Locum Doctors - an area for NHS savings?

Minstadave said:
Basically. You horrible people - you did well at school, got a medschool place, racked up a shedload of debt, trained hard, are in demand and have the cheek to be paid well.
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It does go beyond being paid well though.

Its more of a minor quibble than anything else, but it's only recently that tuition fees have increased massively so 'shed load of debt' to get there... I'm not sure that it's more so than only other student per year for most doctors? Simarly 'did well at school and med school place' - meh. Trained hard, that I will give you - junior doctors and medical students do work blooming hard.
 
I can't seem to edit my posts? Anyway, I'm still not convinced that £1,000 a day is sensible or justifiable for locum GPs - not specialised enough nor a role that couldn't be done by a full time employee. It's particularly objectionable on the basis of squeeze the NHS is facing...

It's a problem with the structure of the NHS clearly. I would oppose a pay cut to my own salary too!
 
Nitefly said:
It does go beyond being paid well though.

Its more of a minor quibble than anything else, but it's only recently that tuition fees have increased massively so 'shed load of debt' to get there... I'm not sure that it's more so than only other student per year for most doctors? Simarly 'did well at school and med school place' - meh. Trained hard, that I will give you - junior doctors and medical students do work blooming hard.
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I had 40k of debt at the end of medschool 9 years ago. When tuition fees were only 3k a year iirc. It's 60-80k according to the BMA currently.

Medical school is 5-6 years. Apart from the vets/dentists everyone else who I started with was off and earning earlier.
 
Minstadave said:
But no one has been moaning about a pay cut. Your issue was locum pay:


I had 40k of debt at the end of medschool 9 years ago. When tuition fees were only 3k a year iirc. It's 60-80k according to the BMA currently.
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Is that anymore than the debt incurred by other aspiring professionals though? Engineers, lawyers, architects?

I just think payment for schooling is a bit of a moot point as everyone does it.
 
Nitefly said:
I can't seem to edit my posts? Anyway, I'm still not convinced that £1,000 a day is sensible or justifiable for locum GPs - not specialised enough nor a role that couldn't be done by a full time employee. It's particularly objectionable on the basis of squeeze the NHS is facing...

It's a problem with the structure of the NHS clearly. I would oppose a pay cut to my own salary too!
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The NHS is only facing a squeeze because the government aren't funding it properly. Compared to other European nations our healthcare spending is low:

https://www.kingsfund.org.uk/blog/2...nding-compare-health-spending-internationally
 
Nitefly said:
Is that anymore than the debt incurred by other aspiring professionals though? Engineers, lawyers, architects?

I just think payment for schooling is a bit of a moot point as everyone does it.
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Lawyers are out earning sooner then docs by a year or two if I remember the last thread about doctors earnings. Engineering is a 3 year course as well iirc.

I've no idea how much an equivalent "locum" lawyer or engineer costs their employer.
 
OOH GPs are required but have to say my cousin's wife does them and she says she spends a lot of her time sitting reading books as there's such a variable need. There isn't really much we can do though - we need the cover, NHS 24 clearly isn't the answer many thought it would be so it's either emergency departments or OOH for many. The question perhaps should be could we merge OOH/ED and look at new ways of working, I've already heard of some EDs having GPs on staff to pick out the clearly "not emergency" patients who rock in with a soar throat.
 
Halfmad said:
OOH GPs are required but have to say my cousin's wife does them and she says she spends a lot of her time sitting reading books as there's such a variable need. There isn't really much we can do though - we need the cover, NHS 24 clearly isn't the answer many thought it would be so it's either emergency departments or OOH for many. The question perhaps should be could we merge OOH/ED and look at new ways of working, I've already heard of some EDs having GPs on staff to pick out the clearly "not emergency" patients who rock in with a soar throat.
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Combined GPs and EDs are the future. There are stupid NHS barriers to this (who pays for what) and problems with physical space.
 
Nitefly said:
That's also a bit of a moot point as it would still be objectionable in principle even if the NHS wasn't under such a squeeze :p

Well, if we all had unlimited money I wouldn't fuss :)
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How do you pay less in a free market? You pay the amount that gets someone to do the job.

I could go to the petrol station and tell them their prices are objectionable, still going to pay up though.

There is a fix for locum pay, it's to train enough doctors and treat them well enough so they don't leave. There's no interest in this though.
 
Minstadave said:
Lawyers are out earning sooner then docs by a year or two if I remember the last thread about doctors earnings. Engineering is a 3 year course as well iirc.

I've no idea how much an equivalent "locum" lawyer or engineer costs their employer.
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lol well I can assure you that if you were a 'well paid lawyer' (solicitor) in the regions your salary would be absolute nothing close to £1,000 a day even if you worked 'all the hours'. Not even in the same league. The only way you would earn anything comparable to that would be if you shared ownership of the business - at which point you would probably be bringing in a huge amount of business. You'd also be looking at 20 odd years to get there. Taking aside the whole 'looking after lives' aspect, that level of senior management responsibility dwarfs stepping in the shoes of a GP that has no management responsibilities.

