The usual solution to staff shortages is expensive locum agency doctors, but NES Healthcare proposes another idea that both lowers cost and provides continuity of care
As of March 2024, there were 8,796 vacant medical posts in the UK, accounting for 5.7 per cent of all medical roles. This vacancy rate creates a cycle of chronic stress, increasing pressure on existing staff, which in turn encourages higher turnover and absence rates.
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Traditionally, the solution to gaps in NHS rotas has been the use of agency locum doctors, which helps in the short term. There is certainly no shortage of locum doctors available, with studies suggesting that more than one in five doctors in the UK are working as a locum at present.
According to the BMJ, NHS trusts spend up to 25 times more on locums than on permanent recruitment, with the bill for bank and agency staff in England in 2019-20 coming to £6bn (Pemberton, 2023).
Lurid examples of eye-watering sums being spent on single locum shifts are easy to find. Leaving these aside, though, the problem remains one of supply and demand. If the demand is high, then the supplier (the locum doctor or the locum agency) can force up the rates almost without limit. With staffing levels as they are, demand is likely to remain high for some time to come.
Locum doctors can be highly experienced, but a model that parachutes an individual into a complex clinical environment and expects them to operate effectively from the outset is flawed. Patient safety is undermined by the lack of continuity of care a locum model engenders.
While regular initiatives attempt to tackle the amount being spent on agency doctors, the practice is so entrenched that this is still seen as the sole option. Whole staffing frameworks are built purely around locum provision to reinforce the message that this is the only way, but is it?
Not necessarily.
A third way does exist, which provides continuity of care at fixed rates significantly lower than those charged by locum agencies.
Managed staffing models operate on a longer-term basis, meaning that gaps are filled not just for the next day or night but for up to 12 months thereafter and usually with the same small team of doctors. This has an obvious benefit for quality of care, patient safety, and improved outcomes.
The cost of such a service is contractually fixed at a rate agreed upon by all parties in advance, meaning it cannot be elevated at times of high demand. This resets the balance of power between the trust and the supplier, enabling the trust to work within set budgets.
One such managed staffing contract, operated by NES Healthcare at a trust in the south of England, was independently audited by one of the Big Four accounting firms. Their conclusion was that the service closely mirrored the costs of the trust employing its own doctors. This trust has, therefore, saved millions of pounds in agency costs over the past few years.
To engage with a service that takes care of the resourcing, employment, administration, cover, and replacement of doctors and improves patient safety yet costs far less than locums seems to make obvious sense. So why are more trusts not looking at this? That might just be down to the need for a change in culture within the NHS.
“We must encourage a cultural change to staffing models in the NHS and demonstrate the benefits for patients, the benefits for the NHS and the benefits for the country as a whole.” – Peter Sheppard, managing director, NES Healthcare
