Scrap the cap that’s bad for doctors, bad for patients

by Shivan Kotecha

Locum pay caps are a contributing factor to unsafe staffing levels in London

Location: UK
Published: Wednesday 31 August 2022
Shivan Kotecha

How many times have you left from a shift feeling exhausted, having to cover an extra person’s work because your shift was understaffed and therefore unsafe?

How many times have you left a shift feeling drained, with that sense of anxiety that your patients may have come to harm because you were short staffed, and you had to decide which sick patient to prioritise first?

You all know that feeling. You also know that feeling of meeting your colleagues after their set of short-staffed shifts in the doctors' mess or the canteen, talking about how frustrated you are by it.

It is sadly too frequent that colleagues are working understaffed and unsafe shifts. What is extremely frustrating is that locum pay caps are a key contributing factor to unsafe staffing levels. It is shocking to me that we have just accepted the fact that HR departments won’t escalate locum rates to try and ensure shifts are fully staffed. This in turn would lead to our patients having the best possible care.

I have had conversations with colleagues across the capital who have chosen to take shifts at trusts outside of the scope of the locum pay cap. Who can blame them? Locum pay caps are a direct contradiction to market forces, and with rising inflation affecting all walks of society, junior doctors are not immune to the cost of living challenges facing the country.

In London, there is a clear lack of transparency about the operation of, or the benefits to patient safety behind a locum pay cap. In a survey conducted by North and South Thames, junior doctors across London, 82% of respondents have been worried that patient safety may be compromised owing to rota gaps.

As your union, the BMA will work to fight for you and your patients. The BMA is calling for an end to the locum pay cap, and is calling upon trusts to work collaboratively to discuss the effects of unsafe staffing – in part driven by the locum rates in London. We need to consider the effects on the junior doctor workforce and what could be the effect on patient safety. Trusts should be reminded that NHS England/Improvement has advised that patient safety should not be compromised by locum pay caps.

Following a motion passed at the UK Junior Doctors Conference on safe staffing and regional locum pay caps, the North and South Thames regional junior doctors committees have attempted to engage with NHSE-I on this important issue to address patient safety. Unfortunately, conversations with them did not bear fruit.

This is why, in conjunction with junior doctors across London, we have created the ‘Scrap the Cap’ campaign, which is looking to bring an end to locum pay caps. We need colleagues across the capital to help us. If you are concerned about locum rates in your hospital, speak to your local reps about this.

Locum pay caps are bad for doctors, and they are bad for patients. They must go, and they must go now.

If you wish to get involved in this campaign, please email Andrew Barton 


Shivan Kotecha is on the North Thames RJDC executive committee and is on the steering group for the Scrap The Cap campaign. He is a GP trainee based in North London