Locum lawyers would be local counsel. Charge out rates for that can be over £1k an hour but that's a) ultra specialist and b) that is their chamber's rates (it's not take home pay) and pays for support staff etc.... again, not comparible to a 'step-in' GP imo.
 
Nitefly said:
lol well I can assure you that if you were a 'well paid lawyer' (solicitor) in the regions your salary would be absolute nothing close to £1,000 a day even if you worked 'all the hours'. Not even in the same league. The only way you would earn anything comparable to that would be if you shared ownership of the business - at which point you would probably be bringing in a huge amount of business. You'd also be looking at 20 odd years to get there. Taking aside the whole 'looking after lives' aspect, that level of senior management responsibility dwarfs stepping in the shoes of a GP that has no management responsibilities.

Locum lawyers would be local counsel. Charge out rates for that can be over £1k an hour but that's a) ultra specialist and b) that is their chamber's rates (it's not take home pay) and pays for support staff etc.... again, not compatible to a GP imo.
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You need to compare like for like really - a locum doctor works mostly OoH shifts, shifts no one else will do or travels from practice to practice on single day or short term contracts. I don't know if something similar exists for lawyers/engineers.
 
Minstadave said:
You need to compare like for like really - a locum doctor works mostly OoH shifts, shifts no one else will do or travels from practice to practice on single day or short term contracts. I don't know if something similar exists for lawyers/engineers.
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True - you can only compare like for like. Lawyers hours are crap by any standards but they all know what they are getting into... the fools!
 
Nitefly said:
Another genuine question - where do practices get their money from?
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I can't keep up with the constant restructuring of primary care but currently I believe its really complicated.

There's multiple pots of cash:

A practice gets a set amount per patient for certain services - called the global sum.
Then there's a performance based pay pot.
There's extra cash for additional services at both regional and national levels.

Some money comes from NHS England, others are paid by the Clinical Commissioning Groups at a regional level.

GPs then are run as a business, using this cash to oay wages, provide services, invest in facilities etc. I think whatever is left belongs to the partners.

It gets even more complicated as GP practices are forming GP Federations and these federations are replacing Primary Care Trusts to fund hospital services. So GPs are controlling the money for hospitals.

Fortunately I'm a hospital doc - imposed contracts and night shifts until I'm 70 woohoo!
 
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Minstadave said:
I can't keep up with the constant restructuring of primary care but currently I believe its really complicated.

There's multiple pots of cash:

A practice gets a set amount per patient for certain services - called the global sum.
Then there's a performance based pay pot.
There's extras for additional services.

Some money comes from NHS England, others are paid by the Clinical Commissioning Groups at a regional level.
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Thanks for clarifying. So, ultimately, it does come from the NHS and is then disturbuted by the practice, in one way or another. I presume it does vary region to region.

I don't really understand how a doctor can quit their post, due to the practice not being willing to increase their pay, and then rejoin the same practice full time as a locum (I.e the circumstances that I'm personally aware of). It just does not compute, unless the 'unavailability of staff' increases the pot of money available to the practice, or in other words the NHS effectively subsidises locum pay rates.
 
It all must come from Government one way or another. I have to be honest and say I really don't understand it at all. This is just what my wife tells me.

If a GP quits their job (which my wife is soon to do) they leave a short term vacancy which often the person who has quit is now available and best placed to do as a locum (my wife's practice offered this as she handed her notice in) - this happens because GP numbers are low and recruitment in some areas is very difficult. The practice will advertise for a substantive GP but there will be a gap in between that needs filling. Some practices are reliant on locums daily to get the work done.

The extra money doesn't come from Government, and there's no subsidy. It comes out of the practice's account - the practice soak up the hit, either by cost savings or taking it out of what's left for the partners.

Overtime it is a real concern that GPs will all shift to locum work as it is far more flexible. GP partnerships used to be the goal, lifelong jobs with a tidy reward. Overtime however partnerships have become more and more unattractive - money into a practice is being squeezed, costs are rising and GPs are being forced into doing both more clinically and as a business.

In the last 5 years or so I've seen partners selling up and taking up salaried posts (purely clinical, for a set wage) as the drop in wage is small but the drop in responsibility and commitment is huge.

If I was a salaried GP nowadays I'd take up locum work, the flexibility and pay is worth the hassle and larger indemnity as it stands. That will change though as indemnity is sky rocketing currently and Government interference is inevitable.

I'm sure my wife will probably do the odd locum shift. It gives her the freedom to work when she wants and work around childcare.
 
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