What is the NHS’s problem with GP locums?

Perhaps it is just me, but have you noticed that NHS England seems to have an almighty problem with GP locums? First it was the locum ‘indicative rate’ where NHS bosses told GP practices to report annually all the instances where they paid over a certain amount for replacement cover. This ham-fisted initiative was included in the GP contract for 2016/17 against the wishes of the GPC and to the bemusement of practices everywhere. In contrast to the cap in hospitals, GPs are independent businesses and so the whole thing was a bit like ordering them to not pay so much for loo roll (come on, do you really need the ultra-soft cushioned variety?).  We are still waiting for the actual rate to see the light of day (I suspect because they have no idea where to set it). Next, the GP Forward View. This accused locums of ‘undermining service continuity and stable team working’ and - rather threateningly - it raised the prospect of ‘new measures’ to create an alternative for those who ‘can commit to working in a practice or an area over a period of time’. What this could mean, we still have no idea, but there was a sign in the recent announcement of reimbursement for indemnity costs. These will be given to practices as a single payment, based on their unweighted list size, with NHS England saying that it expected practices to provide an ‘appropriate share to their salaried GPs and locum GPs’. But let’s be realistic, this is hardly likely to happen. GPC lead on indemnity, Dr Charlotte Jones, had a rather different take saying on Twitter: ‘The view of NHSE is that sessional GPs who are not salaried can increase their fees.’ Hmm that is rather ironic as then they will presumably breach the ‘indicative rate’. Spot that? It is called a pincer movement. I suspect is the start of a mini campaign to make life that bit more uncomfortable for freelance GPs. NHS England chief executive Simon Stevens is a big fan of the independent contractor model, and why wouldn’t he be? It is cheap, popular among patients and there are no limits on the work you can pile on. The rationale is that locums have been freewheeling around the NHS for too long and I am sure some GP partners would agree that locum fees are out of control and that they are being held to ransom in what has become a seller’s market. But for many GPs this is the only way they will stay in the profession. I have been given sight of a poll from the National of Sessional GPs which found 92% of the 77 GPs who answered agreed or strongly agreed that entering a locum chamber was crucial to them remaining a GP and 86% to preventing them from burning out. Now, the poll is very small (and those in chambers may be happier than most) but it is still significant that so many say this is the only way for them to remain practising. A Pulse poll also supported this trend, with half of GP partners saying they would go salaried if the right deal was offered. The truth is there is no magic bullet that will prevent the current drift away from partnerships and it has been NHS England’s policies over the past few years have fuelled this drive towards locuming. Persecuting locums is not a solution. It has been said many times, but is worth repeating: make the day job as a partner more bearable, and then the tide will turn the other way.