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GP practices forced to tell NHS England if they pay over 'maximum rate' for locums

GP practices will be given an 'indicative maximum rate' for locums, which will see them reporting any breaches to NHS England once a national rate is determined.

The scheme – which is to be introduced by NHS England against the wishes of GP leaders – will mean that GP practices will have to report their locum spend for the first time to the NHS.

It is unclear what this information will be used for and when it will be introduced, and there is no indication as to what the rate will be.

But a statement says that practices will have to 'record annually the number of instances where a practice pays a locum doctor more than an indicative maximum rate, as set out by NHS England.’

Although the measure is part of the 2016/17 GP contract deal, the GPC told Pulse it had not agreed to it, and it comes six weeks after a cap on spending on locum agency doctors and nurses was rolled out to hospitals in England.

NHS England has not detailed what will happen to practices breaching this maximum rate.

NHS Employer's guide to the new contract states: 'NHS England propose setting a maximum indicative rate based on a set of rates (which may have some degree of regional variation) for locum doctors’ pay.

‘NHS England will amend the electronic declaration system to include recording on the number of instances where a practice pays a locum doctor more than the maximum indicative rate’.

But GPC chair Dr Chaand Nagpaul said NHS England had 'said they intend to do this unilaterally', despite concerns from the GPC, including 'how the rates will be comparable for locums who fill variable roles at different pay'.

He told Pulse: 'NHS England informed us they intend to do this. There’s no detail, we do not support it and we do not believe it us meaningful or possible. This is fraught with problems.'

He further stressed that the measure would not solve the real issue of 'making general practice more attractive so that dctors want to work as GPs in a permanent capacity'.

He said: 'That is the problem, and the other point is that locums are an extremely valuable resource that allows many practices to have flexibility.’

Meanwhile, National Association of Sessional GPs (NASGP) chair Dr Richard Fieldhouse branded the scheme ‘a knee-jerk, cock-eyed, half-witted reaction’ that failed to understand the root cause of growing locum demand.

He told Pulse that locums, who are rising in numbers because GPs cannot cope with partnership, will continue to 'decide what rates they will charge' or leave general practice altogether.

He said: 'Over the last year, we’ve been recruiting partners when they hit a wall. They don’t want to be salaried GPs, that’s what they have been fighting against.

‘It’s another short-sighted exercise in control from the Government. They are not thinking about why there are 17,000 locums out there. It’s a knee-jerk, cock-eyed, half-witted reaction.

‘Our members decide what rates they will charge and it is very difficult to get them to put up their fees because they are nice people and they understand the pressure that practices are under. This is not going to work. I feel sorry for isolated locums.’

Please note this article was amended at 9:35 on Monday 22 February 2016 to reflect that there has been no indication when this scheme will be introduced.

Does capping locum pay work?

The left-field proposal comes six week's after a cap was set for hospitals in England for spending on locum agency staff, preventing them from paying locum nurses and doctors more than 55% than a permanent staff member would receive, in a bid to save £1bn per year.

It also comes on the same day that The Telegraph revealed nine out of ten hospitals have breached the spending cap on doctor and nurse agency staff to date (the paper's report said 194 (85%) out of 228 NHS are non-compliant, with 20,000 shifts a week being filled by locum staff).

With one one in ten training posts going unfilled last year and a third of GPs planning to retire in the next five years the Government will be fighting an uphill battle to make this target effective.

Amid the ongoing strain under which general practice is creaking, some locum agencies noted a 20% surge in members last year and a Pulse survey showed that just 6% of GP registrars want to take on partnership roles, while 49% intended to become locums.

 

Readers' comments (71)

  • we knew this would happen - the monitor guide though does not specify GP locum rates unless i've missed it. It mentions consultant and junior doctors. It will be interesting what rate they set bearing in mind our high defense fees. This may push those retired but locum GPs and OOH GPs to quit and totally destroy staffing in primary care.

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  • What is NHS England's maximum daily GP locum rate?

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  • please Chaand do us a favor and retire and let one of the juniors take over ?

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  • ".... and then they came for the locums, but still I did not speak"

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  • not sure how easy it is to enforce this.,

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  • Canute tried to stop the tide,the ancient name for Canute is Cnut an anagram of the health secretaries surname,didn't work then won't work now. Market forces dear boy

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  • It's really turning big brother now. We really need to fight the increasing Control NHS England is trying to exert. We need to be more independant.
    If they want locums to take on permenant jobs they need to reduce workload and stress

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  • It seems that GPs must inform NHS England if they pay a locum above some yet to be defined rate. So what will NHS England do about it? (SFA they can do I imagine.)

