Staff shortages leave cash-strapped hospitals reliant on costly cover
OK, so there is so much that needs to be pointed out in this case. Buckle up, because this is going to be a long post. I’m going to take you on a short tour of what the deal is with locum doctor shifts and how the whole thing is often misinterpreted by the media and their dramatic articles, resulting in misunderstandings by the public at large.
Firstly, where did the figure of £155/hr come from? What grade of doctor was this? And what were the circumstances surrounding the appointment? How understaffed was that department? How short notice was the job on offer? These things all matter when it comes to a fair price for a shift you aren’t obligated to do. The money offered depends a lot on which hospital you are at, or how desperate the situation is, but it is hard to accept uncited figures at face value. We know absolutely nothing about where that figure comes from.
I haven’t met (or heard of) people at SHO or even registrar level getting anywhere near that much per hour, nor has anyone mentioned being paid at that level on the junior doctor group. Consultants, possibly. But if you are an experienced and fully trained consultant taking ultimate legal responsibility for many sick patients, at short notice, in a hospital you don’t usually work, around your already busy life, then that what you are paid would (and should) reflect that.
What do locums do?
They take on short-term work. Mostly, this is on a shift-by-shift basis, but occasionally they might need to cover a run of shifts due to employees being on sick leave, or an unfilled slot on the on-call rota.They may sometimes locum in hospitals they’ve worked, but this doesn’t have to be the case. So locums will often be working in a new hospital, where they don’t know where everything is, or how the wards are laid out. This includes things like finding important equipment, knowing where the notes are, and navigating their way around the hospital during their on-call. They won’t know the important bleep/contact numbers of people they will need to contact (though they’ll get a hold of them sharpish from switchboard) They usually don’t know anyone there, so they won’t have the working relationship with other staff that makes working somewhere and getting stuff done a bit easier. They don’t know their local guidelines or procedures, which forms to use, or where all those things are even kept. It’s like the horrible few days at the start of your rotations, except they might go through this almost every shift. This is why it’s riskier to work locum shifts; it’s more stressful and as you don’t know how everything works, it might take longer. It is widely thought to be riskier professionally, too. It is NOT an easy way out.
Do the people complaining actually care about doctors, though?
I’m also sick of people who actually don’t give a hoot about doctors arguing on my behalf. I’m a salaried NHS doctor; the kind you argue that locum pay isn’t fair to. I picked a trust grade job knowing full well I could locum in a severely undersubscribed specialty and earn tens of thousands more than I’m earning now. By all accounts I should be livid that somebody occasionally works the same shift I do for a lot more money.
But I don’t resent locums for earning more. Why? Because I don;t just work in the system, I live in it. I’ve worked severely understaffed shifts. Shifts where we just couldn’t get a locum, sometimes because of the price offered, and sometimes just because it’s hard to get someone to give up precious time at the last minute. I’ve also been begged to put in extra time or change my shifts at very short notice, to cover dangerous staff shortages. I’ve only ever put in extra shifts when begged to by my department; my spare time is precious enough as it is.
It is not the fault of locums that hospitals are understaffed and there is high turnover and poor morale in many places. Medicine and nursing are becoming increasingly leaky pipelines; as pressure increases and the NHS becomes an ever more understaffed, stressful environment to work in, less and less people will want to stay. Putting even more strain on those who remain.
Who are the locum doctors?
Most locum shifts are filled by people already in jobs, a fact quietly acknowledged in the above article (but rather buried amongst all the ignorance). Part time doctors aren’t allowed to do locum shifts, probably because they fear that everyone might go part time if they didn’t make it financially very limiting to do so. This means that quite a few doctors who already have full-time jobs do the odd extra shift, on a day off or during their annual leave. There are some doctors (or nurses) who have left full-time training altogether and just do locum jobs, however even this is not usually a permanent (or even longterm) arrangement. In my experience, it’s often people who are working out what they want to do after FY2, or people who have a few months between one job finishing and another starting. Many of them are doctors who are doing a PhD or Masters or other research (often necessary for senior jobs) , so that they can finance their further studies. The myth of greedy career locums who are purely maximising their earnings by taking on the most expensive short term jobs is certainly overblown; whilst there are probably a small minorityof people out there focusing on earning as much as possible, most people are just trying to remain financially viable or earn a little extra.
