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Gold, incentives and meh

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)

  • The youngesters will go abroad or leave the profession.
    The older ones will retire and not bother coming back as soon a econimically feasible.

    ...those in the middle will grit there teeth until they can do any of the above

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  • This can't come soon enough. As a manager of three GP surgeries I had to barter with doctors to get sessions filled. agencies would withold staff until the day before to ramp up the pressure to accept someone at a ridiculous rate. I would have sooner just closed the service for the day but I could not. The worst aspect of course was that the doctor who would then appear would be a partner with his own service keeping his own patients waiting while he moonlighted. Oh and then of course patient care would be compromised because they always seemed to 'forget' their smartcards. Doctors own little feithdom.

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  • Anonymous | Practice Manager22 Feb 2016 12:39pm

    The day this comes you will find you cannot find ANY locums. Good luck!

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  • Part of a process to make all doctors into indentured labourers.Also just a question of time before they make all medical students legally contracted to spend a certain number of years working for the NHS.

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  • Politicians think doctors are overpaid, arrogant and lazy. Not to mention good for nothing. Thats how much they understand the medical profession and the public feel the same way unfortunately. So, by attacking the doctors they get votes. Simples.
    To be fair though, some GP partners are dodge and they are in complete denial about it, hence giving credibility to the politicians. Fiddling figures etc.

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  • Am I missing something here? If GPs are independent contractors ( well sort of still) and pay their own staff out of their own income what business is it of any external body what they want to pay employees?

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  • Why should anyone know how much I pay a Locum? It's my own money. I should be able to pay a Locum GP whatever we decide between us. It's not a crime. It's market forces at work. We can't work without locums. Can't really get my head round this.

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  • What worries me is that these people run the country -you couldnt make up the garbage that comes out of the Department of Health/NHS England -If they actually took time to reflect on how they are behaving and understood what they were saying and doing they would be incredibly embarrassed .Im not sure they have the intellect to appreciate this .

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  • To john Oldring @2.40 pm.
    Politicians sure have enough intelligence. They also know that this free for all NHS is unsustainable. Its part of game they are playing so that when NHS collapses they can blame GP & doctors including Junior doctors and consultant and show public that they were the one who were trying to save NHS but doctors destroyed it. If they say that NHS is not sustainable and people have to part fund it nobody will vote for them for next 20 years. SO we will have to be scapegoat. Question is how long we are going to tolerate this nonsense?

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  • we had this from our (private sector) Out of Hours provider. Nobody else was to pay too much for GP locums, because it forced up their costs.
    This will drive doctors out of the service or the country.
    RESULT? Poorer healthcare for patients, but bigger profits to some companies

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