GP practices won't pay locums

[crockofshite]

Four in five locum GPs in England unable to find work, BMA study finds | GPs | The Guardian

Is this why you can't see a GP?

Locums get paid huge sums of money. There has to be a point where you stop paying them and use the money to employ full time GPs. Short term pain for longer term gain.

They aren't employing full time GPs either.

There has been a government policy to give surgeries money to employ anybody except GPs.

So surgeries are trying to meet demand, employ who they can afford but fundamentally they aren't GPs and don't do the same job.

So you still can't get an appointment.

GPs generally can't afford to pay locums, and they aren't funded to employ salaried GPs. They receive funding for non-GP and non-nurse positions such as PAs and pharmacists.

So a lose-lose situation all round really.

This is not GP's choice.

Government chose to railroad in something called the PCN DES, which they forced on GPs in exchange for a really important change in indemnity which we needed, which meant that a load of funding didn't come into the normal core funding of surgeries, but it came with restrictions, crucially that it couldn't be used to hire GPs or nurses. It was for new staff, some of whom are useful (physios, social prescribers), some of whom are variably useful (pharmacists) and some of whom are downright dangerous (PAs).

If that funding was made unrestricted, demand for PAs would plummet overnight.

"Average GP locum day rates in England currently range from £600 to £850"

NHS can't afford and absolutely shouldn't be paying locum rates. More salaried positions is the answer. There's the challenge for the new government in July...

So that will be for probably 8 - 10 hours work. For someone who is self-employed, has no job security, no employer's pension, no paid holiday or sick/maternity/paternity leave.

I don't think £100 per hour is at all unreasonable. Financial advisors charge three times that. If the NHS was a better employer it wouldn't have gaps and we wouldn't need locums.

This is because the government have given GPs money to help but they are not allowed to use it on doctors.
Instead they have to spend it on none doctors. Physician Associates which sounds like a grand title but these are people who have done a very basic two year course with 100% pass rate compared with a GP who has a minimum of 10 years studying medicine. These PAs are paid vastly more than qualified junior doctors and are vastly less knowledgable.
IMO it's a politically motivated policy to spite doctors because of the strikes.

I’ve recently seen the head of the Royal College of Physicians has resigned over the physician associate saga but I’m not clear how it all went down and what happens next.

https://www.pulsetoday.co.uk/news/workforce/rcp-president-to-step-down-over-physician-associate-fallout/

That is per session. A session is approx 4 hours.

No, it very clearly says per day.

"Average GP locum day rates in England currently range from £600 to £850"

I'm a GP (not a locum). No-one gets paid that much for a session.

Re. the physician's associate role replacing doctors: a nurse requires a minimum of 3 years of degree. Plus many have have additional qualifications so they can prescribe. Yet, the government decided not to create more senior clinical nursing roles or pay senior clinical nurses more (most top out at band 7, much less than a lot of junior doctors (obviously not the recently qualified doctors who the nurses actually have to help train on the job)), but to go down the route of PAs, with less training than nurses and less experience than senior nurses. And still only impose pay rises on nurses 5% pay rise while offering 12% to doctors, which was rejected and likely to be even more. We need more doctors, but we can't have both more doctors and pay them 35% more. Other countries with higher proportions of doctors train more of them but don't offer the highest pay.
There is a snobbery about nurses and this is where it ends up: physicians associates, who really should be another type of nurse or a junior doctor, but the public don't want to be treated by a nurse, even one with 20 years experience and qualified to prescribe, and the BMA has always wanted limits on how many new doctors get trained and enter the workforce (supply and demand economics).

Another specific and relevant point about GPs in particular is that in other countries they are less qualified than 'doctors' i.e. they have Masters not Doctorates.

This is certainly the case in the Netherlands, where GPs don't have the title 'Dr' but have a Masters in medicine.

I expect there are fewer problems with the GP system in the Netherlands in terms of recruitment because the training to Masters level is quicker and cheaper than training to Doctor level so there are more of them getting trained and perhaps the salaries aren't at senior registrar/consultant level.

Surprised by this, as our surgery seems almost entirely staffed by locums at the moment. I've been 6 times I think this year and I've never seen the same one twice. Makes it really difficult as there's no continuity.

And this is the problem with GP funding. Surgeries get about £120 max per patient per year. You've been 6 times by June. Not a criticiam of you, but how on earth can a service run on this 'all you can eat buffet' type of funding.

@chaostherapy my understanding is that most doctors aren't actually trained to doctorate level, Dr is a courtesy title, unlike being Dr because of having done a doctorate.

I couldn't comment about the different levels of training for GP vs hospital doctors in other countries as I know nothing at all about it, but would be interested to learn how well it works!

I pay them. They do.

If you're paying £650 per session then you're either very generous, or an idiot.

Well dh and the dc haven't been at all this year or last so I guess I've had their budget too.

And I'd have been fewer times if the first one had acted on what I went for.

Fwiw I'd be happy to pay if that's the way the NHS went, same as being charged as an NHS patient for dentistry.

The people who don't go at all are outweighed by those who go multiple times a year.

It used to kind of balance out, but now people are living longer, treatment has got more complex, lots more monitoring required. So the population having 6 or more (sometimes many more) visits a year has skyrocketed.

Average has gone up from about 2 to 7 visits per year

@biscuitcat

That is also my understanding - the Dr title in the UK is a courtesy title following a (non-Bologna) Bachelors degree in Medicine and Surgery rather than the result of PhD studies.

In Germany, the basic training to become a medical doctor is actually longer than in the UK but, in my understanding, does, not entitle you to the title "Dr" in a day-to-day setting because it is not an academic Ph.D. qualification as such but instead the result of passing the dedicated national medical exam to practice the profession of a medical doctor.

Just asked my wife, a GP, says she gets £300 per session if she does a locum.

On the general point of the thread, the massive shortage of GPs pushed up the locum rates, consequently more doctors chose locum. They should have taken into account that this comes at the cost of long term job security.

Because of rising locum costs, systems and GP substitutes have been pushed to force practices to stop using locums.

Where we are now is the inevitable result.

As soon as the workforce stabilises, the ARRS funding will evaporate and practices will then have a chouce between AHPs or MAPs, or, GPs at a lower rate of pay than currently.

Engineered supply and demand.

Exactly. £650 a session is nonsense