‘Incentivise’ doctor posts in NW to address £9m-a-year locum bill

The cost of expensive locum cover in the health authority now accounts for almost 17 per cent of medical staffing expenditure - double the Northern Ireland average and the highest locum bill in the province.

A huge £25m has been spent on locums in the Western Trust since 2007/8 and a new report by the Northern Ireland Audit Office (NIAO) suggests the increase can be partly blamed on a tightening of UK border control which has made it harder for medical graduates from outside the EU to work in the country.

‘The use of locum doctors by Northern Ireland Hospitals’ report published earlier this month shows costs spiked upwards from £4.7m to £9m over the past four years.

New immigration rules, introduced in February 2008, have restricted the number of overseas doctors eligible to work in the UK and have been blamed for the costs increase with the NIAO saying the Trust’s reliance on International Medical Graduates (IMGs) has now been partly replaced by a disproportionate use of locum cover.

Londonderry’s Dr Tom Black of the British Medical Association (BMA) told the Sentinel the Executive needs to do more to attract doctors and their families to work in the North West.

He said: “One of the most important things to organise a high quality health service for patients is the recruitment and retention of medical staff.

“It is more difficult to recruit in the west for geographical reasons and we need to ensure the Western Health and Social Care Trust (WHSCT) can incentivise medical posts for a variety of reasons in order to provide a quality service.

“I would urge the Health Minister to look at the issue carefully. It has been a chronic problem in the west and it’s something that can only be addressed through action by the Executive.”

Today the Sentinel reports how the NIAO found the Trust’s locum bill last year was 17 per cent of its total doctors budget. This was up from 11 per cent in 2007/8 whilst the four year average was 13 per cent.

The NIAO report found that on average NI Trusts spent around 8 per cent of total medical staffing expenditure on locum doctors last year.

And in the four years to March 31, 2011, Trusts spent over £100m covering doctor shortages in hospitals.

But the Western Trust accounted for a quarter of this £100m and was well-above the NI average of 8 per cent total doctor costs.

“Within the Western Trust the percentage was more then double this rate (at 17 per cent). If it were possible for all Trusts to maintain locum costs within the regional average this might yield potential savings of £5m each year.

“Local circumstances may make this challenging to achieve but Trusts should be capable of making savings by more effective management of the demand for locums and improving purchasing procedures,” the auditors state.

The report says it would like to see all Trusts minimising the use of locum doctors by deploying a more optimal number and mix of permanent doctors.

It also acknowledges that both the Western and Northern Trusts have faced difficulties in recruiting staff in some specialities and grades.

In recent years the demand for locum doctors has risen due to workforce issues such as increased difficulty in filling vacancies through changes in immigration law and the impact of European legislation governing working hour.

The NIAO believes the changes have increased expenditure on locums in the North West.

“Within the Western Trust, the percentage of locum use has risen steadily over the four years from almost 11 per cent in 2007/8 to nearly 17 per cent in 2010/11 as the Trust becomes more reliant on locums to maintain services.

“The 2010/11 level within the Western Trust (of almost 17 per cent) is the highest of any Trust over the four years examined. The Western Trust had always placed reliance on International Medical Graduates (IMGs) and the recent changes to immigration laws has resulted in this disproportionate use of locum cover,” the report notes.

Over the past four years the Western Trust spent £198.1m on doctors; £172.2m on permanent doctors; and £25.9m in locum costs. Agency locums cost £18.7m and internal locums cost £7.2m. Locums accounted for 13.07 per cent of total doctor costs over the period.

The Trust said it was committed to the safe delivery of health and social care to the community it serves and is committed to recruiting staff on a permanent basis to fill vacancies which arise.

A spokesperson said: “The Audit Office acknowledges that there are challenging local circumstances faced by some Trusts, including the Western Trust. Where the Trust is challenged in filling posts it engages locums to ensure that it can continue to provide safe services.”