The proposal was announced alongside the 2016/17 GP contract deal unveiled last week, but has yet to be formally agreed. No figure has been set for the indicative locum rate, although NHS England has suggested there could be some regional variation.
If the move goes ahead, practices would have to inform NHS England each time they pay over this indicative rate using an electronic declaration system.
The bid to cap GP locum rates follows recent government announcements that fees will be capped for all agency staff – including doctors – working in hospitals.
GP locum rates
In general practice, GPonline has reported that the average rate paid to locums rose around 6% over the last year, while partners' income has slumped, falling around a quarter between 2005/6 and 2012/13. Doctors are also increasingly abandoning partnership roles to work as locums, survey findings suggest.
But writing on Twitter, GPC chairman Dr Chaand Nagpaul said that even if the proposals for an indicative locum rate are included in the GP contract, practices should continue ‘business as usual’.
‘[NHS England] can’t control what practices pay nor what locums charge,’ he wrote.
Many senior GPs recognise escalating locum fees as being difficult to maintain for practices, but opposition to introducing caps seems widespread.
Although the ‘indicative rate’ proposals are not a formal cap, Dr Richard Fieldhouse, chairman of the National Association of Sessional GPs, warned that it risked putting further strain on practices by becoming the maximum and the minimum pay locums expect.
‘The mere mention of a maximum rate could undoubtedly artificially constrain the locum market,’ he said.
GP locum pay cap
‘Some practices may be prompted to use this indicative rate as a ceiling, some locums will significantly increase their rates to match it, and some GPs will stop work altogether and move to a higher-paying profession.
‘Either way, there will be no winners, only losers. At the end of the day, this could just make it even harder for struggling and overworked practices to find decent GP cover for their patients.’
GPC deputy chairman Dr Richard Vautrey warned that implementing caps would potentially be against competition law. Efforts should instead be directed towards increasing capacity within practices, he argued.
‘Essentially, we need more GPs. That’s the real problem,' he said. 'Not only are there not enough GPs, there’s not enough GPs who are locuming. And not just doctors, we need more nurses, support staff and others to take pressure off the system.
‘The other thing that practices might need to start thinking about is – if they can't get locums – then, ultimately, patients are going to have to start waiting longer to see a GP. Practices will have to have robust dialogues with their local CCG and NHS England about how they can support practices who are really struggling in this way.’
Dr Peter Swinyard, chairman of the Family Doctor Association, said locum fees were currently ‘completely unaffordable’, but attempting to implement a cap was a ‘barking’ idea. ‘That’s a controlled economy, which never, ever did work. You can always find ways around that,’ he said.
To fix the problems of escalating locum fees, extra investment should be directed towards general practice to make partnership a more attractive option, he said.
‘There is no incentive whatsoever to be a partner in general practice right now because you carry all the risk and all the blame and none of the money. Until partnership incomes rise well above the level we pay our salaried doctors, we will never recruit people into partnership and we will always be struggling to find salaried doctors and locums to fill the gaps.
‘They need to sort out the things that have gone wrong: the reductions in the global sum, the reductions in MPIG. MPIG in my practice used to be about the value of a partner and now that is going. And there are all sorts of other pressures on income. The end result is there just isn’t enough to pay the doctors, and you only carry on doing this so long before you decide to close the doors.’
Dr Vicky Weeks, chairwoman of the GPC’s sessional GP committee, said trying to implement a flat locum rate would not work, as different areas and practices require different work and responsibilities from locums.
Measures should instead be taken to improve the work/life balance of GP roles, she said.
‘Instead of vilifying us, the government needs to support general practice. Actually investing in general practice to the levels it needs to be, so we can attract people into the workforce and get a better work/life balance for all GPs, instead of having people in burnout like they are at the moment.
‘Once we’ve got a better work/life balance across the board, then you’ll see locums wanting to become partners. Career development opportunities need to improve – because at the moment it is really nose to the grindstone. When does anybody get a chance to just look up and understand where they want to be in their career?’