The Locum Price Cap is Coming!

Posted on November 10th 2015 by What The Bleep

With the government's plan to cap rates on locum shifts for doctors from the 23rd November 2015, and reducing further the capped rate on two future dates (1st February 2016 and again on 1st April 2016) the prospect of doing locum shifts is becoming less appealing. With the junior doctor contract dominating our attention the government are implementing the locum agency price cap, keeping this under the radar and knowing we can't fight this publicly with the junior doctor contract as it will be hard to gain public support for our fight against this. So we thought it was important for us to make this page to keep you updated with advice on how to fight the locum price cap.
The first thing we all need to do is to register our views and response to the proposals using the government's response form here. Urgent this must be done by the closing date of 5pm 13th November.

It is important to stay together against the cap from the start as otherwise it will gradually drain the NHS of good locums and cripple the NHS. Now some doctors may think that this doesn't concern them as they don't do external locum shifts, and you would be wrong. This will impact everyone, it will affect those who do external locum shifts, those who do locum shifts within your own hospital, and by draining the NHS of locums it will affect doctors on-call who are understaffed when Medical Staffing are unable to find a locum doctor willing to work for peanuts at short notice, and it will also affect doctors during the day when Medical Staffing personnel try rearranging and stretching their own doctors to cover shortages across the rota that they can't fill with locum doctors.

WHAT WILL HAPPEN?

Most trusts have an 'internal'/'bank' locum rate which they offer to their own doctors, and if they fail to fill the shift they will offer it out to locum agencies to fill with an 'external'/'agency' locum. Now unfortunately the difference in pay between internal and external locum can be massive and initially for the first capped rate on 23rd November will most likely affect the external locums worst, bridging the gap between external and internal locum rates, however the further reductions in the capped rate will then affect all doctors.

Below is the new proposed locum pay rate table published by the government's Trust Development Authority.

WHAT WE NEED TO DO

1. AGREE A RATE WITH YOUR HOSPITAL

From the 22nd November if Medical Staffing in your hospital try and alter your rates for internal locum shifts we advise discussing with your colleagues in your hospital and formally agree a rate with Medical Staffing that is reasonable (negotiations should be led by your year rep). For internal rates FY1s should not be getting less than £30-35 per hour, SHOs £35-40 per hour, and Registrars £45-50 per hour (more for A&E), so this may not affect those just doing internal locuming in November, but if you agree this rate in November then Medical Staffing will be the ones facing the problem when the government drops the rate again on the 1st February 2016. If Medical Staffing drop the rate in February then stick to your guns and don't take the shifts, you are stronger united.

Now with the new capped rates we are unsure how the Medical Staffing will react but at the end of the day if the internal doctors don't take the internal locum for less than their agreed rate then Medical Staffing will have to try and fill the gaps in the rotas with external doctors which will be harder for them to get.

2. DON'T GET BULLIED INTO DOING EXTRA SHIFTS

Please be warned with the government's plan it will become harder for Medical Staffing personnel to fill locum shifts and we expect that they may start to take advantage of doctors (especially FY1s) so don't be bullied into doing an extra shift you don't want to do, or into taking a shift for a rate that you don't want. You are not obliged to do additional hours. If you do feel bullied into covering extra shifts then please call BMA for advice. 0300 123 1233.

3. SUBMIT INCIDENT FORMS

If you are understaffed and a locum doctor is not supplied as a result of the locum price cap, submit an incident form as a risk for patient safety, and continually bring it up in junior doctor/departmental forums. For patient safety issues you must also inform the Clinical Director each time this happens. 

4. TAKE YOUR NAME OFF THE INTERNAL REGISTER

If Medical Staffing personnel are not negotiating on the rate then stand your ground and ask to them to take your name/details off their 'internal locum' register. This is a register of doctors in the hospital who have opted out of the European Working Directive and who get emailed about internal locum jobs. This leaves a clear message that you are not interested in the locum shifts for the rates they are offering.

5. JOIN A LOCUM AGENCY

If you do still want to do locum jobs at your hospital then ask to be taken of the hospital internal locum register and join a locum agency (pick one which supplies to your hospital). It is unclear how badly the price cap will impact locum agencies but we would advise joining one, because their interests align with ours they will be an additional defence against the capped rates. Though you may have to take care that some locum agencies don't just follow the government's cap giving you low rates. Let them know early on what set rate you are only willing to take jobs for, then the locum agencies will be forced to fight against the cap to find doctors jobs for these rates otherwise the agency will be out of business. They also have more money, personnel and resources to fight against the price cap.

Registering requires an application form and a CRB, however once done you are sorted and you will get access to the same jobs at your hospital but potentially at a better rate!
It is also worth being aware that if you are in a training post, your contract says you should not take locum work for another employer. This doesn't stop you from working as an external locum through a locum agency in your own hospital.

