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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)

  • Presumably NHS run practices can go over budget without the manager's houses being repossessed.

    There is often also a significant 'danger premium' to locums working in failed practices.

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  • Just Your Average Joe

    They pay ridiculously high fees as they can't step in and do the work themselves - its either pay well above or have no doctor and face the music for why they are unable to run the practice.

    The financial cost of deficits is wiped off by the Health board as overspends, and clawed back by reducing local enhanced services and money to the rest of the GP health economy - so effectively the remaining GMS/PMS practices are subsidising this rush off the edge of the cliff.

    This model will destroy local practices who as stated can't afford to compete so either risk bankruptcy or burn out, by having to cover the sessions themselves.

    Until GP numbers increase, and DOH agrees incentives for permanent posts (salaried or partnership) - GP locum demand will continue to outstrip supply - and practices will continue to fail/give up contracts - speeding up the agenda for private providers to come in and save the day!

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  • Macaque

    Hear Hear Obi.

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  • The locums should hold out for £1000 a session - the nhs board have no choice but to pay it

    Then they will realise how cost effective GMS and PMs practices are. It is a joke that they can spend so much extra much net running a worse service rather than supporting strained practices

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  • Working in health board run practices involves extra risk and responsibilities. Unlike private practice locum work, Drs in the board practices cannot decline to do visits, letters, results etc. The pay is more for this reason. Some GPs prefer less pay and simpler days work.

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  • AlanAlmond

    It’s called a market. If what you want is in short supply it costs more. Apologies for stating the obvious, I have every sympathy for folk who can’t take leave because they feel they can’t afford cover but that’s how much Drs are worth. As suggested already either adjust the quality of the service you’re providing so you can afford to employ the staff you need or become a Locum yourself. You are not a charity and neither are the people you employ.

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  • Took Early Retirement

    Er... GP partners don't get any "annual leave" except (now) for bank holidays, do they? So how can you take a half of nothing? More accurate just to say they couldn't take the leave they were hoping to.

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  • You get what you pay for. If you are lot willing to pay enough, sometimes you get nothing.

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