Achi news desk-
The cost of agency doctors hit the headlines last week after it emerged that the Western Isles NHS spent almost £1.2 million in one year on two locum psychiatrists.
The details emerged as a result of an employment tribunal, but suggest a wider – and growing – issue.
The case
The problems for the Western Isles NHS began when one of its two permanent consultant psychiatrists retired in 2018. The post was subsequently advertised eight times with no applicants. The vacancy was instead filled by a locum.
In September 2020, Denitza Mihaylova was appointed as the islands’ second consultant psychiatrist – filling Lewis’ position permanently. She and her locum colleague provided a 24/7 psychiatric service, including an on-call rota, regular visits to Uist, Harris and Barra, and home visits to patients in crisis across the region.
In September 2021, Dr Mihaylova was diagnosed with myelopathy – a spinal condition that causes back and neck pain. A second locum was hired to cover while he was away sick.
By March 2022, she was gradually starting to return but an occupational health specialist had advised her not to be on call overnight.
In March 2023 (by which time she was on sick leave again with no guarantee that she could ever return to full-time work), her employment was terminated by the health board.
Dr Mihaylova sued for unfair dismissal but lost her case because the tribunal judge accepted that the health board had “budgetary responsibilities”.
Arguably the only real saving has been Dr Mihaylova’s consultant salary. The health board spent £1,073,308 on two locum psychiatrists in 2022/23 (including the one for Dr Mihaylova) and is forecast to spend £1,179,076 on two locum psychiatrists in 2023/24, the year since she was made redundant. This includes the salaries of the doctors as well as the large fees paid to medical agencies.
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The context
Across NHS Scotland, spending on medical and dental agency staff has increased by 77%, from £67.4 million in 2013/14 to £119.6m in the year to March 2023.
Psychiatry accounts for a significant percentage: 20% of consultant psychiatrist posts are filled by locum.
The true scale of the deficit is not always clear, however. Official statistics do not count jobs as “vacant” if there is a locum in place. Previous research by BMA Scotland found that in 2022, when they were – the consultant job rate had doubled from 6.2% to 14.3%.
Freedom of information data handed to the Herald by mental health campaigner Peter Todd also shows that NHS spending on all locum psychiatrists (not just at consultant level) rose by 29% from just under £21m in 2019/20 to more than £27m in 2023/24.
The actual cost will be higher, however, as several health boards only provided data for the first nine or 10 months of last year.
The answer?
Over-reliance on locum doctors is an expensive problem for the NHS, but the implications go beyond money.
It can mean a lack of continuity of care for patients, which is associated with worse outcomes. Temporary doctors are also less likely to be invested in improving local services, and – unlike permanent consultants – cannot provide training for junior doctors.
There will always be a need for a locum to cover a period of sickness, but the best solution is to keep staff and that is mainly due to the culture of the workplace.
It could mean more flexibility in terms of job plans to persuade senior clinicians to stay on instead of retiring early.
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All too often, however, issues such as bullying or victimization of whistleblowers have resulted in experienced doctors leaving one after another from the same department or hospital, resulting in services that are disproportionately dependent on locum doctors.
The Herald’s recent Health Summit also heard suggestions for a “weighting” model that could offer doctors significantly higher salaries if they relocated to areas such as the Highlands and islands where shortages are most severe.
There are no easy solutions but the current situation is not financially sustainable.
