Intended for healthcare professionals

Opinion Taking Stock

Rammya Mathew: We risk creating a lost tribe of GPs

BMJ 2024; 384 doi: (Published 09 January 2024) Cite this as: BMJ 2024;384:q15
  1. Rammya Mathew, GP
  1. London
  1. rammya.mathew{at}
    Follow Rammya on X/Twitter: @RammyaMathew

For the past 10 years the general practice workforce has been flooded with locum GPs. Many practices were unable to recruit salaried employees and instead were paying a premium for locum GPs to provide enough appointments to meet the needs of their patient list. In the past few months, however, I’m hearing stories from locum GPs who can no longer find work and are struggling.

The change in market conditions is similar to what happened as the covid pandemic took hold, when demand for appointments plummeted and locums were cut loose overnight. But now, with the growth of the Additional Roles Reimbursement Scheme, some might say that this latest development was more predictable. As networks of practices have been funded to take on more clinical support staff, practices are now able to offer enough appointments, and it no longer makes sense for them to employ expensive locum GPs. Policy makers insisted that the additional roles weren’t intended to replace GPs, but this is exactly what’s happened.

Being self-employed comes with inherent risk, and perhaps those doctors who chose to locum should have known that the good times weren’t going to last forever. And, after all, locum doctors who are short of work always have the option of taking on a salaried role. Interestingly, however, many of the locums I know are not doing locum work for the extra money—rather, they’re women or primary caregivers who are trying to fit clinical sessions around their other responsibilities because employed roles haven’t offered them the flexibility they need. I’m also mindful of the fact that working conditions for salaried GPs have improved very little, so for many this still feels like an unworkable option given the long hours and the sheer volume and intensity of work involved.

I know from my GP colleagues that it can be frustrating to see other non-doctor clinicians taking up employment at practices that comes with more boundaries, more support, and less responsibility. I fear that, rather than encouraging locums back into salaried roles, we’re set to create a lost tribe of GPs who feel undervalued and want to do anything but NHS general practice. Although the change in market conditions is distressing for those currently caught in the eye of the storm, these doctors are highly skilled and will find other work—be that in healthcare or outside it.

Sadly, in the UK we already have far fewer GPs than the OECD average, so losing more of them isn’t something we can afford to do. It would forever change the face of UK general practice and leave us with a GP-lite model that I fear would be nigh on impossible to reverse.


  • Competing interests: None.

  • Provenance and peer review: Commissioned; not externally peer reviewed.