Hospital Dr News

Spending on locums rockets due to EWTD

Spending on locum doctors by hospitals in England has rocketed in the past two years, figures show.

The cost of hiring locums in 2009/2010 was £758m the Royal College of Surgeons has learned and it blames the introduction of the 48-hour week for juniors in August last year.

Figures obtained from 96 trusts under the Freedom of Information Act show that annual spending on all hospital locum doctors has increased by almost £200million in the past year alone and has almost doubled since 2007.

The RCS estimates that since the introduction of the EWTD in the UK the NHS loses more than 400,000 hours of surgical time a month while still managing the same workload. This escalation in locum costs is because hospitals have to fill rota gaps created by the reduced working hours of staff, it said.

RCS president John Black said: “It seems ridiculous that at a time of economic crisis, with wide-ranging cuts to services across the board, we are seeing astronomical sums of money being thrown at locum doctors in order to prop up services that are only falling apart because of an ill-conceived European law.”

The RCS says the units providing 24-hour acute care, where staffing requirements are high and complex, have been worst affected. Trusts have had to employ staff already working for them to fill gaps. So-called ‘internal locums’, cost the NHS £206m in 2007/2008 rising to £311m by 2009/2010.

The largest increase in costs, however, has been in the amount paid to external locum agencies as the NHS is forced to seek doctors from all over the world on highly paid short-term contracts as the supply of available UK doctors runs dry, the RCS says. Costs rose from £174m in 2007/2008 to £467m in 2009/2020.

Dr Richard Marks, head of policy of Remedy, said: “All of this was so depressingly predictable in advance. The rigid rotas from the EWTD and the inflexibility of annual recruitment were both led by the people who don’t need to foot the locum bill themselves. The costs have increased and the standard of locums is highly variable.”

Regionally, the spending on locums was highest in 2009/2010 in London with £187m, followed by the North West with £130m, and the West Midlands with £92m.

Health secretary Andrew Lansley said the increases were “unacceptable” and acknowledged the negative impact of the EWTD. He recently said he would be supporting the business secretary in re-establishing the opt-out for NHS workers.

In terms of roles, the most (£309m) was spent on locum consultants, followed by CT/FY trainees (£137m), then SpRs (£126m) and finally staff grades (£91m).

Dr Shree Datta, co-chair of the BMA’s junior doctors committee, said: “This is not just the result of the WTD, but also the financial pressures on the NHS. Many hospital departments across the country are experiencing staffing problems as recruitment freezes are imposed to save money. As they become increasingly desperate for cover, they are likely to be forced to pay locum agencies at higher rates than if covered internally.”

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6 Responses to “Spending on locums rockets due to EWTD”

  1. chrissa says:

    what they do not mention:

    locum=every minute paid=a minute service delivery on the shop floor. nothing else.


    substantive staff=a minute paid pays for a lot of things before service delivery is paid. e.g. meetings+admin+annual leave+study leave+courses+sick leave+maternity/paternity leace — all this is paid from a wage before service delivery as such is paid. pricing in these cost and the exra cost for locums is already nowhere near as high as claimed.

    however, the real biggy is still to come: superannuation! once this is priced in, it will show that locums are actually an overall bargain. at least for as long as the actuaries have not sorted out the nhs pension scheme and priced in the fact that the increasinly female workforce will have an even faster than the national average increasing life span during which they will claim their pensions. the fact that agency locums are not accumulating nhs pension rights saves the goverment billions in the long run. not mentioning this fact is dishonest

  2. StruckOffDoc says:

    I sympathise with chrissa, a well reasoned arguement on the financial but the “admin” and “study” leave an employed staff member is balanced by continuity of care , familiarity with operation of the business.
    I agree it is inequitable locums must finance their personal development and, the real worry are those that clearly do not do so.
    The issue is the service requirement versus professional career development. There is clearly a need for individuals working to a medical model of personal accountability for actions who do not wish to advance to consultant status, are not “GP Trainees”, and are willing to provide high standard care in limited areas of specified competancy.
    I think there should be a realistic exploration of the role of “Physisicians Assistant” and note the University of Warwick has people in training on just such a course , based on the widespread use of this structure abroad.
    The fact that the legal profession have paralegals, architects have drafting clerks, yet UK medicine seeks to fill this gap with individuals from a different model of practice and ethical basis- “Nurse Consultants” and looks surprised when we don’t quite fit together without leaving holes for patients to fall through.

  3. chrissa says:

    “physician assistants” – i have worked with one. nice chap, but to think somebody like this could take the place of a junior doctor is unrealistic. this chap got permanent teaching by the consultants because he was not able to do anything independently. if one prices in the extremely slow speed in which he worked, it would be cheaper to hire an experienced middle grade locum even if that locum would cost £200 an hour. acknowledging the real costs of all medical personnel, middle grade locums at anything below £100 an hour are actually an absolute bargain.

  4. Parthasarathy says:

    Why dont NHS try to reduce the costs of the agencies – which make upto 50% of the deal? That money never reaches any doctor! And thats HALF of all the millions we are cribbing about!

  5. Vikas Kumar says:

    I totally agree with Chrissa regarding the pay of locum Doctor, and as Parthasarthy mentioned regarding the locum agency earning 50%.
    But first of all why locum doctor required, in some hospital long term locum for sho and registrar is going on and no body bother to fill the post, some time hospital ask non training doctor to do the job.
    Personally i feel it is HR of each trust who is responsible for this locum.
    And pay will depend on supply and demand thats what i feel, once Govt will allow lot of doctor to come again as in 2004-06 again the rate will go down.

  6. john d says:

    Really Spending on locum doctors by hospitals in England has rocketed in the past two years which the figures show The RCS estimates that since the introduction of the EWTD in the UK the NHS loses more than 400,000 hours of surgical time a month while still managing the same workload.This is a great MATTER OF CONCERN FOR THE GOVERNMENT THAT SO MUCH TIME AND MONEY IS ACTUALLY LOST ON THIS.

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