Luna Williams, a commentator for Arora Medical Education, outlines some of the key challenges faced by locum GPs during the COVID-19 pandemic.
Over the past five years, licensed doctors choosing to take on work as locums has dramatically increased. In fact, estimations show that more than one fifth of UK-based doctors work in a locum capacity. In practice, locum GPs are defined as a general practitioner who temporarily fills in for in-house staff during absences or staff shortages. Locums are often referred to as ‘freelance GPs’.
The role locum GPs play within the UK’s healthcare sector is integral, particularly in light of patient backlogs and increased staff demands in the NHS as a result of the COVID-19 pandemic.
However, as we emerge from social restrictions and further towards a post-pandemic world, many practicing locum doctors – and those considering the profession – are feeling neglected by the industry.
COVID-19’s combination of rapid transmission and the severe impacts it had on those who were vulnerable presented unprecedented challenges to the NHS. As hospital admission rates soared, reporting naturally focussed on the impact COVID-19 was having upon hospital staff and those working on COVID wards. With this, reports on the plethora of difficulties faced by other members of the sector, including locum GPs, were much less common.
Increased uncertainties for locum GPs
Locum GP work has many benefits, including increased flexibility, autonomy, and opportunities for a better work-life balance. However, as with any self-employed position, locum healthcare professionals are also subject to more uncertainty, and this was exacerbated by the pandemic. Uncertainties about regular income, a lack of employment benefits and issues with patient continuity have been made worse by the tumultuous nature of the COVID-19 pandemic.
To compensate for the immediate impact of the pandemic, GP work rotas were combined, and shifts disappeared virtually overnight. There were fewer rota gaps in secondary care and, more importantly for locums, unfilled sessions in primary care. Contracted GPs cancelled and rearranged annual leave plans amid restrictions, and as a result there became less need for locums at practices. One 2020 survey showed 70% of UK practices offering a significantly reduced rate of locum posts after the first lockdown.
To add to this, locum GPs are not entitled to employment benefits such as sick pay or paid holidays, which meant that mandatory self-isolation after testing positive or – in the earlier stages of the pandemic – coming near to someone else who had tested positive was devastating.
Personal health issues
According to research conducted in 2020, 8% of general practitioners in England are at high risk of COVID. Pre-pandemic workforce data actually showed that locum GPs were more vulnerable, with 25% of locums over the age of 70 in 2017-18. This is largely down to a trend showing long-serving GPs who wish to continue working on a reduced basis as they reach an older age.
Practices across the country responded to the first lockdown in March 2020 by shifting most of their services online. Calls, video appointments and online-chat-services were used where possible, but NHS England still continued to enforce face-to-face consultations where this was clinically necessary.
In turn, with unsalaried GPs not entitled to any sick pay (beyond statutory allowance) many locums who fell into the high-risk group were unable to shield, as the potential loss to earnings would be unmanageable. To compensate, many locums chose to take on positions that posed less health risks – such as remote administration and triage roles, but these positions became harder to find amid increased demand. This meant that many locum GPs were forced to risk their health each day in order to continue to make a living and became part of the key workforce.
Increased social isolation
A recent study from the Society of Occupational Medicine found that many NHS and private doctors struggle with their mental health. According to the report, between 30 and 40% of UK-based doctors have at some point in their career experienced significant workplace-related stress and burnout. What is more, a survey of GPs conducted in 2021 found that the pandemic ‘significantly contributed’ to a decline in mental health for a huge proportion of GPs, with nearly half of those surveyed saying they had experienced an increase in stress and a deterioration in general mental wellbeing as a direct result of it.
Social isolation is a common facet of life as a locum GP – and has been since before the pandemic. While salaried GPs have a consistent shift pattern, patient log, and group of colleagues, locums take on roles in practices for a week, day or even a single shift. As a result, there is less access to a supportive network of colleagues, or even familiar patient faces. As a result, loneliness is naturally more common with locum workforces. This issue was massively exacerbated by the pandemic with a shift to remote working and consultations, those working in practices would meet even fewer people taking on shifts throughout an average working week.
This increase in isolation, in tandem with added stress and mental health-related issues, added another layer of challenges to locum GPs during the pandemic.
It is clear that COVID-19 has presented a range of unique challenges to locum GPs. But is it still a worthwhile career trajectory for those graduating from medical school or considering a career change within the health sector?
Practicing as a locum GP has a significant number of benefits and, as we emerge from the pandemic, the weight of these has been increased. Flexibility, autonomy, and variety are all important pros when it comes to considering practicing as a locum – and the loss of these values during the UK’s lockdowns has made these even more important now.
What is more, the demand for locum medical practitioners has dramatically increased now that non-urgent and routine appointments and care have resumed, and the appointment backlog built up during the pandemic needs tackling. This will mean more roles available across the country, and more competitive rates.
About the author
Luna Williams is a commentator for Arora Medical Education, which specialises in providing MRCGP RCA, AKT training for GP trainees, as well as providing revision resources for MSRA and PLAB exams.
Arora Medical Education