Government cost controls fail to rein in spending on locums

Posted: 24/05/2016

NHS hospitals spent £3.6 billion on agency staff in 2015-16, which resulted in the Government introducing spending caps to control the cost to hospitals of employing locum doctors. Since the beginning of April 2016, locum doctors should not be paid more than 55% above permanent pay levels.

However, data gathered by Liaison, the company which manages hospitals’ staff payment systems, since April 2016 shows that 77% of locum staff were paid above that cap. It is reported that some doctors are still being routinely paid twice as much as they should be; consultants’ hourly pay for locum shifts is unchanged; and their out-of-hours pay has increased by 2% to an average hourly rate of £103.55. The figures suggest that hospitals continue to overspend on locum doctors by approximately £3 million per week. 

Experts suggest that the continued practice of overpaying locum doctors is due to hospitals competing with each other to fill their rotas and highlights the shortage of qualified staff available. One hospital told Liaison that it is at the “mercy of the locum market” because other hospitals do not abide by the cap and use “below the radar” techniques to pay doctors more than they should. Techniques employed to encourage doctors to take shifts include paying for travel time or paying for hours not worked.

The introduction of the pay cap appears already to have had serious implications. In April 2016, Lancashire Teaching Hospitals NHS Trust downgraded the A&E unit in Chorley because it was unable to find enough doctors to keep the unit running. Professor Mark Pugh, medical director of the hospital, said: “Changing the service provided at Chorley is a direct response to the immediate and significant staffing problem. We simply cannot staff the rotas.”

Dr Mann, president of the Royal College of Emergency Medicine, said that the recently introduced pay caps were self-defeating because they failed either to save money or to prevent closures. He argued that hospitals will continue to circumvent the caps in order to keep the hospitals safe.

Arran Macleod, a solicitor in the Penningtons Manches clinical negligence team, said: “While it is right that the Government is attempting to control the amount that hospitals pay locum doctors, recent figures suggest that the measures are not working. Hospitals can either hold the line on pay and be unable to staff their units or pay above the pay cap. The only way to control the cost of locums may ultimately come down to increasing the number of qualified NHS staff.”

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