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Extra locum costs 'will block GP involvement in commissioning'

GPs sitting on CCG boards will be forced to relinquish their commissioning roles because ‘stupid’ changes to pension contributions will make locum cover effectively unaffordable for many, the chair of the Family Doctor Association has warned.

Speaking at the Commissioning Live event in Leeds, Dr Peter Swinyard warned that the contract imposition had brought GP morale to its lowest point in more than a decade, and prompted exacerbated a ‘looming recruitment crisis’ which will have grave implications as GPs assume their new commissioning responsibilities from 1 April.

Dr Swinyard singled out for criticism the Government’s changes to how locum superannuation contributions are paid, with locums due to pay the contributions directly from 1 April.

Practices will be reimbursed for the expected hike in locum fees with an extra 0.15% uplift to their global sum equivalent funding – regardless of how many locums they use or how frequently they use them.

Dr Swinyard, a GP in Swindon, said: ‘Some CCG board members are going to be recalled by their practices because locums are going to be too expensive, because of the stupid way the Government has decided to reimburse the locum contributions. If you really wanted to design a system to fail, you’d do it this way.’

‘What I’m going to do is look at my locum spends and say “I’m sorry chaps, we can’t actually afford to pay you 14% more because the reimbursement coming into our practice will cover about 10 locums days a year”.’

Dr Swinyard said the head of one locum agency had told him he feared practices would significantly reduce their reliance on locums, and predicted the additional costs could be unaffordable for some practices.

One practice in another part of Swindon was currently spending £120,000 a year on locums, he said: ‘Add 14% to that. Are they going to carry on spending that sort of money on locums or are they going to reduce their service to patients? I know what I’d do.’

Dr Swinyard said that the consultation on the contract imposition had yielded ‘almost no change whatever’, and warned that CCGs faced a ‘total demoralisation of the GP workforce’ from 1 April.

‘Morale in general practice has never been lower since about 2002, as far as I can remember,’ he said.

‘There is a point at which you say, “Why am I doing this damn difficult job?”’

Readers' comments (4)

  • If GPs stop taking on locums,market forces will kick in causing them to drop their rates and making them cheaper to hire again.I don't see what the problem is?

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  • Meanwhile the GP partners will be having nervous breakdowns trying to do the impossible.

    They have the obligation to see patients even if they are a partner down.

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  • GP partners who are actively involved with CCGs may well indeed be under more pressure in these roles, and some will be forced to spend more time with their practices. But this does not necessarily put commissioning under threat, bearing in mind that there are around 15,000 GP locums around the UK who could, and already are, becoming more actively involved with commissioning. With their flexibility and freedom, and their unique experience from working in so many of their CCGs practices, unencumbered by loyalty to one particular practice, they are ideally placed to be actively involved in CCGs.

    As locum GPs who work for locum agencies are unable to contribute to the NHS superannuation scheme, the good news for practices who use agencies is that they should not see any increase in their costs.

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  • Good in principle Richard but locus hired through agencies are often more expensive to start with. We'll be using fewer locums, using retired Drs who are out of the pension scheme and will be missing commissioning meetings when we would have to find a locum....or, paying locums less to start with.

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