Locum GPs, are they a low quality and overpaid drain on resources or an underutilised pool of agile talent? Ben Gowland seeks to dispel some of the more prominent myths.

The debate about locum staff has raged for years, but the recent strain on NHS finances has brought it into even sharper focus. GP locums have not escaped: NHS England attempted to introduce practice reporting on any payments made over an ‘indicative maximum rate’ as part of the 2016/17 contract. In response the LMCs passed a motion which rejected ‘any attempt to cap the fees charged by GP locums’, asserting the real problem was the GP recruitment crisis.

Is the use of NHS monies on GP locums a waste of scarce resources? Or is it a valid expenditure, pivotal to enabling a fragile system to continue to operate? I recently debated this with Dr Richard Fieldhouse, Chair of the National Association of Sessional GPs (NASGP). He took the opportunity to dispel a few myths.

Myth 1: GP locums are destroying continuity of care. The reality is very few us will see the same GP each time we visit our local practice. For at least half of us, it doesn’t matter which GP we see. For those where it does, practices are rarely organised to enable this. When a practice employs a locum GP, they are just as likely to be asked to see patients where continuity of care would have made a difference to those where it would not. You can’t blame locum GPs for how practices organise care.

Myth 2: GP locums deliver lower quality care. For a GP to be effective they need to be able to access a range of information, including patient histories, test results and local patient pathways. Practices rarely provide locum GPs with the information they need. It is not that locums deliver lower quality care, it is that practices prevent locums from performing and often make it impossible for them to function effectively.

Myth 3: GP locums earn more than most GP partners. GP partners, who sign the cheque for the invoice, see the gross amount the locum receives. They then compare this with the net amount they take home, and, inevitably, the gross amount is larger. This does not mean the take home pay of the locum is greater! And when a locum GP is employed through an agency, the cost includes a 20% or 30% agency mark up. Money to the agency is not money to the individual locum.

Myth 4: GP locums are a small, greedy minority of the profession. The number of locum GPs stands in the region of 17,000, and represents about a quarter of all GPs. It is not one or two GPs out to make a fast buck. It is an increasingly popular career choice, and, as our recent podcast series has shown, attracts a range of GPs with a range of different motivations. Characterising locum GPs as a drain on resources serves to disempower a substantial, and growing, portion of the total GP workforce.

In future, all GPs may be locums. If the profession does eventually follow through with its threat of mass resignation, local locum GP chambers represent one of the most likely future employment scenarios for GPs. Even if GPs resist the temptation to press that particular nuclear button, the growth of multispecialty community providers (MCPs) may also see a rapid growth in local locum GP chambers, as the historically independent-minded profession seeks to resist a salaried fate.

The time has come for the debate to move on. The focus should no longer be on the validity of locum GPs, but rather on how the system makes best use of what Richard describes as “the rich pool of agile talent” it has at its disposal.