Why it's time to see locums as part of the solution to the GP crisis

Locum GPs are an 'immense, forgotten resource' that can play a vital role in supporting a struggling general practice system, says GPC sessional subcommittee chair Dr Zoe Norris.

GPC sessional subcommittee chair Dr Zoe Norris (Photo: JH Lancy)
GPC sessional subcommittee chair Dr Zoe Norris (Photo: JH Lancy)

A year ago at the UK LMCs conference in Edinburgh, Dr Norris won a standing ovation for a speech that aimed to dispel myths about the locum workforce.

Claims that locums were all money-grubbing, work-shy, young, predominantly female GPs were simply not borne out by the facts that emerged from BMA polling, she told the conference. In fact - 42% of locums were former partners - a trend echoed in surveys carried out by GPonline.

Speaking to GPonline this week, Dr Norris said: 'Lack of control over workload and lack of flexibility are the main reasons for GPs choosing to be locums. Practices need support to offer greater flexibility, but as a whole the profession needs an increase in funding and a reduction in workload.

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'We are all struggling, and I think are past the point where policy-makers should be viewing locums as a problem to be got rid of. That will never happen, and they are an immense, forgotten resource to help support the system.'

Dr Norris pointed again to the BMA's 2017 survey of sessional GPs - which found that male locums were aged 51 on average and female locums 46.

'These are experienced GPs who are vital to general practice,' said Dr Norris. 'They need to be treated equally, included in decision making and workforce planning and not sidelined.'

Unfilled posts

Responding to findings from GPonline's latest GP opinion poll, which showed that most practices' reliance on locums to cover sessions had increased over the past year, Dr Norris said: 'Whereas traditionally locums have been used to cover sickness or annual leave, now they are plugging recruitment and retention gaps that simply aren't being filled.

'We know the number of full-time equivalent GPs has fallen, and the generation who worked nine or 10 sessions are those who have been worst hit by changes to pension rules and rising indemnity.'

But as locums become an ever-greater part of the workforce, the system is failing to adapt by making sure they are supported with access to information - and the NHS remains bizarrely unable to count the locum workforce accurately. NHS Digital workforce data rely on a snapshot of staff at a point in time, and show only around 2,000 locums - far below estimates that suggest there could be as many as 17,000 available for work.

'There is still a very long way to go before locums are fully integrated into the workforce planning centrally, and also into the minds of NHS organisations and commissioners,' said Dr Norris. 'It is in nobody's interests to have GPs working in an area who aren't able to access local education and resources, or receive basic alerts such as MHRA and Public Health England warnings.

Performers list

'Some CCGs such as Manchester are now specifically targeting the workforce to build those channels of communication, but until the basics of an up-to-date performers list, and NHS email access for all GPs are in place, it is a real challenge.

'GPs move in and out of different ways of working now; they must be enabled to move from partner to salaried to locum and back again, otherwise we are at much higher risk of losing them to the workforce entirely. Locum groups and chambers are really positive ways for locums to access peer support and training, and I would like to see these being encouraged and funded in areas where there is a demand.'

The GPC sessional subcommittee chair warned that the creation of an up-to-date performers list with accurate data on locum numbers had not been given sufficient priority. Having a clear picture of the number of locums available for NHS work could offer a major tool to 'negate the workforce shortage', she argued.

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