What are the government doing about this?
They aren’t dramatically increasing hospital funding. Instead, they are enforcing a cap on locum rates, meaning that they are forcing hospitals to not oay mroe than a certain amount per hour. The aim is to decrease the money spent on locum staff , but the effect of this is complex and may be hurting the system more than it is helping.
The cap affects internal locum rates more than agency rates. Enfocing much payrates means that the majority of locums, people who were going to do an extra shift on top of existing work, will think twice about whether that shift will be worth time away from their family (or their bed). If people no longer want to do these jobs for that pay, then less locum shifts will be filled. After all, there are only a finite number of doctors in the UK. In medicine, it’s well known that some hospitals struggle to fill locum shifts because their pay is not at all competitive. Trying to cut down what we pay people to work extra, last minute is likely going to mean that many of those desperately needed shifts remain unfilled. As things stand, the caps could even be costing hospitals more than uncapped rates. The reason is that hospitals are allowed to lift the cap at very short notice. If a post remains unfilled just before the shift, prices often go up dramatically in a desperate attempt to get someone to agree. By the time someone accepts, this may well be more than they would have agreed to in the pre-cap days. That’s if it’s even accepted. By that point in time, most people have already made plans and are less likely to be able to take on the shifts. So even raising your locum pay significantly may not get you cover if you only do it short notice.
Noboody is obligated to work for a price they find unacceptable.
And yes, people can shop around until they find somewhere wiling to offer the kind of money they would find personally worth it. Nobody has to do locums, so they also get to choose where to do these shifts. I find it funny when people accuse locums of ‘shopping around’; um yeah, naturally. Are YOU suggesting that if someone’s offering their services on the free market, they should deliberately find the lowest paying employer? I explained above how the NHS as an employer sometimes shoots itself in the foot, practically penalising doctors who try to save it money. And of course the current government policy (which practically comes across as a vendetta against NHS workers by now) is evaporating our goodwill and bringing us to the end of our collective tether.
The article acknowledges (barely) that most doctors who locum are already salaried employees who pick up an extra few shifts here and there. And this matters. Because if you are already working full time, and weighing up whether to spend that time with your loved ones or at work, what you are getting paid completely matters.
How could we decrease locum spending?
Perhaps don’t make locum pay and normal staffing two separate pots of money. Right now, trusts can run out of money for permanent staff (and so will refuse to hire more people even when necessary) but can at the same time afford to pay much more to get a locum to cover the same post. Perhaps changing how we organise funding for staffing may make it easier for trusts to invest longterm into
I hear that places like Australia have staff who are purely hired to float between departments and cover absences, sickness, holiday leave etc. NHS trusts, by comparison, sometimes can’t even afford to hire enough doctors in a department to ensure they all get to actually take their mandatory leave. If you don’t book far enough in advance there won’t be enough people covering, and it’ll be no holiday for you, whether you are entitled to it or not. And sometiems, if your departmental staffing is particularly dire, there may not be enough people for all of you to talke all your leave, even holiday leave was dictated to you as fixed leave. Years of cutting spending means that unless staff are working flat-out all the time, it’s often assumed that departments are too well staffed. This is what I mean by taking slack out of the system; but it NEEDS slack, desperately. People fall sick, people go on holiday. If we had enough slack in the system in terms of regular salaried staff (who are much cheaper than locum staff)
The NHS could (and probably should) just pay doctors a bigger cut than locum agencies. Right now, hospitals have two ways of getting locum doctors: through external companies called locum agencies (who take a huge cut), and through their own in-house bank of doctors who are currently (or have been) employed there. Weirdly, hospital ‘in-house bank’ rates for locum shifts are usually much lower than what external locum agencies pay doctors. Which is funny, because locum agencies also get a huge cut, sometimes as much as what the doctor gets, making the overall cost of getting cover through agencies much, much higher. This means that when doctors try to offer locum shifts to hospitals directly, they are usually offered a much smaller amount than if they went through agencies. Even worse, most doctors I know who work with hospitals and agree to be paid less by doing internal cover end up being messed around when it comes to being paid, whereas agencies pay quickly. In all, this means doctors are financially punished by poorly thought out rules and
The NHS could save a lot of money just by cutting out the middle man. Pay doctors what the agencies pay, and most of them would be willing to deal with hospitals directly, cutting out agencies altogether and saving the NHS a fortune. I personally think this would be a lot more straightforward, and probably save more money than the locum cap, whilst also encouraging a relationship between doctors and their employer without unnecessary agencies.
