Fee rates are a big issue, with some locums bewailing the lack of a regional/national pay scale. It is up to individual locums to set or negotiate their own rates and some find this hard. 'Locum pay structure should be defined nationally and there should not be any professional exploitation,' says one London locum.

Another locum in London says: 'I don't like how practices pay for the appointment time, but for nothing beyond or before that, even when you have to arrive early as their computer systems take ages to start and everyone else stops for a coffee.'

One respondent in the south-west of England says their rates have not increased in the last four years. But some respondents seem to accept too low a price. One locum in the north west of England is prepared to work a half-day for just £100 while the half-day average for other locums in the same SHA is £230.

One South East Coast locum says: 'I have recently joined a GP chambers in order that my work is standardised in terms of rates, number of patients per session and consultation time per appointment. It is very easy for practices to abuse locums who work independently.'

Only 4.5 per cent of respondents are in a chambers. In most cases the locum paid their chambers 10 per cent of their earnings. In terms of their fees (see figures in bold in the table here) Dr Fieldhouse says that although the sample is small, 'it looks like they're holding their own at the higher end of the rates'.

Upsides and downsides
A huge advantage of being a chambers member is that an administrator agrees your fees, books your sessions and ensures that you get paid.

Around 64 per cent were doing locum sessions as a stopgap while hunting for partner or salaried posts. With partnerships few and far between, some locums were scathing about the terms and conditions offered by practices for salaried jobs.

One East Midlands locum says: 'Work as a locum GP, although income is less predictable, is far fairer than salaried GP work, where partners are earning double for the same or less clinical work.

'This is a major issue that is not being tackled. I do not believe the extra admin work involved in being a partner warrants such a major pay difference - a well-organised practice has a practice manager to deal with most of it.'

While between £65,000 and £75,000 a year from full-time locum work seemed fairly typical, for a few, being a locum meant higher earnings than many full-time principals - and far better pay before tax than salaried GPs. The highest paid respondent was from South East Coast and earns £190,000 a year. Next in line was a West Midlands locum earning £182,000 a year, followed by a north-west of England locum receiving £160,000.

However, being freelance means no job security, sickness or holiday pay and other disadvantages. One locum from the West Midlands says: ' The downside is minimal continuity and you have to be willing to travel.'

But the locum adds that the upside is that there is 'less pressure than being a partner and having to worry about practice income dropping.'

Relatively few locums undertake out-of-hours sessions, and because session lengths varied a lot, only the hourly rates they were paid are meaningful.

There was no discernable regional trend in these, but looking at the hourly rate range for weekend work, for example, this varied from a low £50 to £100 (although one locum charged £137.50 per hour). The higher hourly rates are likely to apply to overnight 'red-eye' shifts.

Click here for the full results of the GP Locum Survey 2010

Revalidation
A major concern for peripatetic GP locums is revalidation. 'I am dreading revalidation,' says an East Midlands respondent. 'How can we achieve it?'

Another from the north-west of England says: 'Demonstrating the impact of education is limited to our own consultation behaviour as we cannot influence practice organisation. Individual case studies are practicable but audit is virtually impossible if you are doing sessions for lots of practices.'

There is room here to quote only a tiny selection of respondents' (mainly negative) comments, and Dr Fieldhouse - who has studied them all - says the GP-patient interface is being undermined by a disengaged, struggling, locum workforce. 'Is there any other area of general practice provoking such dire responses? Why aren't the BMA and RCGP responding to this?' he asks.

The BMA is beefing up sessional GPs' representation and the RCGP is addressing locums' revalidation difficulties, but it is open to question whether these efforts will be enough to help locums overcome the difficulties this survey reveals.

GP Locum Conference - 6 October 2010
GP newspaper is holding a one-day event for locums entitled 'Maximise your potential as a locum GP' on 6 October 2010 in central London. For more information visit www.gplocumsevent.com

North West locum Dr Tony Webster has won the survey prize draw for £100 in Amazon vouchers.

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