The price of company medical doctors hit the headlines final week after it emerged that NHS Western Isles spent virtually £1.2 million in a single yr on two locum psychiatrists.
The small print emerged on account of an employment tribunal, nevertheless it hints at a wider – and rising – difficulty.
The case
The issues started for NHS Western Isles when certainly one of its two everlasting marketing consultant psychiatrists retired in 2018. Thereafter, the put up was marketed eight instances with no candidates. The emptiness was crammed as a substitute by a locum.
In September 2020, Denitza Mihaylova was appointed because the islands’ second marketing consultant psychiatrist – filling the Lewis-based place on a everlasting foundation. She and her locum colleague offered 24/7 psychiatric cowl, together with an on-call rota, common visits to Uist, Harris and Barra, and residential visits to sufferers in disaster throughout the area.
In September 2021, Dr Mihaylova was recognized with myelopathy – a spinal situation that causes again and neck ache. A second locum was employed to cowl whereas she was off sick.
By March 2022, she was starting a phased return however an occupational well being specialist had suggested her in opposition to doing in a single day on-call.
In March 2023 (by which level she was once more on sick depart with no certainty that she might ever return to work full-time), the well being board terminated her employment.
Dr Mihaylova sued for unfair dismissal however misplaced her case as a result of the tribunal choose accepted that the well being board has “budgetary duties”.
Arguably, the one actual saving has been Dr Mihaylova’s marketing consultant wage. The well being board spent £1,073,308 on two locum psychiatrists in 2022/23 (together with the one overlaying for Dr Mihaylova) and is projected to spend £1,179,076 on two locum psychiatrists in 2023/24, the yr since her dismissal. This consists of the medical doctors’ salaries in addition to the hefty charges paid to medical businesses.
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The context
Throughout NHS Scotland, spending on medical and dental company workers has elevated 77%, from £67.4 million in 2013/14 to £119.6m within the yr to March 2023.
Psychiatry accounts for a major proportion: 20% of marketing consultant psychiatrist posts are crammed by locums.
The true scale of the shortfall isn’t all the time clear, nonetheless. Official statistics don’t rely posts as “vacant” if a locum is in place. Earlier analysis by BMA Scotland, in 2022, discovered that – after they have been – the marketing consultant emptiness price doubled from 6.2% to 14.3%.
Freedom of data information handed to The Herald by psychological well being campaigner Peter Todd additionally reveals that NHS spending on all locum psychiatrists (not solely consultant-level) has gone up by 29% from slightly below £21m in 2019/20 to greater than £27m in 2023/24.
The true value will probably be larger, nonetheless, as a number of well being boards solely offered information for the primary 9 or 10 months of final yr.
The answer?
Over-reliance on locums is an costly downside for the NHS, however the implications transcend cash.
It might probably imply an absence of continuity of take care of sufferers, which is related to poorer outcomes. Non permanent medics are additionally much less prone to be invested in bettering native providers, and – in contrast to everlasting consultants – can’t present coaching to junior medical doctors.
Locums will all the time be wanted to cowl sick depart, however the very best repair is retention and that’s largely all the way down to the office tradition.
It might imply extra flexibility round job plans to influence senior clinicians to remain on as a substitute of retiring early.
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All too typically, nonetheless, points reminiscent of bullying or victimisation of whistleblowers have led to skilled medical doctors quitting one after the opposite from the identical division or hospital, resulting in providers that are disproportionately depending on locums.
The Herald’s current Well being Summit additionally heard recommendations for a “weighting” mannequin that would provide medical doctors considerably larger salaries in the event that they relocated to areas such because the Highlands and islands the place shortages are most acute.
There aren’t any straightforward solutions however the present scenario isn’t a financially sustainable one.
