A Broken System Leaving Qualified Doctors Jobless

England's locum GPs are struggling to find work despite soaring patient demand, revealing a primary care system in crisis due to underfunding and misguided policies.

A Broken System Leaving Qualified Doctors Jobless
Photo by Nicolas J Leclercq / Unsplash

In a shocking paradox that exposes the deep cracks in England's healthcare system, highly qualified locum GPs are struggling to find work, even as patient demand soars and wait times for appointments stretch into weeks.

This employment crisis, as described by the British Medical Association (BMA), is a symptom of chronic underfunding and misguided government policies that have left primary care in a state of disarray.

The numbers paint a stark picture. A survey by the medical publication Pulse reported a staggering 44% reduction in GP vacancies since November 2022, while the number of locum GPs providing temporary cover dropped by 35% from March 2023 to March 2024. For doctors like Ruth Hennessey, who runs a locum agency in Southampton, the impact has been devastating. "We've seen a 90% decrease in bookings," she says. "Many of our locums who previously had steady work are now struggling to find any at all."

So what's behind this crisis? The BMA points to the government's flagship Additional Roles Reimbursement Scheme (ARRS) as a key culprit. Introduced in 2019, the scheme funnels £1.4 billion into funding various non-doctor roles in primary care, such as physician associates, dieticians, and podiatrists. While these roles undoubtedly have value, the unintended consequence has been a drastic reduction in demand for locum GPs.

"General practices are being flooded with these ARRS roles, which are essentially replacing the need for highly qualified doctors," explains Dr. Richard Vautrey, chair of the BMA's GP committee. "It's a short-sighted approach that undermines the profession and leaves many locum GPs out in the cold."

The allocation of funding is another sore point. Rather than investing directly in GP practices, the government has chosen to channel money into primary care networks (PCNs) and ARRS roles. This redirection of resources, the BMA argues, has left practices struggling to cover rising staff costs and has further eroded the market for locum GPs.

Against this backdrop, the government's promise to deliver 6,000 new GPs by 2024 rings hollow. With more than half of all appointments now conducted by non-GP staff, it's clear that the focus has shifted away from supporting and expanding the core workforce of qualified doctors.

The human cost of this crisis is immense. Locum GPs, many of whom have dedicated years to training and serving their communities, are being forced to travel long distances or even return to grueling hospital roles in search of work. The stress and uncertainty take a heavy toll on their mental health and well-being.

But it's not just doctors who suffer. Patients, too, are bearing the brunt of a system stretched to its limits. With fewer qualified GPs available, the continuity of care that is so essential to effective primary care is being eroded. Serious conditions risk being missed or misdiagnosed, with potentially life-altering consequences.

The solutions are clear, but they require a fundamental shift in government policy and priorities. The BMA is calling for an urgent extension of the ARRS to include GPs, giving practices the flexibility to hire the staff they need.

Funding must be allocated directly to practices, rather than being siphoned off into PCNs and non-doctor roles. And the government must honor its commitment to train and retain a robust pipeline of qualified GPs.

Ultimately, this crisis is a symptom of a broader malaise in England's healthcare system – one that prioritizes short-term cost-cutting over long-term sustainability and patient care. Until we address these deep structural issues, the locum GP crisis will continue to fester, leaving both doctors and patients to pay the price.

The time for action is now. The government must listen to the urgent pleas of the BMA and other medical bodies, and take decisive steps to support locum GPs and rebuild a primary care system that works for everyone.

The alternative is a continued erosion of one of the most vital pillars of our healthcare system, with consequences that will be felt for generations to come.