A total of 54% of 498 GPs who responded to the latest GPonline opinion survey said that locum work was the most attractive career option. Just 15% chose partnership, and 31% said being a salaried GP was their top choice.
The findings show a marked shift in favour of locum roles over the past year - a similar poll in May 2018 found that 44% of GPs said locum work was the best career choice, compared with 20% backing partnership and 36% salaried work.
GPonline reported earlier this year that general practice in England had lost almost 3,000 GP partners between September 2015 and December 2018 - a staggering 12% drop. More than 20 CCG areas have seen far larger drops - losing a fifth or more of partners over that period.
Findings from our latest survey suggest that the decline in interest in GP partnership roles has continued despite promises of additional investment in general practice in England through the £2.8bn five-year GP contract agreement that took effect from April.
As workload continues to rise, with GP numbers falling while the profession looks after an ageing population with increasingly complex needs, many GPs are choosing locum work as a way to control workload - leaving those remaining in partnership roles facing rising pressure.
BMA GP committee chair Dr Richard Vautrey said: 'These results show how important it is to fully implement the recommendations of the partnership review, and while some of those have been addressed through our contract agreement, it will take time for those changes to be seen by GPs who are making career choices, not least on workload reduction. There is also an urgent need to address outstanding issues such as the problems and risks related to premises.'
A final report on the partnership review, published in January, set out seven key recommendations to revive GP partnerships. It warned that reducing personal financial risk for GPs, boosting GP numbers and increasing community staff to support general practice were vital, along with a strong voice for GPs 'at system level', while PCNs needed to 'operate in a way that makes constituent practices more sustainable and enables partners to address workload'.
NHS England, meanwhile, has set primary care networks (PCNs) the task of stabilising the GP partnership model by 2023/24. In a document published last month, NHS England made clear that 'it is now down to PCNs to decide their own long-term future: take responsibility for securing a new generation of partners or by default (rather than choice) become salaried to other NHS providers'.
The GP who led the partnership review, Dr Nigel Watson, has said he believes PCNs could play a significant role in reviving GPs' interest in the role - by using new funding to ease workload and make general practice a better place to work.
But he identified punitive tax on pensions as a key factor that was overriding other efforts to improve retention of GPs. GPonline reported this month on findings from a huge BMA poll that showed three quarters of GPs in some areas had reduced their working hours or planned to do so.
One GP responding to the survey, who worked as a locum, said: It's the only way to avoid burnout and crazy levels of increasing workload and pressure on time.'
Another said: 'Portfolio GP working, which for me includes about 25% of my time working as a GP locum, is appealing because of its flexibility, rather than remuneration. I can choose to work 60-70 hours per week some weeks, and other weeks 0-10 hours. I can take more leave to undertake further study, do other work outside clinical work, and look after my children and my family. No permanent salaried or partnership GP job would allow for this unfortunately.'
One GP said: 'I am very shortly retiring from my GP partnership in order to become a locum GP. Mainly looking for more freedom and flexibility.'
Several GPs responding to the survey said they were concerned that falling numbers of GPs in permanent roles with practices was undermining continuity of care, and urged the NHS to make sure that partnership and salaried roles were as financially attractive as locum work.
One partner said: 'I've never been a locum but I can see the attraction - high pay as in demand, take holidays generally when you like, work more or less sessions as you please. However such working doesn't help continuity and practices need partners to run them. There should be more incentives to take up partnerships or salaried posts. Maybe scrap tapered annual allowances for GP partners for starters.'
Pressure to reduce working hours to avoid heavy tax on pensions is likely to have pushed up demand for locums as partners avoid taking on extra sessions they may have been willing to cover in the past.
One GP described the shift to part-time working in her practice: 'My practice of almost 20,000 patients has only four full 'share' partners. We will soon have 10 part-timers like me along with four or five specialist prescribing nurses and three nursing assistants.'