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GP locum reliance caused half a million overspend in one area

The cost of locum GPs is responsible for a half a million pound overspend in primary care in one area of Scotland.

A board meeting report said that the bill for locum GPs in Shetland was responsible for a projected £554,000, or 12%, overspend this year.

The report, presented to Shetland’s Integration Joint Board, also said that planned targets for efficiency savings in GP employed practices and out of hours are highly unlikely to be met.

Eight of 10 of the GP practices in Shetland are run by the health board, which employs staff directly.

Locum costs this financial year include £67,000 for Bixter, £130,000 for Whalsay, £157,000 for Yell, £137,000 for Unst and £18,000 in Lerwick.

Overall in 2017/18, NHS Shetland is expected to overspend by around £2.7m.

Plans for how to address the funding crisis in Shetland are being discussed but have not yet been made public.

Speaking at the meeting, board vice-chair and local councillor Allison Duncan said the £554,000 predicted overspend in primary care was a ‘horrendous amount of money’, and he questioned what more could be done to attract GPs to the isles.

‘I’ve said it before and I’ll say it again – we have to make a case to the Scottish Government, because locums are costing us an absolute fortune.’

Dr Dylan Murphy, a GP at the Lerwick Health Centre and Shetland LMC chair, said Shetland was facing the same recruitment and retention problems as anywhere else but with the additional pressures of its rural and remote location.

He added that there was no problem finding locum cover and that his practice was currently training four registrars, but finding permanent staff was becoming impossible.

‘There’s always been the odd vacancy in Shetland, a degree of change, but for the past three or four years, recruitment has been very difficult and now we don’t get any applicants at all.’

Dr Murphy added that they warned the health board that there would be a lot of doctors retiring who used to work 24/7 and it would not be straightforward to replace that singlehanded model.

‘The younger generation aren’t looking for that kind of job so we have to rethink how we do that.’

He said for the time being rural boards would just have to accept the higher costs of locums but there needed to be a ‘coherent vision’ for providing care in rural and remote areas.



Readers' comments (13)

  • Parasitic locums with their tendencies to provide medical care at short notice to unpopular failing practices with complex patients, heavy workload, poor peer support and higher risk of being sued. They should be banned!

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  • Just as well it was the health board shouldering that cost, and not an individual GP practice.

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  • hmmm...maybe...why we don't increase the budget in Shetland by...yeah...half a million pounds instead?

    Give that to the them properly...maybe some of those bloodsuckers can be tamed and can!

    Naaah...I don't think so...

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  • AlanAlmond

    Perhaps there wouldnt be recruitment problems if they funded the service adequately. They're basically complaining they over spent their budget because they had to pay staff costs...what a shocker!

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  • I knew someone that worked in Shetland's healthcare and I'm not surprised they can only get locum. She described isolation (nearest hospital is several hours away!), no local collaegues, no career progression, long dark winter, no recreation that's available in mainland, alcohol problem rife etc. She left after a couple of years.

    Can't really compared the recruitement difficulty here with mainland.....

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  • Oh dear blames the locums...... divided we fall.... perhaps if the government actually funded General Practice properly and made it a job worth doing then people would want to become partners again....... I didnt see anyone discussing how much locum consultants cost in comparison (They don't get saddled with practice debts)....... the locum situation simply reflects the skewed values of successive governments, placing hospital medicine on a pedestal and letting general practice rot on the vine so that now no-one wants to take on partnership. Did anyone mention how much consultants get paid for clearing waiting lists????? I too was once one of those blood sucking locums......and now I get paid significantly more in Australia doing 9-5:00 resident in one practice without having to travel all over the UK, not having to pay for accommodation , not having to spend time away from the family, not having to pay higher indemnity, not having to worry about lack of sick pay nor paid holidays..... so what does that tell you about the current state of partnership in the UK if an Australian GP wouldn't go back to do the 'lucrative' locums used to plug the gaps in the service caused by the workforce shortage due to conditions created by the UK government that have driven doctors away from partnership? Am i a bloodsucker for getting paid appropriately in Australia or are the real suckers the ones proping up the system and allowing themselves to be undervalued? For the purpose of discussion my 10 sessions in Australia pays $440AUD /£250k GBP a yr for 44 I a blood sucker? PS the local bariatric surgeon earns $4milllion AUD per annum.... 10 times as much as I do......Am I over valued or are UK GPs undervalued????? When justifying our self worth we need to look at comparable professions.......perhaps as I suggest the locums are not overpaid, but their partner colleagues significantly underpaid. That would be my proposition.......

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  • How much do you think it costs to hire a barrister for the day, and if he/she needed to travel to 'work' their case how much do you think their expenses would be? Do you think you would get away with not paying every single hour of their travel? Compare how many years training a medical professional does compared to their legal counterparts. Do you think a barrister would fly economy? even descend to a 4 star hotel???? If anything the dramatic shift towards locuming is forcing heath boards to re-evaluate the value of General practice when they start to realise that even at £130k a year they can struggle to fill posts.......

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  • Just Your Average Joe

    The 'You can't earn more than the prime minister' brigade would have a field day if that 130K became equivalent to a real commercial value than market forces are slowly forcing.

    However practices can't afford to pay that, which is dragging it down still. Once hospital and APMS practices with no ability to do work themselves, are forced to pay the going rate - all Hell will break loose as it will destabilise the market.

    DOH and JH can't allow huge wage increases to be seen to be given to any one group, without cries for rises for all NHS, police and emergency services etc, and treasury can't allow that.

    Fun days to come - but don't get hopes up for a pay rise until disaster eventually hits and retirement bulge bursts.

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  • That's in an area right?

    I know one practice where overspend on locums was that in 1 year

    I know it very well in fact...

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  • Sceptic you should visit Shetland.... the Gilbert Bain hospital is only hours away from the furthest islands, most of the population are no more than an hour away, and just under half the population live around the main town in Lerwick where the hospital is ..... and the helicopter can be scrambled if necessary. People who live on islands across the world accept this as one of the drawbacks when they make their decision where to live. There are still a number of GPs in Shetland, very approachable and supportive from my recollection. Long winter nights... yes the northern lights are truly awful.... and I suppose the very long summer days are just as bad. You forgot to mention ridiculously low crimes rates, low pollution and lack of traffic jams.....or the fact the schools are amongst the highest scoring in the country, or the facilities of the numerous leisure centres. That said their geographical distance does make it hard to recruit for them, but as a location, there is generally a high quality of life there and good social support. Most people leave their doors unlocked and frequently their keys in the car. Now compare that to Liverpool, Manchester and Birmingham......I lost my wallet in Shetland... got it back, all the cash was still there.... wonderful people! I hear a story that one of their anaesthetists found herself swimming with an Orca... doubt you'd do that in the Thames.....

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