Health leaders in Norfolk have teamed up to 'take back control' of rates paid to locums after more than £60m was spent on filling recruitment gaps with temporary staff last year.
In the 2016/17 financial year the county's busiest hospital, the Norfolk and Norwich University Hospital (NNUH) spent £20.266m on agency and contract staff, and locums.
In the same period the James Paget University Hospital (JPUH) in Gorleston spent £9.003m while the Queen Elizabeth Hospital (QEH) in King's Lynn spent £14.1m.
At Norfolk Community Health and Care £2.5m was spent, while at the mental health trust, Norfolk and Suffolk Foundation Trust (NSFT), £18m was spent on temporary staff, including those on short-term contracts.
A report from the hospitals watchdog NHS Improvement last year found in some areas locum doctors were regularly paid £360 an hour - or £3,600 for a 10-hour shift.
While a further five doctors were found to be charging more than £250 an hour for working limited sessions within trusts.
In comparison a permanently-employed junior doctor will take home between £88 and £185 for a full days work, based on their experience and training.
And even the best-paid consultant could not expect to take home more than £258 a day.
Many trusts have brought their expenditure down over recent years but now they have banded together to 'stand firm' against locums who move around trusts bidding for the highest rate and pitting organisations against each other.
Dr Nick Lyons, medical director at the QEH, said locums made a valuable contribution to the workforce. But he said: 'There is a concern that we are spending too much of our budget on doctors who can earn very high salaries.'
Hospitals find themselves backed into a corner amid a recruitment crisis where one in nine NHS jobs are unfilled.
Dr Lyons said: 'Sadly there are not enough doctors in the UK to satisfy the needs.'
In documents released ahead of a board of directors meeting at JPUH today (Friday) it said: 'Trusts are finding it increasingly difficult to hold rates for medical locums who will often move around for the highest rate giving trusts little choice at times but to pay high rates to enable safe working practice.'
It was proposed that trusts in the east of England come together to agree ceiling rates, which they would then look to drive down over a period of time.
But it was warned the bid would only work if all organisations committed. The report said: 'It is recognised that the initiative will only be successful if all trusts stand firm thus enabling the region to start to take back some control over the market.'
Dr Lyons said at the QEH a scheme called Queen Elizabeth Fellows was encouraging locums to come on board as permanent staff by giving them opportunities to work in their preferred speciality part-time, even if vacancies were not immediately available, while also working in
Jeremy Over, director of Workforce at NNUH, added: 'Over the last 18 months we have dramatically reduced our spending on locum medical agency costs.
'Our monthly expenditure in 2016 was more than £1m per month and this was quickly reduced to around £50,000 through successful recruitment and growing our internal staff bank. We continue to work hard to maintain this excellent position.
'We are now involved in collaborative work with hospitals across the region to help ensure the NHS uses its resources wisely in this area.
'We employ agency and locum staff as necessary as a flexible resource to cover short notice gaps in order to maintain the quality of service for patients.'
Bohdan Solomka, medical director at NSFT, added: 'NSFT is pleased to be part of this joint Locum initiative. It is early days, but we feel that it is important to work together to ensure the best use of local NHS money and fair procurement processes across trusts.'
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