The latest story, published earlier this week, said that over 10,000 patients will lose their GP practice over the holiday period, as four practices are set to close. The reason for the closures? The cost of locums.
The story goes that Burton Road, Pottergate, Arboretum and Metheringham surgeries had been managed on a temporary basis by Lincolnshire Community Health Services NHS Trust since previous provider Universal Health Limited went into liquidation this summer. Universal Health said the practices became financially unviable due to recruitment problems, which had left them increasingly dependent on locum doctors.
This isn’t an isolated example and there are probably similar news stories to come, given that one in four GPs work as locums, and provide an estimated 80 million NHS consultations in the UK every year.
There’s no getting away from the fact that locums can be expensive – there has been plenty of media focus on the hourly rates locums are charging. However, despite the fact there are alternative ways to cover absence – check out our blog post here – locums can perform a very vital role. For a Practice Manager the ultimate goal is to procure the highest quality staff in the most cost-effective manner. So how can this be achieved?
There are a number of different strategies practices could utilise to keep locum bills under control. One way is to limit leave, both in terms of length of holiday taken at any one time and the number of GPs who can book holiday at the same time. Holiday timing can also be something to think about.
One practice manager told us: “We were spending a fortune on locums so we looked at ways to tackle the problem. We actually pulled the data together to find out when in the year we were quietest. That was the during the first two weeks of the school summer holidays, a week either side of Easter and, for a reason we couldn’t put our fingers on, the first two weeks of May.
“As a result we encouraged our GPs to take some of their holidays at these times, which worked out well. We’ve shaved 20% off our locum bill and I reckon other practices can do the same by looking at their stats. Seasonal variations in holiday places, for example, could make a difference to demand.”
As another practice manager pointed out, slashing locum costs can benefit GP partners financially, so that can always be used as a carrot to encourage more cover. Elsewhere, other practices are actually using partners as their internal locums.
“We agree a rate that would be paid in addition to normal drawings,” a PM commented. “We steered away from offering time off in lieu because that just reduces capacity and increases problems down the line, but additional pay does appeal and works well, especially if you have a lot of part-time GPs, like we do.”
Of course, like everything money-related, it pays to shop around and negotiate a deal. If you’re hiring for a block of time, why not negotiate the rate? Locums are freelancers so will probably welcome the security in return for a discount. Prompt payment can also be used as a bargaining chip.
Many trusts have negotiated locum rates on behalf of their GP practices, so don’t forget to see if they can help you.
To avoid any nasty bills it could be worth insuring absence through locum insurance, which can help with the expense by protecting your practice against the cost of paying a locum or covering overtime within the practice. With locum costs averaging £250 a session, these costs can quickly mount up.
An interesting point made by a practice manager is that locum costs should be viewed in terms of value and not cost.
“It might be a bit cheeky but we tend to grill locums when we have them to try and get some valuable nuggets of info out of them,” the PM told us. “If they’re spending short periods of time at multiple practices they are often full of ideas. They can also share stories of what other practices are doing wrong. Add in the fact that they keep services running smoothly and therefore prevent those pesky negative views, and locums are a great resource, even if we do have to avoid using them as much as we can!”
That view is shared by Dr Richard Fieldhouse, chairman of the National Association of Sessional GPs (NASGP). “As locums, we are in a completely unique position. Moving from practice to practice, seeing things anew, with our own regularly updated experiences to benchmark our own perception of quality. Not even a top management consultancy company can access the experiences and insights we come across every day.
“What we can do is to give helpful, confidential, supportive, non-judgemental and constructive feedback direct to those practices we work in that enables them to reflect on their practice from the fresh perspective of a respected colleague, who shares their unique access to patients.”
Use them well
Finally, on the value front, try to make the most of locum time. NASGP research suggests that locum GPs spend, on average, 20 minutes every session wasting their precious time, and having to waste other GPs precious time, to locate very simple, basic information about that practice in order to facilitate a certain aspect of a patient’s management. This ‘enforced ignorance’ reduces practice efficiency and effectiveness and risks patient safety.
This is where the support of well-motivated and informed practice managers can make a big difference to the locum GP, just as much as they can help practices. As with most things in general practices, it’s a two-way street!
What are your views on locums? How have you cut the cost? Please comment below or in the forum here.