    GP partners pay for locums out their own pockets. Perhaps it has not occurred to Mr H that these partners might try and minimise these costs.

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  • Honestly, I dont't understand you dear colleagues. Why are you moaning so much. You know well that nothing will change. Its the end of NHS and GP. There will be no NHS left in the next 20-30 years and GPs will be extinct. If it's so bad , why don't you just leave and let this **nt bite his elbows. I have just applied for a post abroad and hope to leave ASAP.

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  • How is this allowed to happen?!!! Is the NHS becoming a nazi state!

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  • So if GPC haven't agreed to this, doesn't this constitute imposition just as much as the threatened imposition of the Junior Doctors contract?
    This sets a very dangerous precedent, as it gives NHSE a window to interfere in how a practice delivers the contract, what staff it employs and how much it pays them, i.e. the crack in the independent contractor status which may be subsequently wedged further and further open until all practices are merely delivery agencies of the DH.

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  • Yes our Government is becoming more like Nazi Germany or Stalinist Russia. This has happened since the end of the coalition government, now that the Tories have full control. We have another four years of this.

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  • But the silence from the labour politicians is also deafening! Bith as bad as each other.
    Every day now there seems to be another headline about more burdens for gps or doctors. The government are really serious about killing the NHS. They are working flat out to kill it before they are out of power now.

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  • They like market forces when it suits them and try to strangle them when it doesn't. The BMA are hopelessly outmanoeuvred.

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  • Was at a dinner party last night with an ex partner of one of the major accountancy/ management accountancy firms. Her suggestion for sorting out the junior doctors' dispute was to send the army in.
    No, I am not joking and no, she had not had too much wine!

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  • @10:54 I agree

    As a locum this is worrying. What next? Locums having to publish their rates?
    I will be making a complaint to the competition and markets authority as this is anti competitive and the nhs is a monopoly employer - but I don't think it will get anywhere.

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  • locums have been sacrificed at the altar as it was thought that new contract was a sweet deal .
    Time for fresh blood !

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  • First make life sh!t for partners and salaried GP's and then target Locums. Before the solution was to locum, migrate or retire. Now the only way is to migrate or retire. Pretty sad.

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  • Locum caps are very high for hospital consultants, around £1500 a day if I am not mistaken. The issue was with the £3500 a day some consultants were being paid. mind you it must have been that amount or patients died. Tories would rather have patients die than to pay over the odds. Tight b@stards.
    Having said all that, a £1000 /day cap would suit me just fine.

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  • Why is this information of any of their concern?

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  • Pretty disappointed !
    Just want to thank the partners who have come out and supported their colleagues.We stand as #one profession

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  • the real mystery is what is the rate ?

    does it take into account higher expenses of GPs vs consultants ?

    regardless it is the start of cost controls pre-privatization. the aim is to get 7 day 24 hr care down as cheap as possible before selling off the NHS. the targeting of locums is to get them salaried - the 'experiment' with providers providing indemnity is an example - soon we will be offered salaried posts with indemnity at rates better than locum fees (net). once we are all enslaved then it is game over.

    it's text book stuff;

    1. underfund service
    2. blame staff for poor service
    3. target staff's t&cs
    4. continue to underfund
    5. say there is no hope
    6. push privatization as the great savior
    7. offer public chance to make a quick buck by issuing shares
    8. privatization done.

    once it's done there is no going back and patients/public/consumers are happily going along with it.

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  • Long overdue. There needs to be some attempt to regulate locums pay. In my experience they are not good value doctors and I would rather hire another nurse or a paramedic practicioner, than a locum doctor. Can't see what NASGP are squealing about.

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  • @|Anonymous | GP Partner|20 Feb 2016 2:59pm

    You deserve all the misery that you are currently getting. Enjoy.

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  • Chaand is shameless, it is long overdue for him to step down and make way for a leader who has some fight in them.

