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Locum costs rocket since European working hours cut

EWTR regulations have led to vast increase in spend on locums

Louise Prime

Wednesday, 10 November 2010

Introduction of the European Working Time Regulations (EWTR) has led to a rocketing of spending on locum and temporary doctors, with an increase of over £200m just over the past year, says the Royal College of Surgeons of England (RCS).

The College used the Freedom of Information Act to ask 165 NHS Trusts about their spending on locum doctors since 2007; 118 Trusts responded, 96 of them fully. The RCS analysed these 96 responses to look for any change since the EWTR restricted trainees’ work to an average of 48 hours a week in August 2009.

It found that the cost of hiring locum or temporary doctors in NHS hospitals in England has “rocketed to more than £¾ billion a year”. It says that over the past year alone, annual spending on all hospital locum doctors has risen by almost £200 million – and has almost doubled since 2007. For surgical locums, the spending is almost £¼ billion per year.

The College blames the “staggering increases” on hospitals struggling to plug the gaps in staffing rotas created since the EWTR was introduced. It estimates that, since introducing the 48 hour working limits in UK hospitals, the NHS loses more than 400,000 hours of surgical time a month while still managing the same workload. 

The College says that units that provide 24-hour acute care are the worst hit by the EWTR, and about half of surgeons end up covering gaps in their own hospitals – so they end up exceeding the 48-hour limit themselves.

It says the NHS is forced by staff shortages to use locum doctors from all over the world on highly paid short-term contracts: spending on external agencies has increased to almost £½ billion in 2009/10. The RCS is also concerned about the impact on patient care in hospitals using doctors with no prior knowledge of the hospital, the patients or their colleagues.

The survey revealed:

  • Overall spend for all locum doctors:
    • 2007/8             £384,367,109
    • 2008/9             £548,663,681
    • 2009/10           £758,363,084
  • Spend on locum doctors covering surgical positions:
    • 2007/8             £119,015,980
    • 2008/9             £172,756,748
    • 2009/10           £232,025,351
  • Internal locums (employed staff taking extra shifts):
    • 2007/8             £206,165,975
    • 2008/9             £273,399,522
    • 2009/10           £310,875,152
  • Staff brought in from external agencies:
    • 2007/8             £173,758,168
    • 2008/9             £280,101,157
    • 2009/10           £467,284,294

John Black, president of The Royal College of Surgeons, said: “It seems ridiculous that at a time of economic crisis, with wide-ranging cuts to services across the board, we are seeing astronomical sums of money being thrown at locum doctors in order to prop up services that are only falling apart because of an ill-conceived European law.

“Unless hours for doctors working in 24-hour acute care medicine are relaxed to a sensible level, the pool of good, safe doctors will dry up and we will see more units close. The coalition Government has promised to deal with the issue, but the question is when?”

In August, following the RCS’s survey on the effect of the EWTR, he had argued: “Any idea that the EWTR could be accommodated by the professionalism of surgeons and others working in the NHS is wrong.

“The stark truth is that the NHS, like every other healthcare system in the world, just cannot work with these artificial hours restrictions, designed for a totally different group of workers.”

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