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The waiting game

Locums forced to slash fees by 8% due to pensions changes

Exclusive GP locums have cut their fees by an average of 8% since April, or halted their pension payments altogether, as a result of the Government’s changes to employer superannuation contributions.

Figures from Rlocums, a website that matches 1,300 locums to practices, show that locums are being forced to share the burden with practices of paying the extra employer contributions that the Government imposed on practices in April.

GP leaders have backed the figures, saying there has been anecdotal evidence that smaller practices in particular have been heavily hit by the reforms and have taken to paying locums less or stopping their use altogether.

A Pulse survey of 435 GPs reflects the analysis, showing that more than four out of ten GPs say they have made changes to the way they employ locums.

In April, the burden of paying locums’ 14% pension contributions was transferred from the now defunct PCTs to GP surgeries. Practices do receive an allocation of money with their global sum, which the DH says is equivalent overall to the money spent by PCTs on locum superannuation.

But this is distributed evenly across GP practices according to their size, which means that those who do not use locums regularly are actually better off, while those who do – which tend to be smaller practices who cannot cover absences internally - are worse off.

The BMA sent a letter to health secretary Jeremy Hunt in April warning that it had seen ‘dozens of cases’ in which locums were being forced to cut their fees, but the Rlocum figures are the first concrete indication that this is happening in practice.

Dr Steve Leung, the medical director for Rlocums and a GP in Leicester, said the changes are adversely affecting both locums and practices.

He said: ‘Locums are losing out because of the changes. Locums think it’s unfair and so do the practices. Practices are being reimbursed for using locums, but it’s not enough. We need to go back to a system like the one we had before where surgeries get money according to the number of locums they use.’

Locums who still pension their income typically reduced their hourly rates from £82.92 to £76.29 during May – the first month after the policy change – representing a fall of about 8%, said Dr Leung.

Around 45.6% of locums were pensioning their work in March, but the figures had fallen to 41.6% by the start of May - which relates to a reduction of almost 9%. This trend is likely to continue, said Dr Leung.

The Pulse survey found that 58.4% of GPs said the practices had absorbed the extra costs of pensions’ superannuation. A further 10% said they had negotiated a reduction in fees, while 7% said they were employing more retired GPs. One in four GPs said they had taken other action, which normally involved reducing the number of locums they use.

Dr Peter Swinyard, a GP in Swindon and chair of the Family Doctor Association, said the reforms were disproportionately affecting smaller practices because they often rely heavily on locums to cover absences, whereas larger practices can provide cover through their own substantive doctors, added Dr Swinyard. ‘Large practices that have no need for locums have had a windfall from the new payments system,’ said Dr Swinyard.

He added: ‘Some practices have told me that they have a certain budget, and they are sticking to it. It means now that they are using fewer locums or paying them less. I’ve have heard of both situations.’

Dr Sajid Mehmood, a GP in Luton, said that the changes had been affecting his small practice. He said: ‘To try to cover the extra costs of paying locums’ superannuation contribution we decided we would absorb half of the extra and ask locums to absorb the other half. It meant that locums charging £80 an hour would have their payment reduced to about £74 or £75.

‘We had to do this because we work in a small practice with only 1.5 full-time GPs and so we have to use locums when one of us wants a holiday or goes to a conference or a course. We’ve been struggling year-on-year financially, and we’ve been losing quite a lot. It’s been really hard.’

However, Dr Richard Fieldhouse, chief executive of the National Association of Sessional GPs, criticised GP partners who have tried to drive down locum rates as ‘small-minded’. He said: ‘The increase in costs for most practices has been tiny because it is spread throughout their overall costs.’

He added the data highlighted that it would be advantageous for ‘independent, vulnerable’ locums to join ‘chambers’ – collections of locums who work together to provide freelance GP services and have greater bargaining power as a result.

Dr Fieldhouse said: ‘Isolated, independent locums have become vulnerable following the changes. They tend to be female and are often from overseas, and they are not represented nationally.’

Survey results

Have you taken any action to mitigate the cost of providing employers 14% superannuation for the locums working at your practice?

No, we have absorbed any extra costs - 254 (58.4%)

Yes, we have negotiated a reduction in locum rates - 44 (10.1%)

Yes, we now employ retired GPs - 30 (6.9%)

Other action - 107 (24.6%)



Readers' comments (24)

  • As a locum GP i can say that i have stopped paying into the NHS pension scheme but kept my rates the same

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  • When you charge far more than a partner can possibly earn ie £90 per hour and no paperwork, no visits, no extras, no responsibility, no management or meetings it still ain't bad. We have been financially crippled by being forced into regular locum use.

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  • As a locum I am paying the full 25% into my NHS pension scheme as the surgeries decline paying it despite it being a legal obligation. Long gone are the days when the locum does not do HV/paperwork/extra's/path lab results etc.... Working just like a partner but minus the sandwich eating meetings but I do attend whenever i can fit it in.

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  • And so are partners-we pay all our pension contributions....we are not employed....we just don't earn £90 per hour..

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  • A typically sensionalist choice of verbs by Pulse!

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  • In the area where I work I know the "localities" are trying to set a maximum sessional rate for locums. The younger GPs seem to accept this without question worried about the next mortgage payment driving down locum earnings for all. £80/hour is not a lot given the work intensity, responsibility and need to cover considerable expenses. Locums are value for money for the NHS when you consider the charges of other professions eg. my dentist charges £37 to write a referral letter, a private physio charges about £55 for a 30min appointment, and locum nurse practitioners can earn £55/hour. Furthermore these other professions don't have to pay £7000+/year in defence fees.

