Agency spending caps have been implemented by Monitor and the NHS Trust Development Authority and came into force on November 23rd, 2015. The intention behind capping the pay levels for locums was a direct response to tackle the overspending on temporary workers that had become the norm in hospitals, with the chief executive of NHS England, Simon Stevens, stating his desire to see the £1.8bn spent on locums during the previous year turned into “good, paying permanent jobs”.
The controversial move was, however, met with objection by leading bodies, with the British Medical Association (BMA) voicing their opinion loudly that these pay caps should be scrapped. They claimed that “The caps are short sighted, exacerbate the staff crisis and affect the livelihood of thousands of doctors. They are an insult to our profession.” Other doctors have also made their opinions known that the NHS would not be in a position to cope without locum doctors.
Almost a year down the line, what has been the result of these cuts, have they been effective, and will they remain? Many are claiming that the cuts have been a total failure and many trusts are not even enforcing them. In fact, figures indicate that these rules are being breached over 50,000 times each week. This is possible because, while the rules are in place, there is a caveat that NHS bosses can override them if they consider that they would pose a significant risk to the safety of their patients. In virtually all cases, this is easy to argue. The NHS argues however, that despite these figures the cuts have led to a saving in the region of £300 million.
Despite the higher cost of living in London, this is one area where the caps do seem to have been more successful. Training posts in London fill up quickly due to their popularity, so the trusts there naturally have a larger number of doctors to fill shifts. Furthermore, due to the large number of doctors that have worked locum shifts in hospitals there previously, and the familiarity they have gained by doing so, they are more keen on a personal level to return there. This willingness, coupled with high demand, means that they are more willing to take appointments at the lower, capped rate.
They may well do, and the statistics show that in parts of the UK they already have, but this could take a little longer in London. Over time though, it is predicted that more locums will travel outside of London, thereby reducing the pool available and naturally driving up the rates again. It’s an interesting debate with passionate opinions heard from both sides, and one which we will continue to watch unfold over the coming months.