Intended for healthcare professionals


Trusts are urged to cut spending on locums

BMJ 2012; 345 doi: (Published 05 September 2012) Cite this as: BMJ 2012;345:e5977
  1. Caroline White
  1. 1BMJ
  1. cwhite{at}

The disconnection between workforce strategy and business planning in NHS trusts is one of the main reasons for the spiralling costs of locum doctors, concludes a report from NHS Professionals, which was set up by the Department of Health to provide flexible staffing to the NHS.

The report says that trusts should undertake a full strategic and operational review of their management of locums to meet their quality, innovation, productivity and prevention (QUIPP) targets, which require spending on temporary staff to be brought down to 2008-9 levels through efficiency savings of around £500m.1

But the report, which was based on a recent round table discussion convened by NHS Professionals and chaired by the chief executive of the King’s Fund, Chris Ham, concludes that trusts are only “addressing the part of the problem that is readily visible, while nine tenths of the demand and expenditure ‘iceberg’ remains concealed from view.”

Although trusts have managed to rein in their spend on agency nurses, the spend on locum doctors “remains stubbornly high,” it adds.

The report says that trusts are not powerless to cut spending on locum doctors, as many claim, on the grounds that agency costs have been rising. But they need to base their workforce planning on service demand rather than their current workforce profile and integrate this with their business plans.

Meeting participants said that weaknesses in management of locums mean that trusts have to resort to “off-framework” agencies—those that have not signed up to the national framework agreement for the supply of medical locums, which includes a transparent contract pricing mechanism to allow NHS trusts to control costs. Use of such agencies puts patient safety and care at risk, they said. The failure of deaneries to communicate properly about the availability of trainees was also cited as an obstacle to effective workforce planning. Many of the meeting’s delegates, who included senior managers and clinicians, complained of gaps left in junior doctor rotas obliging trusts to make costly locum placements to meet staffing levels.

Stephen Dangerfield, chief executive of NHS Professionals, said that many trusts would struggle to meet their QIPP targets if they continued to focus on the peripheral reasons for high spending on locums.

“In the context of NHS reforms, it’s absolutely essential that the usage of locums has a clear purpose within a trust [and] is managed in a planned and systemic way and that the trust builds positive and productive relationships with locums, agencies, deaneries, and other trusts to get the best results from this valuable workforce,” he said.


Cite this as: BMJ 2012;345:e5977


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