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NHS-run GP practices ‘outbid’ independent contractors on locum fees

GP partners have warned that they are struggling to compete with practices run by NHS commissioners when it comes to locum fees.

As a result GMS practices are struggling to source GPs to cover absences, with some GP partners only able to take ‘half’ of their annual leave.

The issue has been flagged by practices in North Wales, where an increasing number of formerly independent practices are now managed by the health board due to pressures on finances and workforce.

Practices and GP leaders said that paying above going rates – by around ’15-20%’ – was a ‘shortsighted’ measure which would only serve to exacerbate problems faced by practices.

Dr Anne Hoffman, a GP partner in Bangor, said she had been unable to claim half of her annual leave because it was ‘near on impossible’ to find locum cover.

She said it had been particularly difficult in the past two years and had been made worse by the health board paying above the going rate.

Practices in the area had agreed a locum pay rate of £500 a day but the health board were offering £700 to £900 for a shift in their practice, Dr Hoffmann explained.

‘We are a small practice. The partners have only taken half of their annual leave – that is not sustainable.

‘We cannot get reliable cover and sometimes have to do 10 sessions a week,’ she said.’

She said it was short-sighted of the health board to pay over the locally agreed rate as it would end up ‘running more practices into the ground’.

‘The rate that practices would pay was agreed by our GP cluster. It is the right thing to do.’(see note below)

BMA figures from January show that North Wales has been hit particularly hard by recruitment and retention problems with 13 practices now managed by the health board, with at least six others are at risk.

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North Wales LMC chair Dr Eamonn Jessup, who also works as a locum, agreed it was a problem and that working in managed practices tended to pay about 15-20% more than the amount paid in a GMS practice.

‘On top of that GPs who decide that they are going to work only in managed practices as a locum rather than GMS practices do not need to get financial indemnity.

‘This can save someone doing eight or nine sessions of work a week an extra £10,000 a year,’ he said.

‘Many GPs can neither find, nor pay to cover their time out of the practice and now find themselves committing to ridiculous numbers of hours and weeks of work to keep the GMS dream alive in North Wales.’

Dr Jessup added that he has ‘a huge affinity’ for GMS practices and consider them to provide the highest level of care.

‘I feel privileged to be asked to work in them. This is why I will charge them less.’

A spokesperson for Betsi Cadwaladr University Health Board said the rates offered for GPs to work in their managed practices ‘are appropriate given the challenges in meeting demand for general practice services’.

‘The diverse skill mix of staff in health board-managed practices tends to be more diverse than in traditional GMS, which can result in a different responsibility and a higher effective list size per GP on duty.

‘Our rates are significantly less than have been reported in other areas.’

The health board said they were trying to reduce reliance on locums by focusing on hiring salaried GPs.

Please note: Arfon GP cluster lead Dr Nia Hughes said that she was ‘not aware’ of any agreement between the cluster practices to fix locum GP rates and that locums in the area were paid variable rates. She told Pulse: ‘There has never been a discussion about capping pay. I’m not aware of any such practice in the area.’

This was added at 15:00 on 23 March 2018