By Dr Surina Chibber

(@Dr_Surina)

This week NHS England released information about the new GP contract. In this, NHS England propose setting a ‘maximum indicative’ locum pay rate. Practices will need to record the number of instances where a practice pays a locum doctor more than the maximum rate. According to the NHS Employer statement this new rate is not a maximum rate above which locums or agencies can charge but it will represent an amount above which practices need to submit a record to NHS England. This will mean that, for the first time ever GP Practices will now have to report their locum spend to NHS England. NHS England have introduced this scheme against the wishes of GP leaders. 

MyLocumManager contacted NHS England and asked them why they were introducing this cap, what did they want the data for and also how they would determine the maximum rate? We also asked if they would be taking into account the huge indemnity fees that locum GPs are currently having to shoulder. A spokesman for NHS England responded with “Practice reporting of the maximum indicative pay rate is to get a handle on what is actually going on in practices and gauge the scale of this. We want to get an idea of the amounts being spent on locum shifts and what is being paid. At the moment we don’t have much data to hand so this will help. The maximum rate is being worked out over the coming weeks”. 

When specifically asked if locum indemnity costs would be taken into account the NHS England spokesman told MyLocumManager “these details will be worked out in the coming weeks”.

Many locum doctors have voiced their concerns about this proposal. Since the new contract was announced there has been growing discontent in the locum community. Many Locum GPs feel that NHS England are operating a ‘Big Brother’ type mentality. Others argue that the fact that this policy is being implemented, despite the concerns of the GPC is no worse than the contract imposition faced by junior doctors. GP partners pay for locums out of their own pocket and so many feel that NHS England have no right or authority to demand this information. One locum GP from London stated “information is power, NHS England currently hold little power over locums, by gaining data over pay rates and setting a maximum rate, their next step will be to exert control over locums by controlling pay rates”

We contacted the BMA directly for their opinion on NHS England’s controversial plan. A BMA spokesperson told MyLocumManager:

"The BMA will be examining closely NHS England's proposals for maximum indicative rates for locums which were announced last week.  There are currently no details as to how this will be practically implemented. Even if this scheme is implemented there will be no actual or contractual cap on the amount practices can spend on locums nor what locums can charge for the work that they do. Further we have concerns of lack of comparability  of rates since different Locums provide different services for practices within their arrangements.

"The BMA has made it clear to NHS England that their scheme must not be perceived in a manner that disadvantages the capacity of GP practices to recruit locums when needed, particularly at a time when practices are struggling to manage their workload and many are unable to recruit new GPs when others leave or retire from the practice. Locum GPs are an essential part of the GP workforce and do valuable work for general practice often in challenging environments and we should not ignore their important contribution to patient care."

There is a lot of uncertainty about how this maximum rate will be determined and what this rate will be. Events will be unfolding over the next few weeks.One thing however, remains clear, the strain on general practice is ever increasing yet there remains little in the way of sustainable solutions. Locum GPs have been an essential resource for practices and if they are next on the governments ‘hit list’ where does general practice go from here?