Who are the GP locums?BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5043 (Published 08 August 2012) Cite this as: BMJ 2012;345:e5043
- Ben Titford, South West Peninsula Deanery GP specialty training year 4 for workforce data and planning
Ben Titford profiles the GP locum workforce in Devon
Almost all doctors currently training in general practice are likely to work as a locum general practitioner (GP) at some point. GP locums are vital for the functioning of many practices, but information on their numbers, demographic details, and level of experience is sparse.
In addition, knowledge of the factors that influence GP locums’ choice of work is limited. Nevertheless, this sort of information is valuable for GP trainees (current and prospective), to inform their career choices; for practices, to help them find locum cover; and for deaneries, primary care trusts, and clinical commissioning groups, to ensure adequate workforce supply.
A typical view of GP locums is that they are doctors who have recently finished training and are working as a locum for a limited time while looking for a more permanent position. However, quantitative and qualitative survey data from a wider regional primary healthcare workforce study in the South West Peninsula Deanery show that GP locums are a much more diverse group. The findings give valuable insight into the demographics, motivations, aspirations, and working conditions of our GP locum workforce.
The best figures we could find for the number of GP locums in our region came from analysis of the performer list for Devon primary care trust. This showed that GP locums make up just over 20% of the GP population who have their certificate of completion of training , which is between the estimate of 18% from the BMA1 and 28% from the National Association of Sessional GPs.2 The NHS Information Centre does not include GP locums in its workforce census.3
Getting in touch with GP locums for the purpose of a survey was a challenge. We wanted to ensure we contacted GPs who were actually working as GP locums in our region, whatever their performer list status. We therefore emailed our survey with a covering letter to all practice managers in the region, with the request that they forward it to all doctors who had worked as a locum in their practice in the preceding year. We were also helped by the Devon and Cornwall Local Medical Committee and users of local sessional GP and locum group websites (devonsessionalgps.co.uk and gplocumdirect.co.uk).
Our response rate was about 30% (97 responses from an estimated 330 GP locums), which was a good response given the difficulties in accessing GP locums as a group and in light of the paucity of previous studies. Our mode of recruitment meant that the respondents were also likely to represent some of the most active GP locums in our region.
Our survey showed that GP locums are a varied group, with a wide range of ages and levels of experience. Most respondents were in the 31-35 (31%) or 36-40 age groups (14%), although a fair proportion (13%) were over 60. Flexibility seems to be the main attraction of working as a GP locum, with 76% of respondents citing this as a reason for their career choice. The independence of a locum career (52%) and not wanting to commit to a fixed post (35%) were also common reasons for becoming a locum (figure 1⇓).
In terms of previous experience, the most surprising result was the large number of GPs who had given up a partnership to become a locum. These doctors made up the largest group of GP locums in our survey (more than 45%). Most of the former partners cited wanting a change in their working life towards the end of their career as the reason for choosing the locum path. Many compared this career choice favourably with their work as a partner, with the benefits of better lifestyle and clinical freedom outweighing the negative aspects for most respondents. Most were positive about their decision and about locum work in general (figure 2⇓).
With respect to career intentions, GP locums fell into two main groups (figure 3⇓). The larger group was GPs who were doing locum work temporarily during a period of change in their lives, most often at the beginning or towards the end of their career, and who intended to look for a partnership or salaried post, change career, or retire. The smaller group made GP locum work a career choice, either from the start of their working life or (more commonly) after leaving a fixed post.
GP locums were also asked to comment on a variety of subjects relevant to their working lives. These included their reasons for working as a locum, their career intentions, their feelings about GP locum work in general and as a potential career choice, the availability of work, their experience of continuing professional development and education as a locum, factors that make a practice an attractive place to work, and whether there were factors that would make them avoid working in a particular practice.
Education was an area of particular concern. Many locums reported reduced access to information or mailing lists about educational events and increased difficulty accomplishing appraisal requirements, particularly audit and formal feedback (from patients and colleagues). Many respondents expressed a desire to do audit, attend clinical governance and morbidity and mortality meetings, and go to in-house education events but said that these opportunities were not available to them.
Friendly staff and doctors were important positive factors for GP locums when choosing whether to work in a practice (figure 4⇓). Poor organisation, an unrealistic or unfair workload, and computer system issues were among the commonest factors for avoiding particular practices (figure 5⇓). Many GP locums mentioned the potential for isolation in their work. However, most were positive about their work, with “enjoy” being a common word in their comments. The benefits of a strong sessional GP group for peer support, advice, and education were mentioned by many respondents.
More than a third (36%) of GP locums did additional work on top of their locum work, mostly medical education (13%) and work for medical organisations such as a local medical committee, the BMA, the Royal College of General Practitioners, and the General Medical Council (11%). A portfolio career is becoming increasingly popular across medical careers, and for some doctors locum work is the only work that fits around these commitments.
A typical concern for respondents who relied on GP locum work as their main source of income was job security. But they needn’t worry. While there is some seasonal variation in demand for locums, the overall need for GP locum work is unlikely to decline. GP surgeries are essentially small semiautonomous businesses that cannot reduce service demands. Unless they are adequately staffed, patient care and staff wellbeing suffer.
Locums enable practices to maintain their services despite fluctuations in their workforce. There is evidence from our larger workforce study that the need for GP locums is increasing. Of the practice managers in our region, more than a quarter (27%) reported an increase in the need for GP locums over the past two years; almost half (49%) reported no change in need; 15% reported unpredictable fluctuations in need; and only 9.5% reported a fall in need. This growing need is likely to continue as the commitments of partner and salaried GPs increase—as a result of commissioning and of care moving from secondary care into general practice.
GP locum work can be a fulfilling career in its own right. A high proportion (around 20%) of working GPs in Devon are locums. Those in our sample chose to work as locums at different stages in their careers, mostly because of the greater flexibility and independence that it allows. Some locum GPs had previously been partners, and a considerable proportion had opted for locum work as a long term career choice.
A particular issue for GP locums is the risk of professional isolation. The key to managing this is for locums to engage in good peer support and for practices to be friendly and supportive. GP locums are also particularly vulnerable to difficulties in achieving educational, appraisal, and revalidation needs. It is in the interests of primary care organisations, including individual practices, to engage with GP locums imaginatively to ensure that these needs are met.
Competing interests: None declared.