Most locally employed (LE) doctors in England and Wales are working on fixedterm or bank contracts, highlighting a major stability challenge in the NHS’s service workforce, according to the GMC’s Workforce report 2025.  

Using NHS contracts data (available for England and Wales), the report examines employment types among doctors on neither the GP nor specialist register and not in training, an increasingly large part of the workforce. It then breaks down employment conditions for LE doctors, SAS doctors, and consultants who are not on the specialist register.  

The findings are stark. Among 38,353 doctors whose job role was recorded as locally employed in England and Wales in 2024: 

• 76% were on fixed term or fixed term temp contracts 

• 12% were on bank contracts (only) 

• 3% were in locum employment (only) 

• 9% were on permanent contracts  

By contrast, SAS doctors, often seen as a more established nontraining career grade were far more likely to have permanent work. Among 12,575 SAS doctors in 2024, 83% held a permanent contract. For the 4,662 consultants (not on the specialist register), contract patterns were closer to LE doctors, though with a higher permanent share (21%) and lower bank share (8%).  

The report summarises this as a major structural difference: LE is “less secure” employment, with 91% of LE contracts not being permanent.  

Why it matters: This matters for workforce stability, patient continuity and safe service delivery. A workforce that relies heavily on doctors in nontraining roles, particularly in highpressure specialties, may be especially vulnerable to churn if employment conditions are predominantly fixedterm or bank-based. The GMC’s wider report shows that doctors on neither register (not in training) now number 87,151 across the UK and are the fastestgrowing register group. A highinsecurity employment model for this cohort therefore has system-wide implications.  

The report also notes that the “neither register” workforce includes both UK and internationally qualified doctors, with international doctors making up large proportions across LE, SAS and consultant-contract groups. That means stability in these roles is not only a domestic workforce design issue, it also intersects with international recruitment, onboarding, career progression and retention.  

What to watch: The report implies that policy debates about training access and prioritisation could influence how long doctors stay in LE roles and how attractive the UK remains to new international joiners. If LE roles function as a long-term staffing solution, as the scale suggests, then employment security and development pathways may become as important as recruitment volumes.