NHS Locum Doctor Spend Spirals as EU Regulations Bite

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The cost of hiring locum or temporary doctors to prop up NHS hospitals in England has rocketed to more than £ ¾ billion a year since the introduction of EU regulations to reduce doctors’ hours, the Royal College of Surgeons has learned.

The cost of hiring locum or temporary doctors to prop up NHS hospitals in England has rocketed to more than £ ¾ billion a year since the introduction of EU regulations to reduce doctors’ hours, the Royal College of Surgeons has learned. Figures obtained under the Freedom of Information Act show that annual spending on all hospital locum doctors has increased by almost £200million in the past year alone and has almost doubled since 2007. For surgical locums the spend is almost £ ¼ billion per year.

The staggering increases come as Trusts try to plug hospital rota gaps created by the introduction of the European Working Time Regulations (EWTR) which only allows doctors to work a maximum 48 hour week. The RCS estimates that, since introducing the 48 hour working limits in UK hospitals, the NHS loses more than 400,000 hours of surgical time a month while still managing the same workload.

The survey of 165 NHS Trusts* shows:

Overall spend for all hospital doctors and surgical posts:

All locum doctors: 2007/8 (£): 384,367,109; 2008/9 (£): 548,663,681; 2009/10 (£): 758,363,084
Locum doctors covering surgical positions: 2007/8 (£): 119,015,980; 2008/9 (£):172,756,748; 2009/10 (£): 232,025,351

Amount spent on internal locums (staff already employed by the trusts taking extra shifts) and those brought in from external private agencies:

Internal locums: 2007/8 (£): 206,165,975; 2008/9 (£): 273,399,522; 2009/10 (£): 310,875,152
External agencies: 2007/8 (£): 173,758,168; 2008/9 (£): 280,101,157; 2009/10 (£):467,284,294

The effect of the EWTR has been particularly damaging for units providing 24-hour acute care where staffing requirements are high and complex. As a result Trusts are forced to employ staff already working in their Trust in order to fill gaps (so-called ‘internal locums’). A survey carried out by the RCS earlier this year revealed that around half of surgeons are covering rota gaps in their own hospitals, regularly working above and beyond 48 hours.

However, the largest increase has been in the amount paid to external locum agencies as the NHS is forced to seek doctors from all over the world on highly paid short-term contracts as the supply of available UK doctors runs dry. Spending on external agencies has increased by almost £200million in the past year to almost £ ½ billion in 2009/10. The RCS has consistently voiced concerns about the impact on patient care as hospitals choose between running on skeleton staff or with doctors with no prior knowledge of the hospital they are working in, the patients they are treating or the colleagues they are working with.

John Black, President of The Royal College of Surgeons, said: “It seems ridiculous that at a time of economic crisis, with wide-ranging cuts to services across the board, we are seeing astronomical sums of money being thrown at locum doctors in order to prop up services that are only falling apart because of an ill-conceived European law. Unless hours for doctors working in 24-hour acute care medicine are relaxed to a sensible level the pool of good, safe doctors will dry up and we will see more units close. The coalition Government has promised to deal with the issue, but the question is when?”

Charlie Giddings, President of the Association of Surgeon in Training (ASiT), said: “Under the EWTR providing high-quality patient care is already challenging, with multiple handovers and shift systems impacting on patients’ continuity of care. The employment of locum doctors on such a scale only adds to the existing difficulties. Locum doctors are often unfamiliar with colleagues, the hospital or in-patients and require additional supervision, which is inefficient and expensive. This data suggests that existing rotas are unsustainable and true compliance with the working time regulations is masked as doctors prop up the service as internal locums. Surgeons in training have repeatedly called for a maximum of 65 hour working week, including on-call, which we believe would solve this situation.”

*The RCS sent a Freedom of Information request to 164 Trusts, of which 118 responded. Of the respondents, full and accurate data was available from 96 Trusts. Therefore, the subsequent analysis was based on 96 Trusts. A total spend for each year was produced, from which a mean average of individual Trusts spending was calculated. This mean average was then used to calculate the total spend of all 165 Trusts in any particular category for each year.

The full survey is available at http://www.rcseng.ac.uk/ and includes a breakdown by region and by job title.

Notes to Editors

1.    The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit http://www.rcseng.ac.uk
2.    If you have any queries please contact:
Matthew Worrall -- Email: mworrall(at)rcseng(dot)ac(dot)uk; T: 020 7869 6047
Elaine Towell -- Email: etowell(at)rcseng(dot)ac(dot)uk; T: 020 7869 6045
Heather Casey -- Email: hcasey(at)rcseng(dot)ac(dot)uk; T: 020 7869 6042
Out-of-hours: 07966 486 832


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