The scale and scope of locum doctor use in General Practice in England: Analysis of routinely collected workforce data in 2017 - 2020

Background: Numbers of GP locums in the NHS have grown in recent years, yet evidence on the scale and scope of the locum workforce in general practice is sparse. Aim: To identify characteristics, geographical patterns and drivers of GP locum use. Design and setting: Observational study of routine data from general practices in England. Methods: Descriptive analyses of national GP workforce data betwen December 2017-September 2020, to determine the volume and geographical distribution of locum use and examine the characteristics of locums compared to other GP types. We modelled locum FTE using negative binomial regressions and estimated Incidence Rate Ratios (IRRs) for the association between the outcome and practice and population characteristics. Results: In December 2019, locums made up 1,217.9 (3.3%) of 33,996.6 total GP FTE which was fewer than other GP types. Median locum age was 42 years (IQR, 36–51), and the majority were UK qualified (660 of 1,034 total locum FTE), were male (642.6 of 1,178.9 locum FTE), and had long-term employment (834.1 of 1,127.9 total locum FTE). Rurality (IRR=1.250; 95%CI 1.095-1.428), inadequate CQC ratings (IRR=2.108; 95%CI 1.370-3.246) and single-handed practice (IRR=4.611; 95%CI 4.101-5.184), were strong predictors of locum use. There was substantial variation in locum use between regions. Conclusion: GP locum use remained stable over time. Compared to other GPs, locums are younger male GPs, a substantial percentage of whom did not qualify in the UK, who serve underperforming practices in rural areas. This is likely to reflect recruitment or high turnover challenges in these practices/areas.