“Locums are marginalised”

Dr Richard Fieldhouse has campaigned for the rights of locums for more than a decade; he argues that they are ignored by the NHS.

I founded the National Association of Sessional GPs (NASGP) 12 years ago when I finished my GP registrar year. There was no other organisation representing the interests of GP locums and other sessional GPs. During its time, the NASGP has gained many successes and these include: persuading the BMA to negotiate access to the superannuation scheme for locum GPs; increasing the number of locum groups to around 80% persistently lobbying the BMA and the RCGP to do more for sessional GPs; and producing a standardised practice locum induction pack with the MPS, among other things. But there is still so much to do.

For years the medical profession has bumbled along, ignorant of the demographics of its doctors. Official statistics have only ever alluded to the number of partners working in a practice, only recently including the names of employed GPs. The NASGP conducted independent research and found that a staggering 25% of fully-qualified GPs work as locums. Not only does this huge figure obviously have an impact on locums and on workforce planning, but it also impacts on practices and patients too.

So why are there so many locums? We’re quick to blame cost-cutting practices, who are trying to save money and engaging fewer partners, but there is more to it than that. More and more GPs are choosing to become locums. For a start it is a great way to get a feel for the area, staff and patients and eventually to find the perfect practice. It is also flexible, and allows GPs with young children to choose when not to work. However, it is also very hard to choose when to work, which can be unhelpful and cause stress.

Whatever the reasons, the profession is not prepared for the potential chaos of so many GPs working outside a managed environment. So what does this mean for practices? With fewer partners, combined with their higher earnings, more salaried GPs are being employed. So, when there is a demand for extra GPs, the practice manager is faced with a great number of thinly-spread locums. Not only does this increase the workload, but it reduces the chances of hiring locums that are already familiar with the practice, or indeed local services. In terms of risk management, this is serious; the trend is leaning towards locums being hired who are unfamiliar with local systems and processes.

So what can we do about it?

Practices can accommodate locums most successfully by understanding their unique position. As a profession, a lot more can be done. Significant resources need to be allocated to allow locums to work within managed organisations. Working examples of this already exist, ranging from informal sessional GP groups to highly-structured locum chambers – none of which receive any form of funding from the NHS. We need to act together and fight the system of enforced underperformance that permeates through the locum profession, where patients may be exposed to unnecessary risk. Doing nothing is no longer an option.

Dr Richard Fieldhouse is a member of Pallant Medical Chambers, and can be contacted on Richard@pallantmedical.co.uk.