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Gold, incentives and meh

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)

  • 24 June 2013 11:17am for you.
    some practices offer salaried parternerships but pay very little like paying much less for doing 8 sessions than the senior partner will get for doing 4 session yet the junior salaried partener who has probably 5-6 years experience as a gp will still be expected to have all the same duties as the partner in attending meetings etc so yes that will appear as much less pay for much more work, rather locum might be able to work 8 sessions on their own term and even though being insecure towards work but still might be less stressed with regards to work

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  • Once again, the above comments show how 'divided' the GP profession is! this is how the significant changes get made to our profession, 'against our will', yet we are Too busy bickering with each other rather than combining our skills and resources to fight that which is REALLY our enemy!!

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  • I remember being a young registrar when I attended an RCGP summit. They explained why we should give our fees to the RCGP. They explained that this helped the war chest so that the college could defend us. The college is a partner institution. They do not defend me. I have no representation of any clout yet we make up most of general practice.

    As such, partners are unfortunately on their own. 24/7 will become their responsibility not mine. Quite frankly qof is their problem too.

    You are right nobody wants partnership as we all know what is coming round the corner. Partners are unable to negotiate and are toothless against the government.

    The reality is that combining with partners to fight for a better GP contract does not benefit salaried doctors. There is no historical evidence that its fruits have been shared.

    I am not slashing my fees. If partnerships choose not to employ then that is fine. The reality is that people do need to take holiday, attend ccg meetings, suffer illness etc and there is already a shortage of gp's

    It's our market. Of I am asked to cut fees, I wish to see the practice accounts as to why thy are so poor. If they are earning more me, I will not slash. If hey refuse to show me then I assume that they have something to hide!

    - anonymous salaried!

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  • quoting hourly rates is very misleading as only covers the 2-3 hour surgery times which always overrun + admin home visits etc not inclided so 70 per hour for 5 hours of a 10 hour day is 35 per hour really usually 400pounds per day in reality give or take. of course we earn nothing when sick or on holiday or on training courses maternity etc. I don't think that is really a lot and althjough partners have more responsibility I think they still earn more than most locum GPs. we also often don't get pension as cant claim if work through an agency although this may change. I think its similarly unfair that partners have to pay their own employers portion of pension so what sounds like good earnings = 25% to pension. Its not fantastic money for anyone but we shouldn't moan too much about money in a recession. All the ridiculous admin des les schemes and time wasting is what should change

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