Firstly, I should say that locums come in many forms, not just doctors. I’ve recently come across a locum practice manager, a locum nurse practitioner as well as a locum healthcare assistant, a locum pharmacist and even agency reception and secretarial staff, all of whom were highly skilled and beneficial to the practice. However, all these temporary staff will, no doubt, cost more than simply employing new staff. The excessive employment of locum staff may in itself suggest that the practice is in crisis and might well attract the attention of the Care Quality Commission. The practice might also be reaching the point of being financially unstable.

Are the reasons for employing a locum legitimate?

The reasons for employing GP locums appear to have shifted from just needing short-term cover for absent partners who are on study leave, sickness or maternity leave to more serious reasons such as the basic survival of the practice. This might include covering for a retired doctor, a doctor who’s died or a doctor taking early retirement. I worked in a practice recently where there was a certain ease about finding GP locums but the cost was ridiculous and it wouldn’t take long for such a practice to become financially unviable. It’s a question of balance. So, in a practice of, say, five doctors, would it be reasonable to end up with four locums and one GP principal? Strangely, such a practice might be regarded as single-handed.

What daily rates are offered (or demanded)?

What daily rate does your practice expect to pay a GP locum? By my reckoning, the typical cost for a session by a GP partner or salaried GP is around £270, or £540 for a full day. For this you get commitment and hopefully a willingness to take a share in the whole clinical and management workload of the practice. This pay level would produce monthly drawings of around £10,000 before tax. Clearly in a practice with high running costs, this figure will reduce and the actual cost will be controlled by locum agencies who like to take their cut. I’ve come across locums expecting to be paid in excess of £750 per day. Where locum GPs are paid such fees, you could argue that such a locum might need to be employed for four days a week, not five.

Would you employ a locum when no sessions are taking place because the practice is enjoying Protected Learning Time? I know of practices that employ long-term locums, but I do wonder why these doctors don’t have salaried contracts. The problem is that some doctors working as locums now see it as a career that’s more profitable than joining a practice on a more formal footing.

How to avoid over-expenditure

A typical GP works 46 weeks each year. With bank holidays, you could say that’s 44 weeks. Research suggests that only a very small minority of GPs work nine sessions a week spread over five days.

Would you employ a locum to cover extended hours or weekend working? What about regular attendance at CCG or Federation meetings? What does it say in the partnership agreement about employing locum GPs to cover absences? One absence that’s unpredictable in its occurrence and in its duration is jury service.

Manage the employment of locums

So, should locum fees be capped or should the reasons for employing a locum be approved by the CCG? For instance, should a locum covering sickness not be employed until the sixth week of absence? I’d say that, in the first instance, the reasons why a practice should employ a locum should be restricted to long-term sickness, long-term study leave and maternity leave. The employment of locums should be justified and monitored by the Clinical Commissioning Groups. Perhaps practices have been allowed too much freedom to employ expensive clinicians without having a conscious eye on the costs and the financial damage that can be done to a practice.

Reducing GP commitments

In the past 20 years or so, the local health authority, in whatever form it took at the time, would have approved the time commitment to working in a practice of any GPs approved to set up their plates by the National Medical Practices Committee. Normally GPs were contracted to work full-time and occasionally approval would be given to three-quarter-time or half-time practices. These approvals were limited to a small minority of GPs. Salaried GPs were also rare. A relatively small number of retainer GPs worked two sessions a week. The local health authority such as the Primary Care Trust would make these approvals. Whilst working in different practices after 2004, I found that doctors wanted to reduce their commitment to a four-day week and less. Added to this, although there was a reduction in time commitment there wasn’t a similar reduction in drawings.

Expensive but not the full month!

Setting aside the reasons for employing locums, let’s look at the issue of paying for a locum GP. It must be argued that locums are very expensive and may well be restricted in their involvement in the business management of the practice let alone taking any clinical responsibilities. Practice managers, both clinical and non-clinical, may well struggle to get a locum GP to do any more than see a specific number of patients, probably 15 each session. But that’s not the job by any stretch of the imagination; there are home visits to do, repeat prescriptions to process and clinical letters to read, record and act on.

One practice I visited recently found that locums wouldn’t deal with clinical letters or tasks, but still happily took £750 per day.

Therefore, the employment of locums can provide a partial solution to absent GP principals, but it can also add to the stress and workload of the remaining partners. What’s your policy on employing locum GPs?

Author: Robert Campbell