Are medical locums becoming the backbone of the NHS?

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In this blog post we will explore the economics behind headlines such as “Locum doctors are being paid up to £4,000 a DAY as NHS trusts 'throw money' at stand-in staff to plug shortages in care” and “Locums raking in up to £363 an hour – NHS watchdog”

At Locum’s Nest, we don’t endorse locum agencies over-charging hospitals for temporary staff; after all, we are helping hospitals to efficiently deploy their own staff. However, to understand the reasons behind some of these headlines, we must understand the environment they are written in.

In our first post we outlined the pressures facing today’s NHS – rising demand, reduced spending, an aging population and more chronic disease requiring more treatment. We know that admissions to hospital have increased by an average on 3.6% year on year since 2003. Extrapolating from that statistic means that if 100 people were admitted to Hospital in 2003, the same hospital would have admitted around 158 people this year.

How does Hospital A treat an additional 58 patients given the time it has to adjust to this increase?

It has a few options.

Firstly, it can become more efficient. It can investigate, diagnose and treat patients more quickly. Fortunately, the advancement of medicine means that tests are faster and more accurate and treatment is, in general, more precise and effective. However, despite these advancements, people need to be registered with the correct date of birth, have their observations taken, have blood tests done, positioned for x-rays and given a cup of tea all by people, not machines. This equates to more person-to-person interactions to get those extra 58 in and out the door healthy.

Secondly, Hospital A could either build Hospital B to provide more beds or it could increase the number of beds it has available to squeeze these extra patients in. This means that their doctors and nurses have to examine, feed, wash and talk to more patients in the same amount of time. (The number of hospital beds has fallen by around 12,000)

Thirdly (the in vogue option), you improve the provision of primary and social care. You allow GPs and practice nurses to intervene earlier in the course of an illness and avoid some of the extra 58 people requiring hospital care. Hospital A partners with Social Services to streamline effective and safe discharge practices allowing people to return home earlier. This translates to more home visits for the frail and more district nurses checking on people after discharge.

What do these three options have to do with locum doctors?

You will note that each option requires either more doctors and nurses or it requires them to do more.

We know the healthcare system has become more efficient. We provide more with the same resources. The Office for Budget Responsibility (OBR) have taken a meticulous look at NHS efficiency in a recent report. They estimate that healthcare becomes 1.2% more efficient each year. This increase in efficiency does not meet demand. So…

Has the supply of doctors increased in line with rising demand?

While this is an unfair and fundamentally difficult question to answer, the number of doctors has not increased inline with our single measure of demand, hospital admissions. The NHS workforce statistics quote an annual increase of 1.6% in the number of doctors working in the NHS. It was concerning this year to note that only 50.4% of Foundation Year 2 doctors progressed into further medical training this year, a severe drop from 71.6% in 2011. A significant number opted to ply their trade abroad or for a career break.

In fact, it is difficult to find accurate and up to date statistics regarding the medical workforce, something noted by the Kings Fund in their report on Workforce planning.  We do not know how many locum or temporary doctors are employed by the NHS on a daily, weekly or yearly basis. However, we do know that the demand for locum doctors has risen and that the cost of these locum doctors has risen.

This graph extracted from the same King's fund report shows how the demand for the number of agency and bank staff hours doubled from 2012 to 2015. The NHS spent around £1 billion on temporary medical staff last year.

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To sum up:

  • There is rising demand for the NHS
  • The NHS becomes more efficient each year
  • The number of doctors has not increased in line with the increase in demand

It is widely accepted that we need more doctors to meet demand. Many of the headlines we began with, refer to locum consultants covering gaps and thus ensuring a save level of care.  Hospitals are forced to employ locum doctors as without them they could not run a safe service and patient care would suffer, an unacceptable conclusion.

Locum’s Nest is working with NHS trusts to reduce their reliance on locum agencies. We aim to improve the supply of doctors from within a hospital’s workforce as much as possible. We believe we can unlock the potential of the hospitals' own staff through efficient matching with a tool that bridges the gap between clinicians and the rota.

 

Nicholas Andreou