GP locums reject pressure to slash rates under five-year contract

Locums have rejected calls for a blanket reduction in their fees when state-backed indemnity takes effect from April as part of the five-year GP contract.

National Association of Sessional GPs chair Dr Richard Fieldhouse
National Association of Sessional GPs chair Dr Richard Fieldhouse

An NHS England document setting out details of the five-year deal suggests that locums should reduce the fees they charge practices to reflect reduced costs under the state-backed indemnity scheme.

'Locums will no longer need to pay indemnity when working for GP practices or networks,' the NHS England document says. 'The cost of locums for practices should therefore be adjusted accordingly.'

However, sessional GP leaders say a blanket demand for locums to reduce their fees is unacceptable, warning that many have felt unable to increase the rates they charge and have simply 'absorbed' the rising cost of indemnity - along with other costs - over recent years.

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National Association of Sessional GPs Dr Richard Fieldhouse told GPonline: 'There has been a big pushback from practices against locums who have tried to up their rates.'

He said many locums had been unable to increase their rates because 'practices say all sorts of costs are going up and they can’t afford it'. He added: 'The idea of locums in that position reducing their rates doesn’t make sense.'

BMA GP sessional subcommittee member Dr Vicky Weeks agreed: 'Lots of locum GPs that I know, my colleagues, have not put rates up for several years because of cost pressures for practices.

'They have actually been swallowing the increase in indemnity fees, but also rising costs for CPD etc. They have been absorbing that. I’m not sure this sort of blanket statement is really fair on locum GPs - it puts locums in a very difficult position.'

Locum rates

Dr Fieldhouse said it was 'extremely unhelpful' for the contract document to suggest that all locums would be in a position to reduce rates - and hit out at the tone of the statement.

'The way it's phrased suggests that practices can reduce the locum rate, and decide what they pay,' he said. 'We are self-employed contractors - we set our own rates. It is down to the locum, not the practices or NHS England, what we charge. All locums will have different circumstances.'

The NASGP chair said there were 'up to 20,000 fully-trained professional locums out there' - and that at a time when the profession desperately needs more 'boots on the ground' they should be told how they would be supported rather than receiving demands to cut their fees.

Full details of the state-backed indemnity scheme due to start in 2019/20 have yet to be revealed, although NHS England has made clear that it will cover 'all GPs and all other staff working in delivery of primary medical services' - including out-of-hours work.

Indemnity scheme

Dr Weeks called for improved guidance on how practices and GPs should handle the implementation of the indemnity scheme as final details emerged over the coming weeks.

'Obviously the move forward on indemnity is to be welcomed, but it needs to be thought through how this is going to be implemented - for all GPs.'

Dr Weeks called for more work to engage sessional GPs in the formation of primary care networks as GP practices across England move to join them by this summer.

A survey by GPonline's sister publication Medeconomics last year found that 70% of locums said their rates had not increased over the previous 12 months, although average daily rates reported by locums were higher than rates reported the previous year.

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