Wendie Smith reflects on being a nurse locum in primary care and asks if there are things that should change to benefit this valuable part of the workforce.
As a temporary nurse in general practice for eight years pre-Covid 19, I observed a disparity in the support provided to medics compared to non-medics. As I now return to working as a locum to improve my work-life balance, I want to address these discrepancies and highlight key issues that have affected me as I change my working practices.
The increase in locum nurses in general practice has increased. Although figures of current agency use in general practice are not available, in my experience the number of nurses working outside employment, not just agency, has increased in the last 10 years.
In the main I have worked directly with GP surgeries, not through agencies, as I feel strongly that I want to keep NHS costs to a minimum.
To assess the agency burden to the NHS, the Royal College of Nursing – in a freedom of information request – found the total agency spend of 181 NHS trusts in England was just over £3bn between 2020 and 2023.1 The cost of agency is not just in pounds but also compromises care2 , and puts a further burden on substantive staff.3
One major challenge is the NHS pension inequality. Currently, GPs can contribute to their NHS pension while working as a locum as long as they are not operating through a limited company. This option is not available to other staff, who may have to settle for a less financially favourable private pension. Additionally, GPs can charge the cost of the NHS pension to the GP surgery where they are working.
This also links with the general working conditions of nurses in general practice. There is no standard contract within general practice, and also a difference if you work for a primary care network (PCN) or GP surgery.
Two colleagues employed by the same GP surgery doing the same role, could be paid differently and have different terms and conditions. This is a challenge especially attracting staff new to general practice from secondary care who are used to agenda for change contract terms.
Another important issue is that medics and independent midwives not under contract can keep their NHS email, while others lose this. The NHS email gives the ability to transfer information securely and is necessary for all staff working in the NHS, whether temporary or substantive.
If nurses and other non-medics choose to work as locums for better work-life balance this facility is crucial to maintain patient confidentiality. In my view, this isn’t a fair allocation of services.
The retire and return rate is increasing 4 and while some choose to remain or return to employment there needs to be a viable alternative to agency work in primary care that still provides benefits, such as access to an NHS email.
To reduce agency costs in primary care, providing access to benefits for non-medical staff would help retain expertise and improve patient care quality in general practice. Developing a sustainable working practice through a viable bank for PCNs to provide both staff with the ability to continue using NHS email and surgeries with a cost-effective solution would be beneficial.
Wendie Smith is an advanced nurse practitioner in Bristol.
References
1. Royal College of Nursing. Topic analysis: NHS agency spending link
2. House of Commons Committee report. Workforce: recruitment, training and retention in health and social care. July 2022 link
3. Gulland, A. Heavy use of agency staff linked to worse patient and staff experiences. BMJ, Feb 2018 https://doi.org/10.1136/bmj.k553
4. Thousands of retired staff return to the NHS link
