Some GPs love the flexibility of locum work. Others are only doing it while looking for a permanent post.
Some locums believe they are treated unfairly while for former GP principals, going freelance can be a relief from practice burdens.
But common anxieties unite many of the 577 locums who in May took part in our annual UK-wide survey in association with the National Association of Sessional GPs (NASGP).
Chief among these is revalidation: almost 60% are worried about this.
For a similar percentage, the main source of information about health service changes is medical, GP and NHS websites and journals - far fewer say it is their primary care organisation (PCO).
The fees respondents charge indicate that pay rates have remained fairly static since May 2010. A north west England locum says: 'I have not had a pay rise in seven years.'
Another locum comments: 'There should be standardisation of pay rates and conditions. Locum pay in Scotland is way below what I received in England last year.'
Of those doing locum work for at least a year, 57% reported demand for their services was largely unchanged in May 2011. For 24% it was down; for 19%, up. However, since May, it appears demand has risen, see below for more on this.
There were some high earners. The top earner, a former GP partner in the East Midlands, earns £160,000 a year before expenses and tax solely from locum work (in-hours and out-of-hours). A London locum earns £150,000 doing only daytime sessions, but feels isolated, poorly informed and anxious about revalidation.
For 44% all earnings came from locum work. Nine earned £140,000-plus a year, usually from both locum and other work. Fees at the low end of some regional ranges suggest some locums underprice their services. For example, in east England, one locum earned £220 for a day, while another was paid £650.
Those doing locum work while looking for a salaried or partnership post accounted for 32%. Hard luck stories include a south west England locum who works out-of-hours: 'I have not managed to find any GP sessions in surgeries,' she says.
Some locums were semi-retired. 'I took ill health retirement in 2007, but I'm not quite ready for the scrapheap,' says a respondent from Wales.
Another, from north west England, says: 'Since my retirement as a principal I have worked as a locum with a gradually reducing time commitment.'
Others choose to be locums because they prefer the work: 'I am a career sessional GP,' says a west Midlands respondent, and a locum in Wales comments: 'I value my independence.'
Only 5% belonged to a locum chambers. RCGP chairwoman Dr Clare Gerada believes that locums should join (GP) federations, such as chambers, which 'are a good model for sharing not just back office functions but CPD too'.
Dr Clare Gerada: 'Locums should join GP federations, such as chambers, which are a good model for sharing CPD'
Only 21% get bookings through agencies. By and large, agency earnings are in line with fees paid directly by practices - see www.GPonline.com/locumrates for rates paid by agencies.
This summer there have been reports of locum shortages and locum agencies charging very high fees to practices. 'Many locums are female and have young kids, so the school holidays are always in hot demand,' says NASGP chief executive officer Dr Richard Fieldhouse.
But Doc2Docs agency director Dr Peter Bouzyk (also a locum) says: 'Demand has continued in September when we would normally see this as a quieter month.
'I can only speak anecdotally that some agencies are capitalising on this shortage and charging a premium.'
Laurence Slavin, from London medical specialist accountants Ramsay Brown & Partners, says reasons for shortages and hence higher fees include GPs needing cover for commissioning work, a rise in partner retirements and practices unpopular with locums forced to turn to agencies.
He says more high-earning principals are hiring locums to cover shifts and boost expenses to avoid 50% tax.
Huge variety of jobs
Respondents combining locum sessions with other work do a huge variety of jobs: most commonly salaried posts (20%), teaching/academia (11%) and appraisals work (10%). Unusual earnings sources include professional singing and plumbing.
Locums are often perceived as outside the NHS information loop. UK-wide, 37% felt poorly informed about local/national NHS reforms and the score was similar for locums based in England.
'There does not seem to be any structure for getting information to sessional GPs,' says a north west England locum.
UK-wide, only 21% said PCOs were a main source of NHS information. For 61%, medical/GP/NHS websites were a main source, then medical/GP/NHS journals (56%), the BMA (43%) and national media (40%).
The information vacuum is reflected in many locums' worries about revalidation. One locum in north Wales said: 'It is a nightmare trying to gather together peer review, audit and patient review data... how am I supposed to show evidence when I am a peripatetic one-woman band?'
Dr Fieldhouse says: 'The overwhelming concerns are about isolation. Clearly a lot of these respondents have no idea about being a professional GP locum and this highlights the huge gap in locum training.
'By being so isolated, individual locums are hardly in a position to think about changing their rates.'
More than a third of respondents who had received an appraisal in the past 12 months have not been paid for the time and expense involved, while a few locums reported their appraisal was overdue.
Of locums working in England, 41% have 'special interest' skills - ranging from GP remediation/mentoring to GPSI specialties - that could be usefully harnessed by clinical commissioning groups (CCGs). But of these locums only a few believed CCGs were likely to employ them. Our survey results underline how the NHS largely ignores its GP locum workforce and suggests the new CCGs may do so too.
Meanwhile, Dr Gerada says the RCGP is to set up a working group on locums' needs that will look at: 'What we can do in the totality. Isolation is clearly an issue.'
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- Dr Sion Edwards in south east Wales has won the survey prize draw for £100 in Amazon vouchers
- GP is holding a one-day event for locums on 27 September in west London. Visit www.GPlocumsconference.com for details