Use of locums highest in rural, small or poorer performing GP practices

New research led by University of Manchester researchers published today (11/01/22) in the British Journal of General Practice has thrown new light on the use and characteristics of locum GPs in England.

At a national level, the use of locums was low and stable between 2017 and 2020 though some practices and areas used significantly more locums than others.

The proportion of locum GPs, compared to other GPs in rural practices was 25% greater than in urban locations.

Practices that were single handed- where a lone GP works- used locums at a rate 4.6 times higher that of practices employing more permanent GPs.

Practices rated as inadequate by the Care Quality Commission used locums at a rate 2.1 times higher than practices rated as outstanding.

The findings, say the team, are likely to reflect the difficulties many practices have in recruiting doctors and sheds light on the challenges facing primary care.

Locum GPs also tend to be male and younger, with an average age of 42, and more likely to have qualified outside of the UK when compared to other GPs.

The analysis, funded by the National Institute for Health Research (NIHR), used data from NHS Digital on almost 34,000 doctors and found:

• Locums made up on average 3.15% of the GP workforce in December 2017 and 3.31% September 2020, figures adjusted for full time equivalent
• Around 65% of the locums were UK qualified and around 54% were male
• Around 74% of the locums were used to cover long term absences or vacancies
• Locums were concentrated in parts of the North West, Greater London, West Midlands, Essex and the Isle of Wight.

Locum GPs are defined as doctors who provide cover for permanent staff including maternity/paternity leave, sick leave, annual leave, suspended doctors or vacancies.

Lead author Dr Christos Grigoroglou from The University of Manchester said: “Locum GPs have an important role in the delivery of primary care services, particularly in the delivery of out-of-hours care and in helping to address short-term workforce shortages.

“Despite expectations that locum GP numbers are rising we found that locum use in primary care has remained stable over time though their use seems to vary substantially across different practice types and areas of the country.”

 He added: “In recent years, the NHS has suffered from insufficient long term workforce planning, prolonged shortfalls in funding, and a high number of doctors leaving the profession early which have contributed to the current workforce crisis.

 “Before we conducted this study, research on the extent of GP locum use in general practice and the composition of the GP locum workforce was sparse.

“So identifying the drivers behind variation in locum use in English primary care provides useful context for those involved in workforce planning, especially in areas with high GP turnover.”

 Dr Thomas Allen from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform future workforce planning.”

 “We suggest that relatively high and sustained levels of locum use may be an indicator of wider problems which are affecting recruitment and retention.”

“Practices in rural areas and those with inadequate CQC inspection ratings may face substantial challenges in recruiting and retaining permanent GPs, and this study highlights this.”

 Professor Kieran Walshe from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform workforce planning.

“This can be particularly useful to meet local health care needs with sufficient resources for training and deployment of GPs which will help ensure that the targets set out in the NHS long-term plan are met.”