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Gold, incentives and meh

NHS-run GP practices 'outbid' independent contractors on locum fees

GP partners have warned that they are struggling to compete with practices run by NHS commissioners when it comes to locum fees.

As a result GMS practices are struggling to source GPs to cover absences, with some GP partners only able to take 'half' of their annual leave.

The issue has been flagged by practices in North Wales, where an increasing number of formerly independent practices are now managed by the health board due to pressures on finances and workforce.

Practices and GP leaders said that paying above going rates - by around '15-20%' - was a 'shortsighted' measure which would only serve to exacerbate problems faced by practices.

Dr Anne Hoffman, a GP partner in Bangor, said she had been unable to claim half of her annual leave because it was ‘near on impossible’ to find locum cover.

She said it had been particularly difficult in the past two years and had been made worse by the health board paying above the going rate.

Practices in the area had agreed a locum pay rate of £500 a day but the health board were offering £700 to £900 for a shift in their practice, Dr Hoffmann explained.

‘We are a small practice. The partners have only taken half of their annual leave – that is not sustainable.

‘We cannot get reliable cover and sometimes have to do 10 sessions a week,’ she said.’

She said it was short-sighted of the health board to pay over the locally agreed rate as it would end up ‘running more practices into the ground’.

‘The rate that practices would pay was agreed by our GP cluster. It is the right thing to do.’(see note below)

BMA figures from January show that North Wales has been hit particularly hard by recruitment and retention problems with 13 practices now managed by the health board, with at least six others are at risk.

North Wales LMC chair Dr Eamonn Jessup, who also works as a locum, agreed it was a problem and that working in managed practices tended to pay about 15-20% more than the amount paid in a GMS practice.

‘On top of that GPs who decide that they are going to work only in managed practices as a locum rather than GMS practices do not need to get financial indemnity.

‘This can save someone doing eight or nine sessions of work a week an extra £10,000 a year,’ he said.

‘Many GPs can neither find, nor pay to cover their time out of the practice and now find themselves committing to ridiculous numbers of hours and weeks of work to keep the GMS dream alive in North Wales.’

Dr Jessup added that he has ‘a huge affinity’ for GMS practices and consider them to provide the highest level of care.

‘I feel privileged to be asked to work in them. This is why I will charge them less.’

A spokesperson for Betsi Cadwaladr University Health Board said the rates offered for GPs to work in their managed practices ‘are appropriate given the challenges in meeting demand for general practice services’.

‘The diverse skill mix of staff in health board-managed practices tends to be more diverse than in traditional GMS, which can result in a different responsibility and a higher effective list size per GP on duty.

‘Our rates are significantly less than have been reported in other areas.’

The health board said they were trying to reduce reliance on locums by focusing on hiring salaried GPs.

Please note: Arfon GP cluster lead Dr Nia Hughes said that she was 'not aware' of any agreement between the cluster practices to fix locum GP rates and that locums in the area were paid variable rates. She told Pulse: 'There has never been a discussion about capping pay. I'm not aware of any such practice in the area.'

This was added at 15:00 on 23 March 2018


Readers' comments (21)

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  • further demonstration of the cost effectiveness of the traditional system for those that are interested.

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  • you need to pay the locums more or close the surgery if not viable.

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    If agencies are used the higher rates may not get passed onto the locums

    in my experience you'll end up working for every penny of that extra rate.. only locum on site doing the work of 2 or three

    Much higher risk
    Picking up on big backlogs of care

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  • £500 is a bit rubbish especially for somewhere know to be low on GPs. Ive never worked in Wales but there are certainly some good offers for south wales anyway.

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  • hubs are offering overgenerous pay rates to attract enough GPs to run them. This is purely to fulfil Mr Hunts ambitions. They will undermine general practice by pushing up locum costs and undermine OOH but taking away an already thin workforce. We suggested locally that our hub should pay low rates so that it would not take off but the CCG is under such pressure from Hunt and Co they offered VERY generous rates just to get it working. What a stupid system. We will now have three providers of GP care - GPs Hubs and OOH. None of them will be fully staffed.

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  • This is the sad and unintended result of the generous help that LHBs are putting into failed practices in Wales. I am now an ex-partner (from England) and have worked in 2 directly managed Welsh practices. Clinical practice is now complex and it is a pleasure to concentrate on improving this rather than having endless meetings with LMC and CCG and accountants where we spent our time agitating for a sustainable business. Admittedly this change to a salaried role is probably what the NHS wants and we have proved collectively pitiful as a profession at preventing this (Yes BMA I'm looking at you, Sir OneDayaWeek CBE MRCGP). It would be much more sensible to put our joint efforts now into securing a robust and well-structured salaried/ clinical leadership role for our profession (the NHS is really sunk without us) rather than fighting a piecemeal rearguard action to protect the 1948 partnership model. Our professional colleagues in law, accountancy, dentistry think we are morons for hanging on to the dangers of the partnership model. Time to grow up and press our professional advantage nationally. Heads up, look at the strategic picture, please.

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  • Sadly mouths need to be stuffed with gold. Its the only way to induce activity in managed practices. When problems arise its usually the management team that are blamed, the GPs disappearing into the ether or squealing about safety or fairness if held to account. Poor show all round.

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  • AlanAlmond

    Watch out, if your post contains the word ‘cartel’ it will be removed / moderated / erased give the impression, I guess, that the word ‘cartel’ was never used....mmmmm

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