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Debate: Do practices have a duty to support locums during the pandemic?
Two GPs share their perspectives on practices' duty to support locums during this period
YES - Locums have helped practices in their time of need
After becoming a locum due to personal circumstances, I had chosen a lower rate in return for regular sessions at a local practice. This worked well until 13 March, when I developed full-blown Covid-19 symptoms. I had been consulting without any PPE.
Despite requests to organise work from home, my practice did not employ me to do so. Overnight, I found myself unemployed and unwell, and then I was asked to shield (due to brittle asthma).
Not all locums are in my position, but many would have their own stories. Locum groups with daily shift offerings fell silent. The only shifts left were high-risk – patient facing with minimal PPE, even as calls went out for retired doctors and medical students to help the NHS. The biggest irony came when my retired doctor parents were asked to return and offered remote working options.
We know NHS England committed to practices being able to claim back costs incurred during the pandemic, while protecting funds for suspended LES and QOF work. And we also know practices have still had a lot of organisational work to do during this time.
The risk is now way beyond what could have been imagined
So if practices are still being paid and still have high volumes of work, why not use locums as before, for remote consultations or other tasks? This could even allow permanent staff to take time off and avoid potential burnout.
There is a moral aspect. It's true we chose to locum and take the risk of self-employment. But the risk is now way beyond what could have been imagined.
Partners often talk about locums' high fees but many work closely with a small number of practices with which they have built up relationships. Yet this seems to have been forgotten now many of us are facing financial ruin. We have supported practices during sickness and emergencies. And we still need to pay GMC, indemnity, BMA and RCGP fees.
But there are practical issues, too.
We will be an essential part of the efforts during the pandemic and its aftermath, especially now patient demand is rising again and staff need a break.
By leaving us to face financial ruin now, would you be surprised by a mass exodus of doctors out of general practice and the UK when you really need us?
Dr Saumya Jha is a locum GP based in north London
NO - This is the reason locums receive high fees
Can you have your cake and eat it? I would say no.
Why should GPs be different than other self-employed people who aren't given financial favours? Surely part of the reason for the high fees locums charge is job insecurity and the need to save for a rainy day?
When I began my career many peers started off as locums, but few continued with this long term. Recently, the trend for GPs, often early in their career, seems to be to choose long-term locum work.
The NHS Digital GP Workforce Dashboard shows that in March 2020 around 10% of the GP workforce were locums, 58% of whom were under 45. Compared with March 2016, that's almost an extra 3,000 GPs choosing locum work.
This distortion of the GP workforce over recent years is of concern. Market forces have driven up the demand for locums, leading to escalating fees. This has gone too far. Locums are vital for covering sickness, maternity leave and holidays but practices have been left needing them just to maintain a service. The option to locum is also important for colleagues who may have suffered health or personal problems and may be unable to rejoin the permanent workforce. I feel for them in the current situation.
As we come out of lockdown, things are getting busy and I am sure practices will be relying on locums again soon.
Can you have your cake and eat it? I'd say no
I hope some of those who have taken advantage of the benefits of locum work will see that the stability of a substantive post has its advantages. For those who are struggling for ad-hoc work there is permanent work available – practices have struggled for years to replace GPs who leave and there will be opportunities.
If locums continued to be given work even when it is not in the best interests of practices, this will distort the market further and market forces have to work both ways. We are already seeing a rebalancing; practices have applicants for unfilled roles. We've had no difficulty recruiting within weeks of advertising.
Is this part of the post-coronavirus 'New Normal'? If so, then it gives me confidence about the stability and future of general practice.
Dr Simon Hulme is a GP partner in West Yorkshire
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