GP practices spend thousands on locums to fill vacancies

Dr David Chilvers examines patient John Brewer's foot when he visited Waterside Medical Centre, in Gosport
Dr David Chilvers examines patient John Brewer's foot when he visited Waterside Medical Centre, in Gosport

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EACH month GP practices are spending tens of thousands of pounds employing locum doctors to plug staffing gaps.

While locums – doctors used temporarily – have always been used to cover holidays, sick leave and maternity, surgeries in south-east Hampshire area say more are being used to fill job vacancies.

That is due to a shortage of GPs wanting to work in the Portsmouth area.

Today, as part of a week-long investigation into a GP crisis, The News looks at the use of locum doctors and the impact it is having.

Dr Sarah Brook is a practice partner at the Forton Medical Centre in Whites Place, Gosport.

In the past six months the surgery has spent £22,780 on using locums.

Dr Brook said: ‘The problem we have is we can’t recruit GPs in this area.

‘We’re advertising for a GP and in three months we had one application – it’s disappointing. While we look for someone we still need to provide care for patients but with fewer partners.

‘So what we have to do is bring in locum doctors to provide a service.’

Dr Brook said that its locum spend has been on covering maternity leave, long-term sickness leave and vacancies.

‘The job bears no resemblance now to when I started 21 years ago,’ she added.

‘We are being asked to do more stuff than before, and although we have nursing staff, there never seem to be enough appointments.

‘Some patients want to be seen, but don’t need to be.

‘What they perceive to be urgent isn’t always the case.’

Waterside Medical Centre in Mumby Road, Gosport, spent £119,228 on locums last year.

A full-time GP left the practice and to cover this, the surgery has been using a locum advanced nurse practitioner on a full-time basis.

In April the practice spent £4,772 on this position alone.

And between February and April this year, £11,962 was spent on locums.

Dr David Chilvers, a practice partner, said: ‘It has been hard to recruit and so we have to use locums.

‘But we need to look at reinventing primary care to better suit patient needs.’

One practice that, up until about three years ago, was spending between £60,000 to £80,000 a year on locums, is the Derby Road Group Practice, in Portsmouth.

This was due to a change in partners, sickness and maternity cover. Now its annual spend is about £24,000.

Practice partner Tim Wilkinson said: ‘Our practice at the moment is not struggling, but we have struggled in the past to find doctors and nurses to come and work for us, so we’ve had to use locums.

‘I have been a GP for 30 years, and you have ups and downs. Maybe we need to look at the way we are training nurses and GPs and make sure it is being done in the right way.

‘Not only is there a shortage of GPs but there’s a shortage of nurses, too, and in those cases we have to use locums.’

Pallant in Chichester is a chamber organisation.

Locum doctors pay a fee to get ‘on the books’ and then get sent to practices depending on demand.

Dr Richard Fieldhouse helped set up the chamber, which has about 80 members.

He said: ‘The GP role has changed enormously and so have the pressures.

‘Becoming a practice partner is like getting married – in the past a GP would settle into one practice and stay there for years.

‘Now, GPs enjoy moving around, working in different practices and actually enjoy being a doctor.’

Dr Fieldhouse said that locum doctors at Pallant can cost between £65 to £100 an hour. Practice partner GPs are paid a share of the surgery’s profits.

Dr Fieldhouse added: ‘Around 25 per cent of those in the chamber used to be practice partners, who are mid-career and have just had enough. There is more and more bureaucracy in practice work. Ninety per cent of those that have joined us say they are much happier now.’

Why locums are not the solution for surgeries

LIKE any business, using temporary staff is only a temporary solution.

While locum doctors ensure a surgery stays open, there are drawbacks.

Alongside the cost implications, GPs say that locums tend to see less patients, refer more on to secondary care, do not need to do paperwork, and only need to give a day’s notice if they decide not to go in.

Locums also mean patients are denied the chance to have a regular GP they can become familiar with.

Dr David Chilvers, practice partner of the Waterside Medical Centre, in Mumby Road, Gosport, said he has taken a 30-per-cent pay cut this year to ensure locums are paid.

He said: ‘Patients enjoy seeing “their” doctor, and with locums you don’t get that continuity of care.

‘Patients are also more likely to be referred on to secondary care if there’s no quick solution.

‘Patients want recognition – see the same GP who knows their medical history.

‘Staff GPs also have to take up the slack because locums do not have to do any paperwork or administrative duties.’

As reported, depending on what kind of GP you are determines how much you get paid.

A locum charges per hour and a salaried GP gets a fixed income.

But this money comes out of the income pot of the practice.

Once these costs have been met, along with paying other staff, bills and running costs, practice partners divide the remaining money as their monthly salary.

Depending on these variations, a practice partner may take home less money than a locum, but end up doing more work. These thoughts are echoed by Dr Sarah Brook, practice partner for the Forton Medical Centre.

She said: ‘Although the locums we use are very good, they see fewer patients per surgery and do fewer home visits.

‘They also don’t do the other work carried out by practice GPs, such as dealing with prescriptions, sorting through letters, talking to the hospital, and dealing with results.’

Dr Jim Hogan is a practice partner at the Lake Road Health Centre in Portsmouth.

He said that locums should only be used as short-term staff.

‘Having lots of locums can cause problems with continuity,’ he said. ‘People might think being a locum is less stressful, and to a certain extent it is.

‘But being a part of a business and owning it has its merits, too. You can have a direct influence on the healthcare you provide.

‘Having more practice partners would make the role less stressful.’