Why can’t we just make lots more places at med school?
It’s really not that simple. It’s both shortsighted and missing the point to argue that we just need to increase medical school places. We could double the number of medical students (remember, though, the government subsidise a part of their training!), however, if working conditions after they graduate remain dire, or become worse, they will still leave medicine. You can let in as many as you like, but you need to keep them in medicine afterwards, otherwise they will go abroad or leave medicine altogether. You could then introduce rather scary rules forcing them to ‘do their time’ in the NHS, but this would probably do two things; discourage people from even applying to medicine, or increase the already high rates of dropout, mental thealth problems, other health problems, and suicide. I emphatically do not believe that making conditions more pressured would do anything to improve morale or keep people in. Being forced to stay in a job you no longer want to do won’t make you an empathetic doctor who loves their job and wants to go the extra mile, but a dispirited one who has run out of goodwill for the system they work in. That’s not the kind of medicine I want, nor do I want my family to be treated by doctors who hate their job, resent their employer and who have given up hope or caring. And yet, that is what my colleagues are increasingly forced into feeling.
Our problem now is that the number of people leaving is increasing, because we are treating them worse. Even the most idealistic of 17 year olds who ignores what is going on in healthcare now will eventually be on the front line of the NHS deaing with the reality; we therefore need to make that reality better.
Working out how many medical students we need is actually a delicate balance; You need to have a proportional number of jobs at every training level for this to work out; flooding the system now won’t produce any FY1s (first year doctors) til 6 years’ time. It won’t produce any registrars til at least 10 years’ time. Will our system need a sudden flood of doctors all at the same seniority level? Probably not! Whilst we could tweak that balance and train a little more than before, it would be silly to suddenly train many thousands more every year. It would also be difficutlt; medical schools only have the resources for a finite number of students! My med school accidentally accepted too many people into my year, so I can tell you that it can be very difficult to accommodate even a few extra students. To train thousands upon thousands more doctors will actually probably require either existing med schools to expand significantly (new buildings, new lecture theatres, new computer labs, new science labs etc) or for entirely new med schools to be built. Not exactly a cheap option.
It would be much easier, faster and probably be cheaper for us if we worked on keeping most of the doctors who we’ve already put effort into training. We’ve had problems before with bottlenecks in training; you end up with highly trained staff being forced out of their speciality by the lack of available jobs at the next point in training, which is a disaster for the country which trained them, as well as for them personally. So
Who do we blame?
If you want to blame anyone, blame whoever keeps underfunding the entire healthcare service, so that each trust has to make cuts. Over those years those cuts have meant less doctors and nurses, dealing with more complicated patients, trying to give a more rapid turnover to deal with bed shortages. It has meant less support for doctors and nurses; with less phlebotomists, pharmacy working shorter hours, less admin staff, etc it means we shoulder more of that burden and making us even busier. Blame whoever forces hospitals to shut more A&Es, so that the remaining ones are overwhelmed. Blame those who allow hospitals to be shut down, or don’t expand services to cope with an ageing population, leading to increasing winter pressures year on year, with hospitals struggling to cope. Blame whoever decided that locum pay comes out of another pot than salaried staff pay, so that the same hospitals who can’t afford any more permanent staff can only afford to hire locums.
Blame a number of factors, but don’t pretend that NHS workers are the cause of all problems facing the NHS.
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The current state of the National Health Service (NHS) means that they are spending more than ever on employing the services of locum doctors.
