The region's NHS Trusts have been criticised for spending almost £100 million in three years paying locum doctors, with calls for better planning and staff management.
At one point in 2019 there were more than 200 temporary medics, who can be paid 150 per cent or more of their full-time colleagues’ salaries, working in a single hospital on a single day.
It comes four years after NHS managers promised to form a united front across the county to stop locums playing one Trust off against another in an attempt to maximise pay, but there is no evidence of Trusts having done so.
John O’Connell, chief executive of the Taxpayer’s Alliance, said: “The sky-high rates paid out to locum doctors are unsustainable and will leave taxpayers stunned.
“With proper management of staff time and shifts, there would be much less need for agency cover. NHS bosses need to be much smarter about forward planning."
However the locum doctors' trade union blamed inflexible working practices and bullying management in the NHS for driving skilled physicians out of full-time employment.
An NHS spokesman said providers were working collaboratively to use resources wisely and were “committed” to a ceiling on agency pay.
What is a locum and how much do they earn?
Locums are fully-qualified physicians who choose not to work as full- or part-time members of an NHS Trust’s workforce, but instead are self-employed and go from place to place (locum means place in Latin) providing their expertise in areas where there is a staffing or skills shortage.
Placements can be as short as a few hours or can last months or years, and locum doctors are paid much more than standard staff.
However they do not receive benefits like maternity pay, sick pay, or travel expenses, and have to cover administrative costs for regular medical ‘revalidation’ which the NHS pays for its own employees.
In an attempt to bring down eye-watering pay deals equivalent to £400,000 a year or more, the NHS brought in a salary cap of 150% of standard pay in 2015, but Trusts can still make exceptions in cases of necessity.
A 2017 report from NHS Improvement found locums still being paid up to £3,600 a day - ten times the standard day rate for a consultant on a normal contract.
And in 2018 managers at the James Paget hospital in Great Yarmouth reported they were “finding it increasingly difficult to hold rates for medical locums who will often move around for the highest rate”.
The region’s Trusts said they would come together to agree pay ceilings, then “stand firm” in the face of negotiation from locums in order to “take back some control over the market”.
But four years later - and ten weeks after this newspaper first asked whether such a region-wide ceiling had been put in place - the NHS Clinical Commissioning Group (CCG) for Norfolk and Waveney will not confirm that such a regional pay cap exists.
“A cut-class and third-rate employer”
Reliance on some work by locum doctors is crucial to the NHS and certain parts of the country would never have qualified doctors in unusual specialisms if it weren’t for locums' expertise and willingness to move around the country.
They do not receive accommodation costs or sick pay and spend as much as £5,000 a year to maintain their qualifications to practice, and many locums argue their higher wages do not cover the additional costs of self-employment.
Dr Shehnaz Somjee, chair of the Locum Doctors’ Association, said: “Locums provide a very valuable service hospitals can’t get any other way.
“We drop everything when people need help, and without us those hospitals would have shut down long ago."
She blamed poor management, inflexible working patterns, racial bias, and poor terms and conditions in the NHS for forcing qualified doctors out of full-time employment and into locum work.
“The NHS is a cut class and third rate employer, compared to professions like law or corporate administration.
“Why would anyone with common sense and the right qualifications want to spend time in an organisation which doesn’t appreciate them, bullies them, doesn’t provide flexible working, doesn’t allow family-friendly hours?
“We locums are not responsible for the NHS’s failures of recruitment and retention.”
They spent how much?
Freedom of Information requests reveal the Norfolk and Norwich hospital paid out £9.5m in financial year 2018/19, £10.9m in 2019/20 and £14.3m in 2020/21 for a total of £34.8m over three years to locum doctors.
The high-water mark came not during the pandemic but on May 31 2019, when the N&N had 214 locums - either external staff or N&N employees working in a “bank” or “agency” capacity - working on the same day.
The crumbling Queen Elizabeth Hospital in King’s Lynn spent £14.5m, £11m, and £9.1m, which comes to £34.5m.
The James Paget hospital in Great Yarmouth spent £4.8m in 18/19, £4.2m in 19/20, and £2.3m in 20/21 totalling £11.3m.
The CCG, responsible for the region's GPs, spent £3.4m across the three years, and the community healthcare trust (NCHC) spent half a million.
The Norfolk and Suffolk Foundation Trust (NSFT), the region’s failing mental health trust which cannot afford enough beds for its patients, spent £6.2m on locum doctors in calendar year 2019 and £5.4m in 2020.
This week’s damning CQC report into the NSFT found it had filled healthcare roles at a rate of only 4.3 out of 10, relying on locums and agency staff to fill gaps.
It is not known how much any of these locum doctors have been paid, or in how many cases the national cap of 50 per cent over salary has been breached.
“The NHS uses its resources wisely”
The chief executive of Healthwatch Norfolk, Alex Stewart, said his organisation appreciated there is place for locum spending, to ensure continuation of service, but wanted to see frontline care funded as economically as possible.
Mr Stewart added: “We know trusts have previously committed to working on a ceiling on locum rate of pay and encouraged locums to come on board as permanent employees.
"Equally, we are aware anecdotally that some doctors prefer the locum route as they have less administration to deal with.”
NFST chief exec Stuart Richardson said: “It has been vitally important that we have people on the ground to provide care when it is needed. We continue to successfully recruit into these roles.”
A spokesman for the NHS across Norfolk and Waveney said: “Healthcare providers across Norfolk and Waveney are working collaboratively to help ensure the NHS uses its resources wisely in this area.
“All health and care services are committed to a ceiling on agency pay and a Norfolk and Waveney collaborative bank was established last year for staff interested in working temporary shifts.
He said staff sickness and isolation caused by the pandemic pandemic had put unprecedented pressure on the workforce, and the health service employs agency and locum staff as necessary “as a flexible resource to help meet the full range of people’s health and care needs.”
If you have experience of the locum doctor market in Norfolk and Waveney and wish to contact the paper please email joel.adams@archant.co.uk. All requests for anonymity or confidentiality will be honoured.
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