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  • Once again I feel that Pulse plays the " poor Partners card" yet again. I have worked just recently for 2 practices as a locum where the pay per Partner 8 sessions is 190K and 200Krespectively but this did not stop them driving down my pay to the lowest possible 65/hr and then I had to pay my own MPS 150/wk and pension. The problem with locums is we are not united.

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  • The problem with joining chambers is that you have to pay a hefty management fee to the chambers, typically around 10% of income, so you would be no better off in terms of net usable income.

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  • The comments on pay-are Daily Mail rubbish. Nobody earns 190-200K from NHS work-this is total crap. It is simply not possible unless you have a laser printer making £50 notes all day. This is alot of paranoid stuff out there about Partners. Our locum has been earning £2,500 per month MORE than us partners-we had no choice....illness cover so pay or fold the practice.

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  • and we offered him Partnership......but he refused as he said we did not earn enough....he would be taking a big pay is true....I promise you.

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  • "Dr Peter Swinyard, a GP in Swindon and chair of the Family Doctor Association, said the reforms were disproportionately affecting smaller practices because they often rely heavily on locums to cover absences, whereas larger practices can provide cover through their own substantive doctors"

    If you choose to operate a small business with only a few GP's then that is part of the risk that using that business model carries. The problem with primary care is they expect every change to be a win for every practice which is just not realistic. No other area of commerce expects this to happen so why should provision of primary care?

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  • I'm a partner in average earning practice working 50hrs/week (that doesn't include extra work such as attending federation, partnership away day, weekend flu clinics etc). After taking out my holidays & study leaves from total number of hours worked in a year, I calculate my hourly pre-tax, pre-expenditure earning is

    £41/hour (and that includes my pension contribution as well).

    I understand the risks involved in locum and the need to earn a bit more than those in stable job. But expecting to earn over twice a full time partner without having the same responsibility is unsustainable. Hence reduction in income, not just to do with superan changes

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  • Just a short reply - I actually know the 190Kand 200k practices are real as I worked long term in both Practices - the Daily Mail world is accurate here, please do not imply that I lie! I admit that one Practice was part-dispensing and the other had 2 partners and 6 salaried with over 16,000 patients - perhaps you should employ more salaried GPs and less Partners if you wish for the attainable high salary?

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  • Response.......I would rather earn alot less than run a crap service thanks!! as would the vast majority of GPs. As you sound so keen why don't you copy these "characters" who give GPs a bad name-let us hope that the CQC shut down anyone who behaves like this.

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  • No thanks, I'm not in this just for money. I am trying to keep my income stable and work load managable but have no intension of milking it so that I can pay the locums more!

    p.s. There was an article here not so long ago with partnership tax which stipulated 150k+ income practices are only 2.5% (off my memory) of the GP practices. If you wish to use 2.5% as an example to comment on rest of the general practice, then I'm sure you'll understand why you wont be taken seriously

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  • Its a great shame that once again its turning into "us versus them" argument.The government must be laughing their heads off at the way they have divided our entire profession.Last week it was GPs versus hospital doctors.Before then it was GP partners versus GP salaried docs and now its non GP locums versus locums.

    The entire system of GP practices having to pay NHS employer superannuation contributions,whether it's of GP partners or locums, is illogical and assinine.It should be the notional employer's responsibility to pay of those contributions (PCTs in the old days,?CCG now) rather then bundling it all via the global sum which has no bearing on what the locums actually pay.Its utterly ridiculous.We should not be paying any employer's superannuation because we're not the notional employer for pension purposes.I wonder who negotiated this nonsense.

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  • Anonymous | 24 June 2013 11:13am

    Sorry, but true... Dr Bickle of Barra earned huge sums for his OOH, which started £1,000 per night and then was re-negotiated to £800 per night. If you are THE ONLY doctor and in reality always attending as an OOH - how much do you think that adds up to? It was suggested at some point by Andy Kerr (then Minister for Health in Scotland) that this was an April Fool Day story. If only! You could earn in Scottish Isles in excess of £10,000 for a weeks locum work.

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  • @Anonymous | 24 June 2013 11:13am

    What are you whingeing on about?It's market forces.If you don't want to pay then don't.Who's stopping you.

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  • Having worked as both a locum and a partner, I would say that I'm much better off in my Partnership but a lot of this is down to job security. Locuming is not a mystical pot of gold. You spend loads of unpaid time managing your bookings and accounts. In addition you end up with voids - unfilled sessions for which you still pay session insurance. Furthermore, some practices forget to pay you or pay less than the rate agreed! I did very similar paperwork and extras as a locum. Partnership seems to carry more costs such as employers national insurance and various other expenses but on balance I think is better remunerated even when you count the unpaid work you do in all the various meetings and fixing things. I think all GPs need to be aware of the divide and conquer strategy being pursued by this government. The differences between salaried, locum and partner are often trivial but have become increasingly divisive. Ultimately we have very similar interests.

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    When partnership earn profit, the GP partners wanted all for themselves (majority of Partners) and hardly wanted to give a partnership to new GPs. Historically they replaced almost every retiring partners with salaried GPs or with nurse practitioners.

    When partnership income got into crisis, they are blaming the locum GPs as greedy doctors!.... The whole world know who is really greedy.

    The reason for the problem is the government and not the locum GPs.

    Please unite together and fight as a single force rather than side track on locum GPs.

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