Exclusive: Practices reveal rising dependence on GP locum workforce

Three in five GP partners say their practice's reliance on locums has risen over the past year, with around one in six sessions now filled by locums on average, a GPonline poll reveals.

Locum GPs make up growing part of the workforce (Photo: iStock)

Just over a third (35%) of partners who responded to the poll said that the proportion of GP sessions filled by locums at their practice had increased significantly over the past 12 months. A further 24% said sessions filled by locums had increased slightly.

The average proportion of sessions that partners reported being filled by locums was 16%. One in five of the 274 partners who took part said more than a quarter of sessions at their practice were filled by locum GPs, with a handful of respondents reporting higher rates - up to two thirds of sessions.

Across all 654 GPs who responded to the poll, 58% said the proportion of sessions filled by locums at practices they worked in had risen in the past year - and they reported locums covering a fifth of sessions on average.

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GPC chair Dr Richard Vautrey said the findings were 'further evidence of the impact of the recruitment and retention crisis facing general practice'.

Dr Zoe Norris, GPC sessional subcommittee chair, told GPonline that in areas with the most acute recruitment problems it was 'not at all unusual' to see practices that were 'exclusively staffed by locums'. But she warned policymakers against seeing locums as 'a problem to be got rid of' - urging them instead to recognise what an 'immense resource' they offered to support a struggling NHS system.

The findings come just two months after official workforce data confirmed that the number of GP partners in England fell by 708 in 2017 - a 3.4% drop almost equivalent to the loss of one partner for every 10 practices in the country within a single year.

Some partners who responded to the survey were despondent about their increasing reliance on locums and factors that have made partnerships less attractive.

Dependence on locums

One GP said: 'General practice is now following the disastrous route of dependence on locums that trusts found with agencies. Recruitment into substantive posts is dire and many locums only provide clinics and are unwilling to help with administration such as path results and Docman.

'Locums covering sickness and maternity leave has always been essential but is a very expensive and short-term solution to the enormous workforce shortage across the whole NHS.'

Some former partners explained why they had been forced to switch to locum work. 'I was a committed partner but it made me mentally unwell,' said one GP. 'The workload is still rising inexorably. No-one can do five days/week in general practice and maintain their sanity until retirement aged 70 these days.

'I have used the flexibility of freelance working to do lots of other things apart from locum work and effectively embark on a career change. I think most new GPs will do other things apart from GP-ing and keep max patient contact at six sessions.

'Locum work is in my view the only way currently to control your workload and practice safely and sustainably. I would not return to full-time GP partnership even for £500K per year. I value my life and my children's lives more highly.' A GPonline/Medeconomics poll last year found that a fifth of locums had been partners a year earlier.

Essential workforce

Dr Vautrey said: 'Practices depend on the services of locums and these sessional GPs make up an essential part of the workforce. However these findings provide further evidence of the impact of the recruitment and retention crisis facing general practice, with large numbers of practices struggling to find GPs willing or able to join their practice on a permanent basis.

'Ultimately this impacts on continuity of care, something many patients value and which is a key element of good quality care. The need to invest in general practice is greater than ever, as is tackling the factors that put doctors off joining practices, such as the risks around premises ownership and unsafe workload levels. It's only by addressing these fundamental problems that we will be able to attract more doctors into the profession.'

Recent BMA polling has shown that around half of GP practices have struggled to find locums when they needed them - suggesting that an even higher proportion of sessions could have been filled by locums. Dr Norris said: 'The GP workforce is just too small -there are not enough GPs out there in any capacity.'

She added: 'Lack of control over workload, and lack of flexibility are the main reasons for GPs choosing to be locums. Practices need support to be able to offer greater flexibility, but as a whole the profession needs an increase in funding and a reduction in workload.

'We are all struggling, and I think are past the point where policy makers should be viewing locums as a problem to be got rid of. That will never happen, and they are an immense, forgotten resource to help support the system.'

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