As many of you might know, I’m an active participant on social media and regularly add my ‘two penneth’ to comments fired at healthcare providers. I usually try to give a balanced response, avoiding saying anything too contentious that could come back to bite me, while still trying to get my point across.

I was, however, upset to read a tweet yesterday from a single-handed GP who has had to forego her annual leave (half-term) because she couldn’t get a locum, leaving her partner, kids and elderly mum to fly off without her. This was a long-standing booking – not a ‘flash in the pan’, last minute.com attempt at a break. She knew half-term was coming; she’d been trying to find a locum for months and months.

Now, I don’t know all the details of course; I don’t know how many locums she’d tried or whether agencies were ruled out because of the cost. I wondered whether the doctor had contacted her CCG to see if they could help, but she commented that there was no assistance available.

What I do know is that locums are in really short supply now. We’ve had three locums locally who have all decided to do something entirely different – they’ve left the NHS completely. They’re disillusioned, burnt out and unable to continue facing the demand from patients and the lack of support from on high. I also know that, as a patient, I wouldn’t want to see a doctor who was exhausted, and I’m pretty sure that any worn-out GP would be anxious about their own capacity for making good decisions.

Whilst there aren’t that many single-handers left, when any GP goes on leave (it doesn’t matter how big or small the practice is), it leaves a gap that has to be filled. Even if you don’t fill every single session, you need to provide support for those GPs who are left holding the baby – and let’s not forget, the GP on leave needs to go on holiday knowing that their colleagues are supported by someone else.

Some surgeries are using other healthcare providers and mixing up how they offer care – locum advanced nurse practitioners, locum paramedics – borrowing ARRS team members from their network colleagues. But what if you can’t get one? What if that ARRS colleague has no capacity to help out? What the flip-floppin’ Nora do we do then?!

We can tweak our appointment systems, have more ‘on the day’ slots to cope with demand, switch some face-to-face slots back to telephone slots. Some locums offer a ‘remote-only’ service, so they’ll deal with phone appointments only, and that’s better than nothing, but if that remote GP needs a slot for someone to come in and be seen, you’ve got to have something available for them to book into.

We could also bang on about demand from patients – they’re asking more of us and they’re not happy to hang on for that routine slot – but this isn’t going to change any time soon and there’s a real danger that more and more GPs will decide they’ve had enough. Not being able to go away on holiday might just push them over the edge.

We can’t force doctors to become locums in the same way that we can’t force newly qualified doctors to only look at primary care as a career. So, can we make primary care more attractive? Do we need to look at our own practices and make them more appealing than our local colleagues’ practices – who are all trying to nab the same locum? Does it mean that we pay more for doing less? Is that what ‘attractive’ means now? What if you can’t afford inflated charges? Or is the whole problem another reason for network practices to merge?

Is the answer more collaborative working? Should we, as managers, be looking at our joint appointment systems and spreading the load amongst the clinicians, using existing GPs in our network to help cover the shortfall where locums can’t be booked? And, if we did, how on earth do we get our patients on board? Working in a very rural practice, I’m not certain that my patients would want to travel further to access healthcare – but you could argue that they might not even have a choice.

The only thing I do know is that if my docs can’t have their holidays, my life won’t be worth living… and, to be fair, I need a break from them as much as they need a break from work! If anyone out there has some ideas and would like to share what’s worked for them, please do comment – we need all the help we can get.

Nicola Davies