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Gold, incentives and meh

Out-of-hours cover is worth every penny we can get

Re-your news stories on out-of-hours pay and locum charges (August 4). Whenever co-operatives cite their hourly rates, and people fuss about them going up, I always wonder if no one except me has been recently to a solicitor.

Their hourly charges start at about £150. Why do we think £150 an hour minimum is fine for them but far less than that for us to stagger on over bank holidays and overnights is OK?

Out-of-hours is the least popular part of GP work so we should pay those willing to do it as much as it takes to accept such a disrupted work/life balance. If that costs the PCTs real money, tough. It's high time the Government were appraised of market force reality at last kicking into primary care to reflect the gross labour shortages it (with its predecessors) has watched develop. Orwellian double-think about one part-time incoming lady doctor in her 30s being as useful to the NHS as a retiring full-timer might finally get challenged for the illogical bunkum it is.

Out-of-hours cover will have to be incentivised ­ ie, bribe doctors to do it. Inadequate incentive (insufficient bribe) will mean lack of cover, which will mean rates will rise till cover is sufficient.

The same goes with locum rates. What on earth do people expect to happen to prices in a market where there is a key commodity that all purchasers (principals) need and where the number of vendors of the product (non-principals and their time) is smaller than the demand?

In a land of famine the man with the bag of rice to flog will set whatever price he can get for it, and the worse the famine gets the higher the price he'll be able to charge. Why, why, why does everyone think this is so odd?

The role of the BMA over rates should be to set minimum scales and be explicit in saying that is what they are, not be disingenuous as usual and call them guide prices or similar.

If the market is such that a principal wanting cover has to pay more, there are choices: do your own out-of-hours, don't go on leave, retire, become a non-principal and do highly-priced locums (leading eventually to market stabilisation), bin the NHS and go private, and so on.

Dr Ross Walker

Independent Free-Marketeer

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