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 GP 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.
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.
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.
For example, between July and September 2020, 1,765 distinct individuals were identified as working as an ad-hoc locum GP. However, of these GPs, 1,213 worked in no other roles in the general practice workforce and most worked very few hours during the quarter. As a group, they therefore contributed 1,213 to the headcount figures, but accounted for only 45 of the total FTE. This means that the inclusion of ad-hoc locum figures in the GP headcount totals carries a risk of distorting our understanding of the figures.
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.
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 Annex B of the Excel Bulletin. Since July 2021 onwards, this series has been published monthly rather than each quarter. We expect there to be a slight delay in the availability of ad-hoc locum-related data so the monthly figures presented in Annex B are marked as provisional and may be updated somewhat in arrears. Users should always refer to the most recent publication for the most up-to-date ad-hoc locum statistics.
Annex B 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.