Investigation: The GPs out of work

It would have been unthinkable two years ago, but there are a number of GPs out of work today. As part of our major new series on recruitment and unemployment, Jaimie Kaffash explores the extent of the problem

‘I’ve applied for about three or four prison GP roles and between five and 10 salaried roles. I’ve also applied for around four or five ARRS roles,’ a GP locum in the Midlands says. ‘I’ve also just been emailing my CV with a cover letter to well over 50 practices about salaried roles, for any amount of sessions. I got only one response, asking for my locum rate – I sent over my terms and conditions but didn’t hear back.

‘In the last two months, I have secured two locum shifts at a surgery an hour’s drive away. I am continuing to apply for salaried roles. Never did I imagine I’d be coming out of medical school and three years of GP training, and struggle to find work.’

This GP’s experiences are not uncommon – but are shocking, especially when we consider that health headlines over the past decade have been dominated by the recruitment crisis in general practice. 

Locums: the canary in the coalmine

In September 2023, reports began to emerge about GPs being out of work. The canary in the coalmine was a lack of work for locums. They reported having to change their rates to compete with ARRS staff. By September, this had become a flood of reports. 

Andy Pow, board member of the Association of Independent Specialist Medical Accountants (AISMA), says: ‘That would have coincided with the Government announcing the uplift to staff pay of 6% but then not providing the full funding for it. It’s quite limited how practices can control costs, and locums are a variable cost which you can cut when money is tight.’

This situation has only intensified over the past year. In Pulse’s September 2024 survey, locums overwhelmingly reported a cut in shifts since September 2022 – more than half said work had dried up, while a mere 4% of the 172 locums who responded reported an increase in shifts over that period. 

Since September 2022, have your locum sessions worked:

Sam Hargreaves, director of Hargreaves Medical Chambers in Liverpool, says locum bookings ‘fell off a cliff from September 2023’.

‘We used to be booked at least three months in advance outside school holidays, and always 100% booked for the month we were going in to. School holidays were booked even more in advance, with August being fully booked by the previous January.

‘We would usually have an average of 200 sessions booked per month, year-round. Now we are lucky to have 80-100, and most of those are booked at very short notice.

‘Locums are having to cope with unprecedented income insecurity, as work is now scarce and much less reliable,’ she says.

Locums’ experiences on the ground reflects this. One locum in London says: ‘Our work has significantly reduced in the last 18 months in West London and all over the UK. Many colleagues are finding it very difficult to find work. Furthermore, we have accepted a reduced hourly rate in order to get some work. This is not sustainable. I have spoken with many colleagues who are planning to leave London, the NHS or retrain in something else. Some have already left and moved to Canada or Australia.’

Some are having to look much further afield. One Bristol locum reported having to take shifts in the Shetland Islands. She says: ‘For 20 years, I had been earning most of my income as a locum GP in Bristol. In March 2024, I noticed fewer vacancies being advertised in Bristol. I saw an agency advertising for vacancies in NHS Highlands. I’d previously worked for a week in Shetland - because I wanted to at that point, not because  I needed to. But when I saw the role come up this time around, I felt like I had no other option.’ Meanwhile, Pulse has reported on locums travelling several hours to shifts, including from Cumbria to Cornwall.

Have you travelled further than you would reasonably wish in order to take work?

GPs and practice managers agree there are fewer locum shifts available, with 50% saying the number they offer has fallen.

Lisa Fall, a practice manager in Dorset, says her practice found two salaried GPs in early 2024, which meant reliance on locums was reduced. ‘Since then we have been very careful about when we do and don’t employ a locum due to the financial restrictions that practices now find themselves in and the fact that some locums now want quite a high hourly rate.’

A practice manager in South Cumbria says: ‘We had seen our locum cost increase from £34,000 in 2016 to almost £80,000 in 2023.  In addition, like most practices, we were replacing like for like – ie a full-day clinician for a full-day clinician. In the autumn of 2023, we recognised we needed to reconsider our use of GP locums due to the increasing costs and incoming funding not keeping up with inflation and other rising costs, so started proactively planning for the whole of 2024.’

