Changes in 2017
Early in 2017, we issued additional guidance to practices about recording information on locum GPs. In March, 2017, the reported locum FTE and headcount figures were considerably higher than in March the previous year at 1,187 FTE compared to 670 in March 2016 and with a headcount of 3,072 in March 2017 compared to 1,592 the previous year.
There is some anecdotal evidence that use of locum GPs was generally increasing during the early years of this collection. However, we believe that the large increases in locum FTE and headcount recorded in March 2017 are primarily due to improvements in how the data was recorded because of the new guidance, rather than being indicative of a sudden rise in locum usage.
After comparing the data submitted for March 2017 with the historical data, and following a consultation with stakeholders, we calculated FTE estimates for the locum GP workforce to account for records that should have been submitted in earlier collections. These FTE estimates are included in figures between September 2015 and December 2016 and mean that figures are comparable across the years. However, we do not calculate these estimates by personal characteristic such as gender or age so caution should be used when considering such breakdowns in earlier reporting periods.
We believe that some of the increase in FTE identified in March 2017 resulted from practices reclassifying some GPs from other job roles, for example Salaried GP on a Fixed Term Contract. To avoid double-counting them, we did not calculate estimated records for these GPs, as they were already included in counts of non-locum GPs prior to March 2017.
Although there is still a small ‘step change’ between December 2016 and March 2017, nonetheless, the overall counts of GP FTEs are believed to be consistent and comparable.
Different types of locums
The nature of the GP locum workforce is complex. Some work full-time while others work only a few sessions as locums and may hold other roles within the GP workforce. As a result, while we can calculate FTE estimates for locum GPs, it is not possible to produce reliable headcount estimates. For example, a week’s GP absence at a practice could be covered by a single locum working full-time or by multiple individuals each covering one or more sessions and these working patterns cannot be predicted. Therefore, when we produced the FTE estimates, we did not calculate estimated headcount figures and there is an unavoidable break in the locum headcount time series meaning that headcount figures after March 2017 are not comparable with earlier figures.
We are advised that some GP locums are based in a practice to cover long-term absences such as maternity leave or a vacancy while others may cover one or more sessions on a planned or regular basis such as every Wednesday. In these cases, these ‘regular’ locums have consistent and generally predictable working hours and their presence in the workforce is expected on a planned and/or ongoing basis. Details about these regular locums are collected in the main part of the National Workforce Reporting Service (NWRS) collection tool in the same way as permanent practice staff.
However, there is another cohort of locum GPs with less predictable working patterns. We refer to these sessional GPs as ‘ad-hoc locums’, and we collect and publish different information about them as described below.
In addition to details of permanent general practice personnel, we also collect information about the ad-hoc locum GP cohort (formerly referred to as infrequent locums). Please note that the concept of an ad-hoc locum is an artificial construct implemented for data collection and publication purposes. GPs do not consider themselves to be “ad-hoc locums” per se, but the nomenclature can help to understand how these sessional GPs interact with practices.
Ad-hoc locums are locum or sessional GPs who typically work briefly at practices to cover for short-term or unexpected absences. Depending upon the practice’s needs, these GPs may work as little as a single one-off session in the entire period covered by the data collection or may be employed several times to cover multiple sessions. In some cases, practices will employ the same ad-hoc locum GP whenever they need temporary cover for sessions, while in other situations, the ad-hoc locum may work at a given practice only once.
We introduced this ad-hoc locum category in the autumn of 2017 and published the first figures for this group in the December 2017 release. Until the introduction of this category, we were able to capture information on these ad-hoc locum GPs and their working hours only if they were employed by the practice at the time of the snapshot, (i.e., on the date of the data extract). This means that we were not able to reflect the entire contribution of this subset of the GP workforce, because GPs working on other days in the month, and the hours that they worked, could not be captured. This was exacerbated for months when the snapshot date was at the weekend or on a public holiday as many practices are closed on these days and their usage of ad-hoc locums was minimal.
Introduction of ad-hoc locums into the collection
To allow us to better understand the ad-hoc locum workforce and its contribution to the general practice workforce, we changed the data collection and issued new guidance to practices. Instead of providing information for a snapshot of the ad-hoc locum workforce, since December 2017 practices have used a special section in the data collection tool to tell us the name, GMC number (General Medical Council professional registration number) and the total number of hours that ad-hoc locums have worked during the reporting period; this is a subset of the data that we collect for the permanent practice staff, so we know less about this cohort than we do about the main practice workforce. Nonetheless, it has greatly enhanced our understanding of the sessional GP workforce.
The fact that the ad-hoc locum figures are calculated differently means that the FTE and headcount figures are not directly comparable with the snapshot of the main workforce.
Ad-hocs locums who hold other roles
Some ad-hoc locums work exclusively as sessional GPs providing short-term, short-notice or other temporary cover as described. However, some hold other roles within the general practice workforce in addition to acting as ad-hoc locums. For example, they may work in long-term locum placements in another practice, fixed term contracts or as salaried or other GPs. However, when interpreting the ad-hoc locum headcount figures, it is important to note that most ad-hoc locum GPs work only a few sessions during a reporting period, and many of these GPs have no other role in the primary care workforce i.e., they do not appear elsewhere, for example as salaried GPs. This means that the inclusion of ad-hoc locum figures in the GP headcount totals would carry a risk of distorting our understanding of the figures.
Provision of additional resource
It is also important to bear in mind that the ad-hoc locums are not necessarily providing additional resource for the general practice workforce as they tend to work in practices to provide temporary, short-term cover for short periods of sickness or other absence. (GP absences of longer duration, such as for maternity or paternity leave, or long-term sickness are likely to be covered in a different fashion, such as with a GP on a fixed-term contract.)
While it is important to understand and quantify the scale of the contribution of ad-hoc locums to the general practice workforce, there is a risk that including them in the main workforce totals artificially inflates our understanding of the figures, as in most cases they are not increasing capacity within the workforce. For example, a GP working 37.5 hours per week who is absent due to sickness for a week is still a member of the practice’s workforce and is counted in the statistics with an FTE and headcount of one. At the same time, an ad-hoc locum providing cover would also contribute one to the headcount figures and a pro-rata’d amount to the FTE total. This means that two people would be counted for the week in question, but with only one available to work, thus distorting the figures.
Due to some issues with the data quality in the last quarter of 2020, the ad-hoc locum FTE figures for December 2020 include some estimates.
Changes due to the introduction of monthly collections
Until June 2021, we included information about ad-hoc locums in the main publication figures. However, because the nature of the ad-hoc locum cohort is different to the rest of the practice workforce, and since the measures are calculated differently, from June 2021 we have removed information about ad-hoc locums from the overall totals and publish figures about this cohort only in Annexes B and C of the Excel Bulletin. Since July 2021 onwards, this series has been published monthly rather than each quarter. There is a delay in the availability of ad-hoc locum-related data so the figures presented for the two most recent months in Annexes B and C are marked as provisional and are updated in subsequent months. Users should always refer to the most recent publication for the most up-to-date ad-hoc locum statistics.
Annexes B and C in the Excel Bulletin also includes headcount figures for the additional roles that some ad-hoc locums hold in general practices. We recommend that these figures be treated with caution. While adding the ad-hoc locum FTE figures to the FTE totals in the Excel Bulletin can give a clearer picture of the level of service delivered by general practices, it is not appropriate to simply add the ad-hoc locum headcount figures to the totals in the main bulletin.