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GPs go forth

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)

  • 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.


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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


    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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