How does your use of locum GPs compare now with September 2022?

For locums themselves, this has made life incredibly tough. But it has had wider ramifications for GPs. First, many GPs start locuming because they want to continue practising but fear burnout – as the GMC puts it in their State of Medical Education and Practice report ‘take matters into their own hands’. The lack of work has removed this potential avenue for them. 

Competition for salaried jobs

Second, because of falling numbers of shifts, many longer-term locums started looking for permanent roles for income security. This influx of new jobseekers meant some areas had more demand for jobs than available roles. One locum in Hampshire says she has not put up her rates in six years, and now expects to have to travel further for work. She adds: ‘I don’t particularly want a salaried role but I’ve looked at what’s available out of interest and there seem to be considerably fewer roles available than in previous years. 

Another GP in the North West says: ‘I was salaried, and then I left my role in October 2023 to get a better work-life balance. Finding locum work wasn’t easy at the start, but I was able to get some roles, including in one practice for a couple of months. 

‘Then in September, October 2024 work started to dry up. I applied for salaried roles and was either getting no responses, or being told posts were closed because of too many applicants. I started panicking – thinking of getting work in Aldi over Christmas. I have a job now for two days a week. Ideally, I’d like to have stayed in a locum role, but I needed a bit more security.’

Their experiences are not unique. Of the 399 salaried or locum GPs responding to Pulse’s survey, around a quarter were actively looking for a new permanent role – either seeking a move or because they are currently out of work. On average, these respondents had been looking for seven months, and had identified 2.5 suitable roles over the past three months. They also reported a decrease in the number of appropriate roles since they had first started looking.

Are you currently looking for permanent work?

This has had an even greater effect on newly qualified GPs. An RCGP rapid survey from 25 July to 8 August 2024 found around 60% of new GPs had either struggled or failed to find a role.

At the time, RCGP chair Professor Kamila Hawthorne wrote in an op-ed for Pulse: ‘It’s absolutely staggering that there are not enough GP roles available when existing GPs are being pushed to breaking point. It’s especially worrying to see stark regional disparities in our findings, with GPs struggling hardest to find roles in areas that have higher levels of deprivation – potentially further entrenching health inequalities.’

While PCNs are now allowed to hire GPs under the additional roles reimbursement scheme, in mid-December, Professor Hawthorne told the Westminster Health Forum only 300 of the 1,000 roles had been filled.

Funding uncertainty

This ARRS extension hasn’t yet proved helpful for either practices or jobseekers. For practices, Professor Hawthorne said this low uptake was due to the uncertainty around the funding of the role, with some PCNs only able to guarantee this until March 2025. The level of funding itself is problematic, according to the BMA. It pays towards the bottom of the pay scale, and at £73,114, is only £600 more than GP registrars at the end of their training receive following the resident doctor deal agreed in September 2024. 

The jobseeking GPs responding to our surveys are also finding problems. ‘A lot of the jobs were only for ARRS GP roles,’ says the GP in the North West. The GP in Hampshire adds: ‘Some roles are restricted to newly qualified GPs due to ARRS funding restrictions, so experienced locums are in a difficult position.’ The ARRS GP funding terms say candidates must have qualified in the previous two years, and not done a substantive role before. 

However, the funding is going some way to alleviating practices’ recruitment problems. The GP in Salford says: ‘We have recently recruited a new salaried GP... who came highly recommended. We didn’t need to advertise as there seem to be lots of GPs looking for jobs at the moment. We are using the GP ARRS money to almost fund one session of the new salaried GP’s time. Recruitment doesn’t seem to be an issue at the moment.’

A Liverpool managing partner says: `If we were looking to recruit further, there are currently lots of GPs in the city seeking employment, so I’m confident we would be able to find one that matched our recruitment needs.’

Yet despite these practices having problems eased, the recruitment crisis has not gone away – as we will see in the second part of the series on Monday. 

To download the full Cogora report, which includes all the data and the methodology, click here