Locum work suits some GPs, but the Medeconomics February 2009 survey of locum pay rates reveals that a large minority of respondents were locums because of the lack of alternative employment rather than as a career choice.
The survey shows, however, that it is still possible to achieve high earnings from locum work.
Carried out in conjunction with the National Association of Sessional GPs (NASGP), close to 450 GP locums took part.
Of these, 40 per cent said they were working as locums because they had not been able to find a salaried GP post or a practice they could join as a partner.
A drop in demand
Of the 306 respondents who had been doing locum work for at least a year, 56 per cent reported demand for their services was lower. Only 22 per cent stated that they were in greater demand.
'Locum work in this area has dried up,' said a male locum in North West England.
A female locum in South Central England said: 'It is a buyers' market for those employing locums. Lots of locums want to leave this way of work and have job security, but there are few opportunities. I have applied for numerous jobs, but I can't leave locuming without a job.'
Of the GPs working as locums for at least a year, 76 per cent said that their rates were about the same as 12 months previously, 11 per cent said they were lower. Only 13 per cent said that their rates were higher. The table opposite shows respondents' 2009 fee levels compared with 2008 in different parts of the UK.
Locums' stagnant pay rates probably reflect falling profits at many GP practices as well as an increase in the number of GPs doing locum work.
A male locum from Bristol said: 'There is much less locum work around. Practices are trying to force down hourly rates, in some cases to as low as £50 an hour, even when on-call is involved, and they can get away with it. The locum market is flooded every year here in Bristol with a net gain of 10 extra locums a year, all desperate for work.'
Another male locum from the South East Coast said: 'Some practices refuse to negotiate prices - especially those run by private companies - and so I and many other local locums have refused to take on further work from them.'
Commented a female locum based in the Home Counties: 'I would like to increase my rates which have been the same for the past two-and-a-half years, but I feel the market is not right for this.'
NASGP chief executive Dr Richard Fieldhouse says there are now about 15,000 GPs doing locum work compared with half that number six years ago.
The dearth of GP partner vacancies and the fact that there are not enough salaried posts to go round as practices tighten their financial belts and do not replace retiring GPs is helping to fuel a rise in locum numbers.
'There are no partnerships available and only a few poor quality salaried posts. Unfortunately practices are protecting profits rather than the future of UK general practice,' a male locum in Scotland (Firth, Forth Valley and Tayside area) commented.
A female locum in South East Wales said: 'I was made redundant from a salaried post after six years. My ultimate aim is to find a partnership but the lack of partnership vacancies raises concerns for my long-term prospects.'
High earning potential
Forty-four per cent of respondents derived all their earnings from locum work and some were making a very good living.
Of the respondents who told us about their earnings, 5 per cent earned £80,000 or more a year just from locum work. The highest earner was a West Midlands locum who claimed to earn close to £170,000. All of these top earners were based in England.
Sixty per cent of respondents were women but this is understandable given that more female doctors than male are qualifying as GPs.
Only 12 per cent did locum work outside the area they were based in. Usually this was in adjacent areas, but one female locum from East of England said she worked everywhere in England and, before tax and expenses, she put her annual earnings at £80,000 a year.
A male locum from London said he worked across the UK. His annual income of £100,000 was entirely from locum work.
Forming a team
Most respondents booked their work directly, but 17 per cent used locum agencies. As well as working in-hours sessions, 33 per cent of respondents did out-of-hours work, covering practices' extended hours or working for out-of-hours organisations.
Sixty-two per cent belonged to a local sessional GP group. Dr Fieldhouse believes the best way to succeed is to take this a step further and set up a formal sessional GP support team in the form of a chambers or locums' co-operative and pay a manager to take bookings and deal with administration. He recommends using the NASGP model.
A locum himself, Dr Fieldhouse says: 'If the support team's members include locums preferred by local practices a few years down the line you'll have a very positive economy.
'My chambers booked 40 per cent more work in 2008 than 2007 and in November and December 2008 we were up 50 per cent on the previous year.'
Some respondents were highly critical of the way practices treated them. Another South West England locum says: 'I only work at practices where I feel valued. Locums should also beware of practices that try to get them to do unreasonable tasks like a partner's paperwork.'
He says it is a pleasure to work at practices that know how to make a locum feel welcome by having computer passwords to hand as well as a locum folder.
A locum working in Arran, Ayrshire and Lanarkshire said some practices believe in playing 'locum buckaroo by piling work on the locum before the remaining partners start to take up the slack'.
Why become a locum?
There are many reasons why GPs choose to become locums. Some are portfolio GPs doing locum work on top of part-time jobs. For others, locum work fits in better with family commitments. Older GPs often choose to do it before taking full retirement. Others commented that they simply enjoyed the freedom and flexibility to work when and where they wish.
But a few respondents mentioned the impetus for them was a less than happy spell as a GP partner or salaried doctor.
'I left a salaried GP position because I found it a dead end. As a locum I have more freedom and I can choose my hours,' a South Central England female locum said.
Another South West England locum said: 'I have been both a partner and a salaried GP. The experiences in both situations were so awful that I have no desire to go back.'
- Dr Jacky Anderson, a locum in Surrey, won the survey prize of a Philips DCP750 7-inch portable DVD and iPod video docking entertainment system
- www.nasgp.org.uk (National Association of Sessional GPs)