Junior Doctor Contract - Longer Hours, Less Pay, Patients Suffer #NotSafeNotFair

Posted on November 1st 2015 by Taha Nasser on the The Utopia.

What are the DDRB recommendations in question?

Recommendations 3, 4, 5, 6, 7, 8, 17, 18 increase routine working hours from 7am – 7pm Mon – Fri to 7am – 10pm Mon – Sat. This increases ‘standard rate’ working hours from 60 – 90 hours per week, an increase of 30 hours.

What would be the effects of this?

It would mean that ‘standard rotas’ and standard days can be much longer. Currently, having to pay us more than basic rate for that extra 30 hours a week with a banding system means that there is a financial incentive for rota co-ordinators to not rota us on for even longer hours back to back and to make sure that our rotas aren’t purely shift work.

If we did move to a system that resembles shift work, for which there would now be no financial penalty, it would cause:

• Greater social strains on doctors since it’s likely they would be working evening, weekend and night shifts even more routinely.
• Greater fatigue and potential damage to patients due to mistakes
• Less interaction with our consultants and thus end up less well trained by the time we become consultants

How do we know that we will work hours for less pay?

(Dr Steven Bishop models effects of DDRB proposals on doctors’ pay)

Broadly speaking, the changes to the contract are likely to cause an overall pay cut in the vast majority of specialties. This was modelled by Dr Steven Bishop, an Academic Clinical Fellow in Anaesthesia and a Specialty Registrar from the Cambridge University Hospitals Trust. His model, based upon the pay scenarios proposed by the DDRB showed that the majority of specialties including general medicine, surgery, psychiatry, A&E, Obstetrics & Gynaecology and Anaesthetics suffered sizeable pay reductions throughout their training period, with Anaesthetic trainees being especially badly hit.  The exact pay cut varies depending on what the DDRB sets as their basic pay rate for non out of hours work, but at it’s most severe it may lead to a pay cut between 10 and 30% depending on the specialty. The changes in pay structure would also mean that doctors would end up in a higher bracket of pension contributions earlier but since their overall pay would be cut, they would actually get a lower pension return when they retire. The DDRB also recommends a cut down on current annual leave, which is tantamount to an even greater pay cut.

What has been the Department of Health’s Response?

It’s worth analysing Jeremy Hunt & the department of Health’s responses to the realities that I’ve outlined so far.

(The BMA explains why the new contract proposals are unacceptable)

In September, the BMA walked out of negotiations after the department of health had made 22 of the 23 points on the DDRB proposal ‘non negotiable’ before the negotiations had even concluded. The department of health then released a statement claiming that it was the BMA that was at fault and that the new contract ‘increases basic pay’ and ‘rewards those who work across all clinical specialties’. In reality whilst basic pay may increase marginally, for many overall take home pay will decrease significantly. By only mentioning part of the picture whilst not explaining what the overall effect would be, the department of health has purposefully tried to mislead us and the public on the issue. And as for the second part of the department of health response, that the new contract ‘rewards those who work across all clinical specialties’ – that simply isn’t true. Many general medical and surgical specialties as well as GPs will suffer pay cuts.

(Parliament debates the Junior Doctors’ Contracts from 16:15 onwards)

This past week Jeremy Hunt was involved in the commons debate where he attempted to claim that no junior doctor would suffer a pay cut. Unless the sample pay schemes that we have been shown are going to be totally revised, this simply cannot be true. As Dr Steven Bishop’s analysis shows, every pay scheme proposed by the department of health creates a pay cut to multiple specialties. Bearing in mind that that this is the same department of health that misrepresented research about deaths on the weekends then used those false conclusions to make an attack on consultants who already work weekends, and then purposefully attempted to mislead the public into believing that we were actually getting a pay rise by only mentioning our basic pay it’s little wonder that we’re forced to conclude that Jeremy Hunt is lying when he says that no doctor will suffer a pay cut, likely in a crude attempt to divide our ranks the week before we are set to vote on a strike. It is  therefore absolutely vital that we see through this tactic and continue onwards united behind the BMA.

Two things to do:

1. Make sure that you vote yes and yes to both types of strike in the forthcoming BMA ballot. The wording of these strikes may not be exactly what you want, but they are worded in accordance with legislation that means that the BMA then has the freedom to go forward with a complete strike if needed.

2. Make sure that you find out who your local MP is (Find your MP) and write to them, making it absolutely clear why you are opposed to the contract and if they’re conservative, make it clear that allowing these contracts to go through will cost them your vote.

See Taha Nasser's blog on the The Utopia.