Understanding the GP locum conundrum 

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.

Editor’s note: We have edited this on 18 July 2024 taking on feedback from readers. I agree with the comments – on reflection, this wasn’t the right tone and was too promotional. To give context, I was speaking to Dr Fieldhouse at an event, and was intrigued by his take on the employment crisis, which gave a counterpoint to what many people are saying. And, while Dr Fieldhouse does have a commercial interest, I felt that his position, the figures he has got through these commercial interests, and his knowledge of the issue made this a worthwhile opinion – and I still do. That said, I failed to edit this appropriately, and that is my fault, not Dr Fieldhouse’s. Just to clarify, we received no money for publishing this, and no fee was given to Dr Fieldhouse. Again, please accept my apologies. Jaimie Kaffash, editor.

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 issue that may distort the perception of a lack of work 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, which often lead to them bringing a halt to locum work.

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.’ 

What we are seeing

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, our figures show that locums worked 14.5% more sessions and 16% more hours in May 2024 compared with May 2023.

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 matching the needs of locums and practices, we can create a more cohesive, engaged, and motivated GP workforce.

Dr Richard Fieldhouse is a GP locum in Sussex. He is the founder and chairman of NASGP, which runs LocumDeck