The National Association of Sessional GPs (NASGP) has said that last month's GP Forward View suggested NHS England had ‘its head in the sand’ over locum GPs, making little mention of them and citing workforce statistics that exclude locums.
The group estimates that locums make up around a quarter of the GP workforce, and that their numbers are progressively rising as GPs move out of permanent roles to escape the stress of partnerships or salaried positions.
A fifth or more of clinical sessions are provided by locum GPs at one in seven GP practices, a GPonline survey published last week suggested.
Locum GP workforce
NASGP chairman Dr Richard Fieldhouse said NHS England should recognise the growing role of locum GPs and work to improve how they fit into NHS general practice instead of trying to push them into partner and locum roles.
But he said the GP Forward View was 'negative' about locums, pointing to a line in the document that said the shift to a reliance on locums was ‘undermining service continuity and stable team working’.
Official GP locum workforce numbers for England have historically not been recorded at all, although data from the Health and Social Care Information Centre (HSCIC) workforce recorded some data on locums this year for the first time. However, HSCIC data counted just 1,000 locums - far below the NASGP estimate of up to 17,000.
The HSCIC told GPonline that its figure was based on data submitted by GP practices. A spokeswoman said: ‘Capturing data on locums is difficult as they often move between multiple practices and work at places for short periods of time. If a practice fails to identify locums who are working there then they will not be included.
‘The collection is a snapshot in time, as at 31 March and as at 30 September so if locums are not providing services on those specific dates then the practice will not include them.’
GP performers list
In future, the HSCIC will review the national performers list to estimate GP locum numbers, she added.
But Dr Fieldhouse said it was ‘crazy’ that locum numbers had not been properly assessed for so long. Neglecting 25% of the workforce was ‘a huge hole in their plans’. He said it was time to recognise that locums represent a growing proportion of the GP workforce.
‘Quite pathetically, the GP Forward View talks about trying to attract more GP locums to become salaried GPs and partners,’ he said.
‘The only career progression that seems to be happening is in the opposite direction. They have to reverse that – they have to slow the exodus of migration from partner to locum before they can think about GPs going from locum to partner.
‘They're not going to turn that around on a two pence piece over the next few years – this has been happening for ages and has not been taken into account.’
He called on NHS England to look into supporting initiatives such as locum chambers - a model Dr Fieldhouse himself works in - to improve the way locums work and recognise the direction the workforce is shifting.
‘Step one is find out about chambers,’ he said. ‘Step one is to open their eyes and talk to people who already run these chambers and find out more about them. Do some analysis and research, look at the pros and cons – but they've done nothing. They've just said locums should be partners.
‘Rather than GP locums working in isolation and competitively – and therefore almost slightly destructively – working in chambers allows them to work collaboratively to create something better than the sum of its parts.
‘GPs can work in teams, pool resources, share learning and support each other. It stops them becoming disenfranchised. We did a survey a few months ago, and we found that 90% of all locums working in chambers said that the reason they were still a GP – the reason they hadn’t left the profession entirely – was because there was a chambers that they worked through.'
But he said the NHS was 'not even trying' to look at this type of alternative. In the GP Forward View, he added, 'the only reference to locums seems to be moaning about them'.
An NHS England spokesman said: ‘Locums provide an important service, particularly during staff shortages and surges in demand.
‘But patients value greater continuity of care, and for most practices the priority is filling permanent GP posts, which is why the GP Forward View set out action to make partner and salaried positions more attractive.’