Exclusive: Pressure on GPs sparks exodus from partnership roles

Unsustainable pressure on general practice has sparked an exodus from partnership roles and rising costs as GPs switch to locum work, GPonline can reveal.

GP leaders said the shift away from partnerships meant the government’s pledge to recruit an extra 5,000 GPs by 2020 was ‘laughable’, and that the real increase needed could be as much as four times that number.

Around a third of GPs now working as locums were in partnership or salaried roles a year ago, a poll by GPonline’s sister website Medeconomics suggests.

Increases of nearly 6% in the average rates locum GPs are charging for their services in parts of England show how the huge shift away from partnership and salaried roles is driving up practice costs.

View the locum rates on Medeconomics

Rates charged by locum GPs rose 5.8% in the past year in the north of England and 5.6% in London, with rises of 4 to 5% in the Midlands, south and east of England, the survey found.

One in five of the 701 locum GPs who responded to the poll said they were partners 12 months ago. One in 10 locums said they were in salaried roles a year ago.

A total of 60% of GP respondents who were doing locum work a year ago said demand for their services had increased in the past year, while 29% said demand was unchanged.

GPC deputy chairman Dr Richard Vautrey said: ‘The current unsustainable and damaging workload pressure that many GPs are experiencing is leading many GPs to leave practices and become locums. This enables them to regain control of their workload and work-life balance. However it is at the expense of continuity of care, something that our recent survey demonstrates both patients and GPs place great value on.

‘Both the rising costs of hiring a locum, and the need for more of them as practices struggle to retain GPs or recruit new ones, adds more to the costs of running a practice. This then becomes a damaging vicious circle as rising expenses leads to less funding for the practice workforce which leads to more workload pressures for those left.

GP funding

‘The answer has to be the government taking this current situation far more seriously than they are and identifying significant new resources to fund core general practice.’

National Association of Sessional GPs chief executive Dr Richard Fieldhouse - a director of locum organisation Pallant Medical Chambers - said the findings underplayed the extent of movement to GP locum roles.

‘I’m surprised the figures aren’t higher. I go around doing a hell of a lot of talks about setting up locum chambers and 50% of people applying to join chambers are currently partners.

‘The biggest cohort of our members, prior to joining, were partners, and these are not GPs of retirement age. Only two of our members have drawn their pensions.’

Many former partners cite intolerable workload as the reason for moving into locum work, said Dr Fieldhouse.

GP workload

Salaried GPs too were becoming locums because of the pressure on practices, he said. ‘These salaried GPs are employed by partners. As partners become stressed, they develop a siege mentality, and they cease to become nice employers so as a salaried GP you don’t want to work there.’

Soaring medical indemnity costs are a 'huge factor' behind rising rates locums are charging, Dr Fieldhouse said. A recent GPonline investigation found that one in three GPs say their medical indemnity fees have risen 20% in the past five years.

Longer consultations and a sharp rise in the intensity of GP work over the past decade also meant locums felt justified in increasing their rates, Dr Fieldhouse said.

On the increasing shift to locum work, he said: 'We are witnessing a huge change that for too long has been ignored. 

'What is driving the change is these GPs want to return to the values they had when they started in general practice. It is hard to be good GP as a partner as you have to do so much other work on ticking boxes, hitting targets. It takes you away from the job and the values you started with.'

The profession and the government needed to embrace the change and support locums to maintain good general practice. Part of the solution was more GPs, he argued, warning that the 5,000-GP rise in workforce pledged by the government was 'laughable'.

With the current workforce we are struggling to do a five-day service. We could probably do four days quite well. We probably need 15,000 to 20,000 more GPs.'

GPs responding to the poll cited flexibility, falling practice income, work-life balance and freedom as key reasons why they had opted to work as locums.

A DH spokeswoman hit back at claims the 5,000-GP recruitment target was not enough: 'It is a shame that some people want to talk down plans that are building up general practice, attracting new GPs and reducing pressure on doctors.

'We will deliver an estimated 5,000 more doctors in general practice by 2020 as part of a 10,000-strong boost to primary and community care staff. GPs tell us these other health care workers are invaluable; reducing pressure and freeing them up to spend more time with patients.'

Subscribe to Medeconomics to access full details of the Locum Rates for 2015

Photo: iStock

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