Last updated:

Fixed locum rates raise safety concerns

Hospital signage on wall SMH2016 
St Marys/Hammersmith Hospitals 21-12-16

Hospitals have been accused of increasing pressure on doctors and risking patient safety by fixing maximum locum pay rates across London.

The Pan London Bank and Agency Steering Group has set a ceiling of £20 per hour for foundation doctors, £50 or £67 for associate specialists depending if they are working anti-social hours, and a highest rate of £100 per hour for an emergency medicine consultant working unsocial hours.

Trusts have been told that, by September, they should not pay more than the ceiling rate.

London North West University Healthcare NHS Trust chief executive Dame Jacqueline Docherty, who chairs the group, said it had set the ‘voluntary local London rates’ in response to rules on agency pay and price caps introduced by NHS Improvement in 2015.

She said: ‘These rates are not standardised across London, but are intended to act as a ceiling which trusts should only exceed in exceptional circumstances to secure patient safety and care.

‘Each trust is responsible for making local decisions to cover vacancies and manage their staffing requirements.’


Secondary impact

But while briefing papers prepared by her group say the high cost of locums ‘ultimately impact on the availability of resources elsewhere to invest in patient care and safety’, BMA junior doctors committee chair Jeeves Wijesuriya said the new ceiling created safety issues of its own.

Typically, he said, trusts would offer an unrealistic rate and fail to attract locums. This would mean the department would be left understaffed, others would be forced to work additional hours or be pressured to cover the additional shift.

Finally, the rates would be raised and locums would be brought in at short notice and with little knowledge of the department, damaging communication and continuity of care. A London-wide ceiling on rates threatened exacerbating this problem, he said.

He said: ‘We are not getting the staff internally working these shifts, and at the eleventh hour either higher rates are being allowed for external locums or, more commonly, staff are being forced to work beyond their hours.

‘This is yet another area in which greater flexibility, better notice and appropriate rates for internal staff could save money instead of worsening safety issues by putting pressure on an already overstretched workforce.’

Find out more about locum work


Update, August 2018

The BMA has made it clear to our members that they are free to negotiate rates of pay for extra contractual sessions that they feel are reasonable.

They are not obliged to accept the lower, imposed rates and are free to refuse to provide sessions if they feel the payment is not fair.

Equally we underline to members that doctors in a trust who wish to work as employees via a locum bank or for waiting list initiatives may organise themselves, with LNC support, and agree local minimum rates at which they will work.

It is also possible that multiple LNCs in a region could undertake such discussions so that those rates were agreed across trusts.

Read the letter from Jeeves Wijesuriya, chair of the BMA junior doctors committee and Rob Harwood, chair of the BMA consultants committee



Read more from Keith Cooper and follow on Twitter.