NHS England has encouraged practices to create additional salaried positions that are ‘attractive to practices and locums’ with a £150m GP Covid Capacity Expansion Fund launched this week.
The funding, intended to support GPs until the end of March 2021, can also be used by practices to increase existing staff hours or employ returning GPs, but cannot be spent on hiring locums.
The capacity fund comes after plans proposed by NHS England in July to set up local banks of GPs working flexibly rather than practices employing 'more expensive agency and locum options'.
National Association of Sessional GPs (NASGP) chair Dr Richard Fieldhouse told GPonline that the funding will do nothing to solve the chronic GP shortage, but will ‘shoehorn in a way of working’ that is unattractive to locums and could undermine the primary care workforce.
Dr Fieldhouse said that the first wave of the pandemic had sent ‘shockwaves through the livelihoods’ of many locums - and that plans for the £150m fund looked like a further threat. He said: ‘What this appears to be, quite clearly, is that NHS England wants to corral these GPs into a salaried service. It's asking GPs to join a salaried scheme that's not practice-based but community-based - and those tend to not be very attractive.
‘You get all the negative aspects of locuming without any of the positives - you lose your control, you get told where you're going to be working. When those schemes have happened in the past, GPs have felt very isolated, and they are put into practices that [they sometimes] feel are unsafe to work in, or they have concerns about.
‘Why would you [sign up] when the funding ends in March? They would have built up contacts just to throw them to the wind, and then they would have to start locuming again. It's really difficult being a freelancer to take a big break like that because you lose your place. And so as locums we've got to be really cautious about that.'
He added: ‘Bearing in mind the chaos that we all find ourselves in for all the right reasons, now is not the right time to be trying to shoehorn in a way of working that really should have had a lot more thought going into it.’
Salaried GP roles
GMC figures suggest that as many as two in five GPs carry out locum work - sometimes in addition to a permanent role - but this huge part of the workforce has been hit hard by the pandemic, with more than half seeing income drop significantly during the first wave of coronavirus as bookings dried up.
Dr Fieldhouse's comments come as the England conference of LMCs prepares to debate a motion later this month highlighting the ‘economic and professional impact' of the pandemic on locum GPs, and a call for practices to be able to recruit locums using funding from the additional roles reimbursement scheme (ARRS).
A lack of support during the pandemic, with concerns that locums have missed out on some available work as retired doctors were encouraged to return during the pandemic and with continuing inequality over death-in-service benefits, has seen an estimated 1,000 locum GPs move to the private sector in recent months. A recent GPonline opinion poll revealed that a third of locums are considering moving into permanent roles.
General practice capacity
NHS England leaders have stressed that ‘every possible measure’ should be taken by practices to maintain and expand general practice capacity by making use of the new funding. But Dr Fieldhouse argued that the measures around salaried GPs would not have the desired effect.
‘When I first saw the plans I thought of the Titanic, are we just shuffling deck chairs around on the deck of a sinking ship? This doesn't increase capacity in any way because it's not creating new GPs, it's just moving them around a bit. Instead it seems to be encouraging them from being flexible to take up a mixed position that then needs to be managed,’ he said.
‘I think what they should have done instead is created a governance framework, using the £150m to support GPs to work wherever they are needed, in a way that they will find fulfilling, and useful, and that they can contribute to the local health economy,' he added.
NHS England has yet to reply to a request for comment.