Leader: Too well paid to take NHS jobs, locums’ fees must be checked

BARELY a month goes by without some earnest report of stresses and strains in the NHS budget and worrying accounts of service cutbacks. It is against this backdrop that the Audit Scotland report on the rapidly rising bill for locum doctors is especially concerning.

It finds that locum doctors working in the NHS in Scotland are turning down permanent jobs because they can make more money in their current roles.

A locum doctor is one who temporarily fulfils the duties of another, taking the place of the regular doctors when they are absent, or when a hospital/practice is short-staffed. According to an earlier Audit Scotland report, the NHS bill for locum doctors has doubled in a decade to almost £50 million a year, and that hospitals could save £6m a year by cutting back on their use.

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This sparked calls for the costs to be brought down. But this is proving difficult as locum staff do not wish permanent jobs. By setting themselves up as limited companies, they can earn two or three times what they would as full-time NHS staff. The different tax status also enables them to employ family members as staff and makes it easier to claim back expenses against tax. So, while there are NHS vacancies, locum doctors are extremely reluctant to forego the lucrative benefits of being a limited company.

Consultants working full-time in the NHS are well rewarded, with salaries of up to £100,000 a year. The key benefit of locums, from the NHS point of view, is flexibility and the benefit of extra cover that the locum can offer without the expense of a permanent addition to the hospital or GP rota.

But locums can also earn large amounts, with pay of more than £100 an hour in some cases, depending on their grade, speciality and whether they work through an agency. And they have greater freedom to choose when and for how long they are on call so that interference with family commitments can be kept to a minimum. This can lead to frustration and resentment among permanent staff.

Patients, too, will have concerns over a health service that can come to rely too heavily on temporary or infill staff. While the locum may be fully competent, there are many patients with long-term conditions and with an age or disposition which makes it difficult for them to explain all the nuances of their condition and the specialist treatment required. Patients also feel more reassured dealing with a regular GP or other doctor with whom they have built a relationship of trust over a long period of time.

Locums are an inevitable – and valuable – part of today’s NHS on whom it relies to maintain cover. They provide critical service in the event of staff absences and emergencies. But the reward system must not become so skewed as to put full-time regular NHS staff at a disadvantage. The administration must look at how the Audit Scotland concerns can be addressed and taken forward.