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GPs buried under trusts' workload dump

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)

  • I forgot to ask - does NHS England inform anyone if it pays over a national set rate for consultants from McKinsey?

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  • Ridiculous as usual.. I'm an Aussie GP working here (yes really!!!) But if the UK Nanny-State politicians want to decrease GP pay... well it's back to the good old colonies for me!!!!

    BTW Locums are VALUED in Oz-- They help out when GPs cannot get time off- when they need a break etc etc....

    Also why don't politicians drive a usual vauxhall etc - why their big expensive cars if the treasury is broke.. ?!!!! Plus how about with flying... economy class on Easyjet like I do???

    Well I'm off to do my evening shift in OOH.... So many many many pts. every night and weekend the same... and by decreasing locum rates how can that help these patients??????

    Also locums don't get holiday pay, sick pay, study leave , etc etc....

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  • David why would an Aussie GP work here?!

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  • Dear 11.15pm.... Well.. for "God, King and Country!"... every colonialist's duty is to serve our Mother Country!!

    Mmmm... Actually my German wife's mum is sick so we've come over to Berlin to help her and so I commute to UK to work (!)

    But to come and work here the bureaucrats made it so hard for me- having to do that ridiculous returner scheme thingie, sit exams, etc etc (even though I did my MRCGP here years ago and I'm fully up to date with the Aussie CPD etc-- totally ridiculous- our medicine is so much like UK's- same drugs, same referral methods... only the policies/bureaucracy/admin stuff is different- I reckon more young Aussie GPs would love to spend a year or so here in the mother country... yet you seem to have forsaken us for all those other countries across the Channel!!! But i digress....

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  • Just ignore this - utterly impossible for them to police. They can't see your accounts or even tell when you used locums, so how will they check on it for 8k GP practices? As thatcher said - starve them of the oxygen of publicity.

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  • what is the maximum rate - if we don't know then there is no need to report it?

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  • "Anonymous | GP Partner21 Feb 2016 8:31pm"
    Sounds like you're going to enjoy (with government help) sticking it to those irksome locums you seem to look down on so much. It's amazes me how naive you are regarding the governments divide and rule have swallowed it hook line and sinker.

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  • Anticompetitive. Good old EU Supreme Court (or whatever it is called)would love this. BMA was criticised for fixing locum rates in late 90s and had to back down. Precedent set..sit back and enjoy. Market forces will win out. More Private Companies taking chunks of the NHS, more deregulation and this will include off-radar spending. Don't panic, just keep going.

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  • It seems to me that the right hand does not know what the left is doing. I thought that Monitor and TDA were monitoring breaches. The least that they should be doing is ensure that there is consistency or seek clarification from NHSEngland.
    Redge Carpen

    From: AgencyRules []
    Sent: 23 February 2016 16:09

    Good afternoon

    Thank you for the email and forwarding the article.

    As the article relates to NHS England I cannot comment on procedures they may be looking at. I can however state that with regards to the agency rules issued by Monitor/TDA (link below) it states:

    “GPs are not covered by these price caps, except where they are employed by a trust. Where this is the case, the appropriate equivalent medical price caps should apply.”

    Kind Regards,

    The Agency Team

    Wellington House, 133-155 Waterloo Road, London, SE1 8UG

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  • Agree with the analysis by locum 20 Feb 2.13pm and somzii.
    Don't kid yourselves that the DH is filled with incompetents and this is all just a result of poor thinking. Having recently completed an MBA at a top business school, the techniques being used by the highest levels of the health service are recognisable and being driven by an agenda to destabilise the NHS to a crisis point at which time privatisation will appear to be the salvation of healthcare in the UK.
    In my opinion, we should be supporting the establishment of a politically independent doctor think tank with media expertise to publish papers which argue our case with evidence, as the real armoury is really the minds and hearts of the public.

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