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  • Easy response if NHS tries to impose a cap. Lets all not work for a month and see what happens

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  • Currently corporation tax 20% on net income after expenses. Dividends no tax up to £42,385. After that 25%.
    New Dividend tax 7.5% after first £5000 from April 16 instead of 0% currently. personal allowance around 10 K. Effectively up to 15k - 20% corporation tax. 15k to 42k 20% CT+ 7.5%. 42K onwards 20% CT + 32.5% (effectively above 50p/1£ earned.)
    Next step locum pay cut in gp land same as locum pay cut in hospitals. A&E registrar locums are being told by hospitals - can't pay more than the limit. The norm over the last 6 to 7 years was around £65 to 70/hr for any shift day or night or twilight like 5 pm till 1AM. No unsociable supplement there. Future is this.

    Registrar (SP3+) - Core Unsocial

    Max. charge from 23 Nov 2015
    £57.05 £68.94
    Max. charge from 1 Feb 2016
    £45.64 £55.15
    Max. charge from 1 Apr 2016
    £35.37 £42.74.

    This is just the agency pay. The agency have to take their cut before passing on how much ever they can give you. You can't work directly for the trust with limited company. Trust would say PAYE and full tax implications and usually lesser pay for direct work with the trust.

    Any GP trying to compare yourself to hospital consultants, it is going to be more likely close to or below registrar rates.

    Its all part of the game. GP partners and salaried trying to escape the squeeze and become locums. Squeeze locums, they will return to salaried and partner posts and then imposition of 8 to 8, 7 day contract first and then slowly 24/7 contract. If someone feels contract is unsustainable and give it back, spread the patients to neighbouring practices, stretch them and then domino effect kicks in. Then bring in the saviours private companies to save NHS and then whip the doctors and performance manage them with efficient managers - mostly kids less than 20 yrs of age who don't have any common sense and have to follow the letter of the law, "Not more than £35.37/hr for locum as per the law."

    Poor GPs who have mortgages to pay, bills to pay, stranded in this country due to family ties and righteousness and morality and indebtedness to NHS have to do some work. You see they can't even go back in to hospital locum - same rates there. Young ones can't even go back to training due to the severe contract impositions on junior doctors - Can't afford the mortgage.

    First step to do above - data collection about GP locums pay.

    CHECK MATE.

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  • The Tories are not that clever to control market forces. Their plans are ideologically driven by those who are stupid, ignorant and arrogant. We should be calling for a vote of no confidence.

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  • The ideology is more fascism than free markets.
    GP locums are the purest market signal in the entire NHS!

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  • Somzii 1 | Sessional/Locum GP21 Feb 2016 1:53am

    agree.

    luckily they are only collecting data at moment - i give it 5 years then it will not be economical to locum with rising expenses and higher taxes. just enough time to pay a chunk off the mortgage and change career. co-incidentally it's the time frame that many GPs have said they are going to retire as well. Given falling income, expenses and revalidation - i think many who retire won't come back. I really pity the youngsters as they have absolutely nothing to look forward too. For established locums it might be time to go into the private sector ?

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  • Bob Hodges

    Firstly, how will they know if you DON'T inform them?

    Secondly, a private provider would regard this information as 'commercial in confidence' surely.

    Anyone fancy some pro-bono legal work?

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  • Do we live in Stalinist Russia?
    This conservative government is using a state monopoly to destroy market forces in health care. Ironic. Is it even legal? Do they think they can control the market?? The law of unintended consequences will, with out doubt, exert itself = fewer GPs locums at a time of GP recruitment crisis, leading to ever increasing demand, and ever reducing supply. Fools

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  • If we stand together as a profession - and even more so if we stand with teachers and workers in social care - we have the power to bring this government down. The question is simply having the will and co-ordinating the profession. I'm up for the fight - who else is?

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  • It amazes me just how naive so many views expressed here are. Of cause governments control markets. That's what they do. Or try to do where they can. Ever heard of customs and taxes? They exist exactly to control market forces. And they control Partners income indirectly through practice funding. As they do all over the globe. The names of payment arrangements vary, but the gist is that doctors are paid roughly what societies expect us to be paid.
    You, locums, had an easy ride for few years. Walked away from any position of responsibility and in doing so lost any voice in any decision-making. So don't complain when decisions are made not in your favour and you haven't been consulted. It's your own freely made choices that got you here.
    Judging by the speed the "efficiency savings" are being introduced elsewhere, I predict another 12-24 months of locum bananza, after which you lot will be named and shamed. And when you disappear, no one will really notice.

