Dr Zoe Norris: Salaried and locum GPs can help solve NHS workforce crisis

It's time the NHS woke up to the fact that GPs opting for salaried and locum roles can be part of the solution to its workforce problems, argues Dr Zoe Norris.

The BMA’s latest survey of grassroots GPs demonstrates one clear fact: that it is locum and salaried GPs who are keeping general practice afloat as the entire service is undermined by unmanageable workload and endemic staff shortages.

And while there are positives among the gloomy picture of a general practice under unprecedented threat, it is equally obvious that the government needs to act urgently to prevent primary care from collapsing.

Few GPs will be surprised by the findings of the BMA’s poll of more than 3,500 GP partners. Almost a third have been unable to fill vacancies in the last 12 months while a paltry 13% said they are in the lucky position of never facing serious gaps – many others are waiting months to get a fully staffed workforce in place.

GP workforce

What is striking is that nowhere is spared. The West Midlands (35%), the East of England (35%) and the East Midlands (34%) are the worst affected areas for year-long gaps, but they aren’t far ahead of the least affected area, London, which still has 27% of practices reporting the same level of vacancies.

The crisis in general practice is affecting every area, with similar levels of unmanageable workload and staff shortages. For patients this means that wherever they are, they are going to be faced with a local practice that is simply unable, despite its best efforts, to provide enough appointments or services to the community. This is no longer a problem people read about happening somewhere else.

Locum and salaried GPs are not immune to these pressures. Many services are being propped up by hard working locums and this is dampening enthusiasm to get involved in the running of a practice. Three quarters of non-partners surveyed are put off becoming a partner because of workload pressures, which is the same proportion of current partners who think their current role is too onerous.

The most popular reason for working as a locum GP is control over one’s own workload, something that partners simply cannot achieve. Looking forward to the next five years, locums and salaried GPs see a variety of options ahead of them.

GP partnerships

Almost half wish to become a partner within the current independent contractor model (despite concerns about workload). Other popular options favoured by roughly a third of respondents each include working as a partner within an at-scale GP organisation or as a portfolio GP – the latter is clearly an increasingly popular choice.

What is frustrating is that the NHS and the government are missing an opportunity. They have a workforce that is prepared to be more diverse and more flexible in its working patterns, which with a changing population with different needs is exactly what the health service needs.

This change could be capitalised on, but instead it’s being wasted as salaried and locum GPs are being told they are part of the problem, not the solution; they are focused, like all other healthcare professionals, on the basics of preventing a buckling service from falling apart. The government has had more than enough messages, signs and smoke signals about the dangerous state of primary care.

The BMA has forced out of NHS England commitments in the GP Forward View for more funding and staff, as well as acceptance of the Urgent Prescription for General Practice campaign. But that is not enough. What all GPs want is to be able to do their job and care for patients. This will only be achieved if politicians start delivering: and that has to happen now.

  • Dr Zoe Norris is chair of the GPC sessional subcommittee

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