The Royal College of Surgeons has recently called for specialist hubs to increase capacity for clearing the backlog of delayed surgeries post-lockdown. The RCS is one of many medical and regulatory bodies calling for temporary facilities and staffing boosts to clear treatment waiting lists. Whether the solution is insourcing or outsourcing based, it will require temporary staff. Whilst those hired for these hubs must be on temporary contracts, the overwhelming majority of active NHS locums are delivering routine services, which is costly and inappropriate.
In May 2021 the UK media ran stories on the ‘catastrophic’ impact of Covid-19 on waiting lists for standard treatments. Whilst at Remedium we’re not sure we agree with the use of the word ‘catastrophic’, when estimates range to as many as 4.7million waiting for treatment it is clear there does need to be action to tackle the backlog.
The calls of organisations like the RCS advise for the creation of specialist hubs, accelerator stakes, and other waiting list clearing initiatives is very much needed. Thankfully, they aren’t going unanswered, and the UK government is investing both finance and resources in ensuring the NHS gets back to BAU as soon as possible.
Many of the proposed solutions will require substantial additional working hours from doctors to cover. It’s unrealistic to expect these hours to be covered by permanent staff. Whether it’s an insourcing solution, such as introducing weekend or out-of-hours treatments or outsourcing to temporary/private facilities, locum doctors are going to play an essential role in its successful implementation.
However, these temporary Covid recovery measures are one of only a few instances where locums are being used appropriately. Research from the General Medical Council (GMC) found that nearly 20% of doctors (almost 1 in 5) were working as locums. It is highly unlikely that so many clinicians needed on a temporary basis, especially when you consider this includes 39% of UK GPs.
Remedium have been advocating for the reduction of excessive NHS locum spend for many years. There is always going to be a time and a place for temporary, bank and locum doctors. However, as we’ll show, far too many locums are used inappropriately, at great cost to the NHS. Instead, we champion the increased use of fixed term and substantive permanent doctors – particularly for routine NHS services.
Locum doctors: An over-used resource
The NHS is overly-reliant on locum doctors. A 2016 investigation by the British Medical Journal found that acute NHS trusts spend 25 times as much on locums (and associated agency fees) as on hiring permanent doctors. For the 2019/2020 period, this equated to £6.2billion in taxpayers’ money on doctors which could (and in the majority of cases, should) have been placed on a permanent contract.
There will always be a need for temporary doctor posts, as Covid-19 and the NHS response proves. A peripheral body of locum doctors that can be flexibly deployed as need dictates is a consistent necessity. However, in general, the overall health needs of the UK population are predictable enough to be served by a mostly permanent workforce.
So why is it that, in 2019, there were some 9000 full-time NHS doctor vacancies when (for example) as many as 31% of stroke, acute medicine, geriatric, and dermatology consultants in the NHS were locum? At Remedium we’ve long been outspoken about the doctor and skills shortage (for example, when we made clear in 2020 how Remedium welcomed the BMA consultant workforce shortage report). For us, it is clear that the abundance of locums with specialisms that are notoriously difficult to find permanent equivalents for is indicative of a significant over-mobilisation of locum doctors within the NHS.
The financial impact of locums in routine services
Locum doctors cost significantly more to NHS trusts than those on permanent contracts. The increased earning potential is part of the reason many doctors choose the locum career path. What many do not realise is just how much greater a dent relying on locums leaves in the trust budget.
Using NHS Jobs with 3rd party staffing partners to streamline hiring costs and timescales that offer a locum-free hiring solution (such as Remedium) exponentially reduces the impact of staffing on the yearly budget. Unfortunately, many trusts are hesitant to approach 3rd parties for permanent hiring, opting instead to rely on the NHS Jobs platform. Whilst NHS Jobs does serve a purpose, the limitations it has as a hiring platform leads to many trusts relying on long-term locum placements to cover unfilled permanent posts.
Is NHS jobs actually cheaper than outsourcing recruitment to a supplier? Many NHS hiring and procurement managers mistakenly believe so. The reality is that engaging with Remedium for fixed-term and substantive recruitment is a much more cost-effective solution than going through NHS Jobs directly. This is why we’ve managed to save the NHS £200million since 2013, a staggering amount for such a short time frame.
Most NHS trusts are loathe to pay expensive locum and agency costs, but the inability to effectively recruit permanent doctors forces their hand. Having a post unfilled simply isn’t an option; patients need treating. Nevertheless, the current situation will change very little unless more NHS trusts begin to take a proactive approach to finding and securing permanent doctors.
How locums compromise patient care
The impact of locum reliance isn’t only felt financially. Research has suggested that current practices around recruitment and use of locums doctors may result in a higher risk of harm to patients. It doesn’t take an expert-level understanding of healthcare logistics to understand why this is the case.
Continuity of care is one of the essential principles of effective healthcare provision. For a patient, this is best enabled by having a single person coordinate treatment throughout the process. Whether it’s a family GP or oncologist, the reliability and familiarity of a recognised face has considerable benefits to patient’s mental and emotional health. What’s more, tailoring and adapting a treatment plan over time is much easier for a doctor present since its initial creation.
Is this continuity of care really possible in routine services with locum-heavy teams? The risk of incorrect or misaligned treatments increases dramatically whenever patient care is handed over. If a patient is treated by a revolving door of locum doctors, the chances that one will make an error in judgement which leads to further complications is high.
Change can only come from an organisational level
The NHS has been actively trying to reduce locum spend for many years, with initiatives such as staff banks, as well as through using trusted permanent recruitment partners like Remedium. Locum use, however, remains high. Whilst the need for locum doctors will inevitably increase during the pandemic recovery period, it’s important that trusts don’t allow this spike to become long term. Unless those in charge of workforce planning and recruitment at NHS trusts around the country significantly change their approach, locum spend in the NHS will remain excessive.
Fortunately, many NHS trusts have already spoken to us about using the opportunity to further reduce locum numbers to below pre-pandemic levels as the increased demand eases in future. We are already in conversations with clients on ensuring that the post-pandemic recovery coincides with the start of a new period of consistent patient care and financial resources free to be allocated where they’re really needed.
There will always be a need for locums during periods of temporarily high demand. For routine services, however, we should strive for an NHS where locum doctors are a noteworthy rarity. Contact our workforce consultancy team today to see how we can help you to reduce your locum spend.