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  • Took Early Retirement

    I am not clear how this info can be helpful; even to NHSE.

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  • What the GOV are doing is clear. They can't make salaried jobs and partnership attractive so their solution is to make locumming unattractive. @ssholes!

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  • I walked away from partnership after a decade to preserve my sanity. There is non-NHS, non-clinical work out there which will become increasingly attractive as indemnity rises and pension tax relief goes. If work as a salaried GP or partner was sustainable in the UK, I would do it. Having 70 patient contacts in a day, working 15 hour days, is unsafe for patients and a risk for mental ill-health in GPs. Along with junior doctor contract imposition, this will do nothing for increasing GP trainee numbers.

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  • This is the works of one character - Mr Hunt whose manipulative activities- along with his type of politics and ideology is the end of the NHS as we know. This will be very slow but inevitable painful transition to part-to full privatisation of GP practices/Hospitals with us workers bearing the pain. At the moment the poor juniors are in the middle of it and for BMA it will get guts/determination to fight this man. Watch this space.

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  • Sessional/Locum GP - 21 Feb 2016 1:53am

    And don't forget IR35. As a locum pharmacist who was targeted as I was deemed to be working as an employee rather than a locum (even though I worked in three pharmacies), I think they will attack locums even more.

    This in turn will give them even greater control over the workforce.

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  • The way things are going, only a fool would become a doctor. The Goodies are ready to fill the void as shown here. The Goodies become doctors in the National Health Service; their methods of curing the nations ills causes conflict with the minister of health
    https://www.youtube.com/watch?v=UpxZOFgYFsA&app=desktop

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  • Don not worry. No pay no work

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  • Anonymous @21Feb08:31 is spot on.We are public sector workers.Our ultimate employer is the government (of whatever hue).If you don't like it, try the private sector.
    The locum cap is an idiocy given that,as an earlier post pointed out, we pay for locums out of our pocket.Forget the vacuous drivel about "evil Tory plot",this is simply some NHSE apparatchik who fails to understand how General Practice works.

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  • Surely this is a form of racketeering/price fixing? If I was a locum, I'd get enough locums to form a non BMa group and mount legal challenge to the government.

    We try not to use locums as it is poor value for money. We know average GMS partner earns around £40/hr (before tax, employee pension and expenditures but minus employer pension and locum insurance to make it comparable). Locum earns about £90/hr. I appreciate locums don't get annual leave.

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  • Agency staff cap (including Drs) has been implemented in Acutes. The max agency rate is 55% above the basic equivalent perm staff rate (eg excl pension, hols, sickness etc). I'd assume something similar in GP world.

    So this 55% 'premium' has to cover:
    - Hols
    - Pension
    - Sickness
    - Agency fees
    - Travel and accommodation
    - Professional fees
    - Training and development
    - Risk of being out of work

    start the car...

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  • Why?? If you are a stressed out small practice and need a locum and the only locum decides to charge twice the average rate, surely that's market forces?
    You can decide to pay, which will obviously have a knock on effect with your profits and ultimately pension, or not get a locum.
    What has it got to do with HMG?

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  • Market forces and the control of is simple when it comes to employees that are tied down to their jobs ( for one reason or another ). When it comes to medics, push us hard enough and suddenly those bonds break. Stupid Tories, oh they are in for a nasty surprise.

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  • About time for a GP strike don't you think folks?

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  • mind you, I just did a rough calculations on how much a salaried GP on BMA model will earn/day based on 9k/sessionand actual days worked (no indemnity cover included)

    It's £550/day

    Still less then a locum who earn around £700 for a full day's work but not off 55% limit mentioned about. Much more expensive then a partner.....

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  • Jeremy Hunt is a control freak who could not cope working the hours that GPs and Junior Doctors work. i qualified in the 70,s and it was bad then for doctors hours -my son is doing a hospital GP rotation in Obs & Gynae. he has had no training in suturing, normal deliveries- all he does is run rounfad from ward to ward and has no time for training in the job- the words `'training post``' is a joke

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  • Not sure this story is even feasible. We are independent contractors - how can they even demand to see our books? Surely this is private information between a surgery and their accountant

    But I do agree with some of the comments that this is a plan to squeeze people into salaried positions and then impose 7/7 working.

    The reality is most people will just leave the profession

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