Consultations with locum doctors in UK general practice: longitudinal analysis of electronic health records.

Abstract

Locum doctors are vital for maintaining healthcare provision, especially in general practice. However, their levels of use, role, and impact remain relatively understudied and official statistics cannot be compared between UK countries. To explore locum use more comprehensively in the UK, over time and across geographies. A retrospective cohort study using the Clinical Practice Research Datalink (CPRD) GOLD from April 2010 to March 2022, analysing consultations across UK general practices. Consultation types were categorised by GP type (locum versus permanent). Multilevel mixed-effects logistic regressions modelled the association between locum consultations and patient and practice characteristics. Between 2010 and 2022, 914 UK general practices contributed to the dataset. UK locums provided more care than previously estimated, with a 2019 (pre-COVID-19 pandemic) mean of 14.9% (standard deviation 20.7) and median of 7.5% (interquartile range 2.3-17.5) of all consultations, indicating substantial variation. Over time, the use of locums in the UK remained relatively stable, but this masks different trends within the UK. The study found that use in England is increasing, in Scotland and Northern Ireland decreasing, and in Wales is flat. Regression analysis found that variation in locum use was largely unexplained by patient and practice characteristics. This study indicates higher use of locums across the UK than available NHS statistics would suggest. These differences are probably because of alternative ways of measuring GP activity (consultations versus hours worked). Regional and country differences highlight diverse workforce challenges where local solutions may be needed. These findings contribute to understanding NHS workforce dynamics and may help inform strategies for primary care service delivery.