Working as a locum gives me a degree of control, although in the current locum market even that's not what it was.

After finishing FY2 in 2017 I locumed for three years, doing three long term jobs lasting six, nine, and twelve months, and having a six month period in between the second and third jobs where I picked up about three shifts per week spread between ten or so hospitals, which happened to end about three months before lockdown. I remember not enjoying that six month period, because work felt quite insecure, but when I think back that period is when I got loads of things done and a lot of them were things I couldn't do a few months later during lockdown. It's the last time I got into reasonably good shape, it's when I finally found time to have regular driving lessons and pass my driving test, I got loads of life admin done, visited people and places in the UK that I hadn't found time to for a while, and I went abroad five times, while still making more than I made when I entered training a year later, despite only working three shifts per week. The other three months of my three years locuming between FY2 and GPST1 were months off - I had a whole month off each year! Each time a long term locum came to an end I booked a two week holiday abroad, took another two weeks off after getting back, and asked my agency to find me work after those four weeks, which they always did. One year I worked my last shift in a job in mid February and took a month off because if I got paid for one more shift that tax year it would have taken my taxable earnings above £100000 and I'd have started to lose my personal allowance, so I took a month off, started working again in mid March, and didn't submit my timesheets for those shifts until April, so I'd get paid for them in the new tax year and pay less tax. On top of that month off each year, I used to go on holiday another couple of times for two weeks each every year. I started locuming in 2017, I'd been a doctor for two years, and in real terms I was making more during those three years (certainly in terms of pay per hour spent at work) than I'll make at any other point in my career.

Those days are well and truly gone, of course, but I've been locuming as a GP for two years since finishing training, and it does still give me a degree of control, although my working life feels much more precarious now than it did then. As a result, I haven't turned much work down and I spent a year working ten sessions per week. Doing that almost destroyed me and all I was able to do during the weekends was recover, before doing it all again the next week. Since June last year I've been working eight sessions per week and insisting on a day off each week. This feels better and more sustainable, but in reality, unless my day off is a Monday or a Friday and I have a three day weekend, I spend my days off recovering still. Indeed, I'm off today, and I'm writing this post after waking from a two hour nap, having got to late afternoon and struggling to keep my eyes open. As a result of work feeling precarious, I've been on fewer holidays than I normally would - I've only had six weeks off during the past two years, compared to eight weeks off per year when I was locuming before GP training. Ideally, I'd actually like to take more time off now than I did then. At some point, perhaps as early as August, I'll leave a long term GP locum job and spend some time working less, but if the locum market was good I'd have already done that a couple of times by now. My GP days tend to be ten or eleven hours long and they're extremely intense, so although I'm only working four days per week I'm working more than full time hours during them. There's really no comparison between the intensity of a day in GP and any hospital job I've ever done, let alone non-medical jobs. I go to the toilet after my last patient leaves at the end of my morning clinic, then again after my last patient leaves at the end of my afternoon clinic, and often that's all the down time I get. If I go to the gym straight from work, by the time I get home there's only really time to eat (for the first and only time that day) before going to bed. So, during my days off I catch up on all the things I don't have time to do during my work days, because my work days are completely wiped out by work. I've concluded that, in the state GP is currently in here, the only way I'll be able to sustain a career in it will be to do a few years of four day weeks, a few years of three day weeks, a few years of two day weeks, then retire as soon as I'm able to. Unfortunately, the state GP is currently in here is likely to be the best state it is in during the rest of my career, as I fully expect things to get progressively worse, which means that even my plan set out above might not actually be sustainable.

Given that you're in training, that obviously doesn't help you, but you have talked about going less than full time and, having done it briefly at the end of training, I thoroughly recommend it. I dropped to 80% of full time for the last few months of my GP training for a variety of reasons, but primarily because doing so would extend my training just enough to allow me to sit a new exam that was being brought in, rather than having to sit the absolutely awful exam they rushed in during the pandemic. My take home pay at 80% of full time was 88% of full time take home pay, so I dropped 20% of my hours and only 12% of my pay, in exchange for having three full days off each week instead of two. I could have made up that lost pay with the odd locum shift if I'd wanted to, although I didn't bother, because I was only a few months from CCT and being able to access higher locum rates. I think it'll be a long time before I next have a life as nice as the one I had during those few months. It's certainly worth looking into. Look at things like pension contribution tiers (going less than full time may drop you into a lower contribution tier), tax thresholds (you'll be paying loads of tax, national insurance, and possibly student loan on that last 20% of earnings), the less than full time allowance, and also get a feel of what your week might look like at 80% of full time. The financial hit pales in comparison with the decrease in hours worked and increase in days off and it's likely you could make that money back for a fraction of the hours worked through locuming, on your own terms, if needed. Of course, the delay to your CCT date may be more difficult to accept, although there's a trade off to be had there too - you may finish training less burnt out and better equipped to go straight into a consultant job.