Locum GPs and the New GMS Contract
Doctor Magazine, July 2004
The new GMS contract came into effect in April of this year. It effects significant changes in the way primary care services are funded and delivered, and in the way that practice income is generated. It has also opened the way for the involvement of private companies in the direct provision of general medical services.
It is still too early to be sure how these changes will affect locum doctors, but there are several area that it are already likely to be important for locums.
Market forces
Self-employed locum GPs are virtually the only doctors in the NHS who can effectively use the leverage of market forces to affect their income, terms, and conditions. The shortage of GPs in the UK has meant significant rises in locum GP fees in the UK. This in turn has led more GPs to leave the NHS to become locums, deepening the recruitment crisis, and giving GPs a stronger position in the new contract negotiations. The combination of an ageing population and shrinking workforce means it is unlikely that this situation will be reversed in the short to medium term, even with the importing of doctors from Eastern Europe.
It remains to be seen whether the new contract will slow, or even reverse, the retention crisis. If it cannot, and/or if workload increases, then the demand for locums will accelerate and rates are likely to increase further.
Out of Hours (OOH)
The ability to opt out of 24 hour care is one of the cornerstones of the new contract. Up until now most OOH care has been provided by co-operatives of GPs working together. The co-op hourly rates have been artificially depressed by the fact that the pay was essentially circular (i.e.: the more GPs paid themselves to do shifts, they more they had to pay into the co-op to keep it going). This means that night rates are currently significantly lower than daytime locum rates in many areas.
However, with the PCTs taking over responsibility for OOH, there are opportunities for locums to negotiate higher rates of pay for difficult to fill shifts. OOH sessions are likely to be more intensive, and less popular, than before because PCTs will want to maximise the use of the GPs they employ.
Nurses and paramedics are unlikely to replace OOH GPs in the short to medium term, as there are shortages of staff with appropriate experience, they have high training costs, see less patients per hour, and refer more patients to secondary care. Even a small increase in the referral rate to secondary care will far outweigh any payroll savings.
It will take around 12-18 months for market forces to properly exert themselves, but it is likely that night rates will need to rise to around £100-£150 per hour to attract locums.
Computer skills
Practice income is highly dependent on the proper recording of income generating activity (‘tick box medicine’), and the various GP IT systems (Vision, EMIS, Torex, GPASS etc.) have introduced modules that will help practices maximise their income under the new contract. Although there is no shortage of locum work available at present, locums that can maintain or even improve practice income will be in a strong position to negotiate higher fees or better terms and conditions. In business terms this is referred to as ‘value added service’, and a key skill for locums will be the ability to generate income for practices using a variety of IT systems.Private providers/Enhanced services
The new contract, and the new rules on the sale of goodwill, will encourage private companies to enter the GP market. This will take the form of either provision of specific services (eg: warfarin monitoring), or the provision of a full range of primary care services (eg: GP walk in clinics). NHS GPs may also form new companies to bid for contracts for non-core services. Such companies are likely to use mainly salaried doctors, but locums may find that they are willing to pay a premium rate for unfilled shifts, as failure to do so would jeopardise their contract(s).Blurring of distinction between locum GPs and GPs in partnerships
GPs in partnerships are now negotiating and bidding for work with the PCTs in much the same way that locums negotiate for work with practices. In some cases, such as OOH, the two groups are bidding for work alongside each other.
Both groups will need to develop good negotiation skills in order to thrive, and the new contract is likely to widen the gap between the highest earning GPs (organised and good at negotiation) and the lowest earning (disorganised and poor at negotiation).
Robbie Coull
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