Dr Richard Fieldhouse, locum GP and chairman of the National Association of Sessional GPs, breaks down the crisis affecting locums across the country and offers a plan for the future.
We’ve been hearing a lot about the difficulties GP locums are facing in finding work in England. Stories of locums struggling to get bookings, with some even taking up jobs as Uber drivers or resorting to food banks, are both worrying and pervasive. So, as chairman and founder of NASGP, let me share my perspective and offer insights that might help us better understand what’s causing this so that we can better address the challenges.
Understanding the problem
In an attempt to explain this, it’s tempting to leap to recent headlines, such as the underfunding of general practice, making it harder for practices to afford locums.
Since 2017, based on the GMC’s methodology, the number of GP locums in the UK has grown from 17,000 to around 20,000. This means the same amount of work now has to be distributed among more locums, naturally leading many of us to feel the pinch. This, combined with the inefficiencies of traditional booking methods, no doubt contributes to the lack of work that many GP locums are experiencing.
Communication methods
Another key observation is the way in which practices let GP locums know about vacancies. For the past decade, many locums have relied on WhatsApp groups to receive adverts for work. In doing so, the customer (in this case, practices) is empowered to set the rates, terms, and conditions for the service provider (in this case, the GP locum). The practices then send these adverts to dozens or even hundreds of locums at once.
But that’s where the problem starts: the practice is then inundated with an initial surge of responses, which then subsides into a constant trickle for days or weeks after. GP locum work is complex, and always involves the exchange of delicate or nuanced information – far too much to handle on a staff member’s phone.
It is chaotic and inefficient, often resulting in practices opting out of advertising altogether; not due to a lack of work, but because the process is overwhelming.
Just as Airbnb transformed the ability for individuals to offer their bed and breakfast services to customers, NASGP has designed its platform, LocumDeck, to work in the same way. Here, GP locums set their rates, terms, conditions, and advertise their availability. The practice can then browse these listings and book locums instantly, making the process smooth and efficient.
This model reflects the effective market matching principles championed by Nobel Prize winner Alvin Roth, who pioneered the USA’s kidney donation programme, where supply and demand are balanced optimally. The success of LocumDeck in our partner ICBs highlights not just the efficiency of this approach, but also the utility of locums, where they are a valued and integral component of the GP workforce.
NASGP’s real-time booking and invoicing platform LocumDeck is in use in all ICBs in England. In seven of these regions, the ICB has directly funded the GPs’ membership, ensuring widespread adoption to nearly every practice in those areas, and providing a rich source of data on the number of sessions worked each month.
And across these seven ICBs, the number of sessions worked every month has actually increased by 15% over the last 12 months, suggesting that practices are actually spending more on GP locums every month, not less.
Existential threat
As GP locums, our raison d’etre is agile support for GP practices. We know we do a good job, with research conducted by the University of Manchester finding that the quality of care provided by GP locums is not systematically different from that of permanent GPs. If a practice can’t find a GP locum, it can be a significant problem for that practice and their patients, albeit one that is short term. But, if a GP locum can’t find work, it can be catastrophic; highly trained and experienced GP locums are seeking alternative careers in foreign countries, and that is a long term problem for the NHS.
Another factor often cited is the additional £1.4 billion funding for ARRS roles, including physician associates, since last summer. While physician associates are not direct replacements for GPs, there are reports that they have been used in some areas as ‘substitutes’. For example, Pulse’s recent investigation into PAs reported concerns from Birmingham locums, with one noting that the ‘15 practices in his local area that used to take on ‘regular locums’ have now ‘completely substituted’ them with additional roles.’
But if this were the case, since ARRS funding has been equitably distributed across England, we’d expect to see a fall in demand for locums in all areas. But instead, we’re seeing that locums worked 14.5% more sessions and 16% more hours in the ICBs that fund LocumDeck in May 2024 compared with May 2023.
Moving forward
The GP locum crisis is a complex issue with multiple contributing factors. However, by adopting a data-driven approach and shifting to more efficient communication platforms, we can tackle these challenges head-on. It’s essential to understand the true causes behind the lack of locum work and avoid attributing it to simplistic explanations like funding cuts and the introduction of ARRS roles. By embracing these strategies, we can create a more cohesive, engaged, and motivated GP workforce, ready to meet the needs of our communities.
Dr Richard Fieldhouse is a GP locum in Sussex. He is the founder and chairman of NASGP, which runs LocumDeck.
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