There is an increasing demand for locum doctors which means that more and more are creating their own limited company to be able to take advantage of the benefits of being self-employed which can be extremely appealing.
Current statistics show that the NHS is spending approximately £83.3million on locum doctors which is just to work in the ‘Accident and Emergency departments’ in 2013 which is an astonishing figure. This shows that there has been a steady increase in the demand for locum doctors services which has grown by 60% in the last few years alone.
How will I benefit from forming a limited company?
There are several key reasons why you should consider setting up your own limited company if you are a locum doctor or thinking about becoming a locum doctor. Here we look at some of the main areas you will find which should hopefully help you to make your decision.
More flexibility around hours of work
One of the most demanding parts of a job in the NHS or as a doctor, in general, are the demands on the individuals in terms of the number of hours you are required to work, especially in the earlier parts of your career as a junior doctor. Setting up your own locum doctor limited company means that you will be far more in control of the hours you work and how much work you are prepared to take on which is incredibly appealing for a majority of people.
Increasing rates of pay
As with most other types of contract work as limited companies, you can benefit from a number of improvements in take-home pay simply by working with a specialist accountancy service who has the right expertise.
According to a recent report in The Telegraph, there was an incredible £2billion spent on locum doctors over a 3 year period, the report also showed that some locum doctors had earned over £2,000 for a days work.
The main reasons for being able to achieve such high rates of pay by setting up your own limited company is because the employer (NHS) does not have to be responsible for offering you an employee benefits package. As with most contract work, you would reduce the demand on the employer due to them not having to pay holiday pay, sick pay, pension contributions and other costs that come with employing a person.
You should remember that demanding £2,000 per day is very much the top end of the scale for a locum doctor. As with any other type of profession or occupation, the amount of pay you will receive will generally be directly related to your experience as well as the geographical location (e.g. Central London will usually be higher pay).
By speaking to a locum doctor, limited company accountancy specialist, such as Gorilla Accounting, you will be able to calculate how much your take-home pay would be for a potential new role as a locum doctor.
Improve your work skills and experience
You will know that as a doctor your career path will depend on the type of work you do, the amount of time you have spent working and which locations or hospitals you work in, which can dramatically improve as you work on different types of contracts.
Setting up your own new limited company as a locum doctor means that you should have a greater choice of where you work and in which areas you decide to specialise which can dramatically improve your personal development. If you are looking to change areas that you specialise in or if you want to improve your chances of being successful at winning higher level contracts, working as a locum doctor can help you to achieve that.
Work opportunity for retired professionals
It is fairly common for doctors careers to be shorter than other professions which is mainly because of the demands that are placed on the individuals, however, that does not mean that you need to retire altogether. Setting up your own locum doctor limited company as a mature and experienced professional means that you can keep on working well into your retirement with the flexibility to work as and when you choose.
Do I need a locum Doctors limited company accountant?
There are several key considerations for someone setting up a new limited company which can include:
- IR35
- VAT charging
- Annual returns
- Expenses
Working with a specialist in this field will generally mean that they are better equipped and have a greater understanding of your needs from other similar clients in the same situation. Working under your own limited company means that you have a number of potential advantages to be had from your accounts which you should ensure that your accountants know how to benefit from for you.
Visit our website and speak to one of our experts at Gorilla Accounting today to find out more about how we can help you with your new locum Doctors limited company and make the most of your business.
Taxation of Locum Doctors - Tips on how best to manage your tax return
Self-employment is becoming a popular option in the UK, with many individuals seeking more control of their career development and flexibility to improve their work-life balance.
However, for the self-employed, completion of Self-Assessment tax returns each year can be a daunting task. This is true for locum doctors working in NHS trusts under umbrella companies or operating as limited companies. Locum doctors operating in this manner experience need to dedicate time to managing the business and financial aspects of their own self-employment, including submission of an annual tax return.
When starting off as a locum doctor, compiling all of the necessary paperwork and government ID references related to your finances can be stressful. Below are some tips to make the process easier:
1. Compile your paperwork effectively
As a self-employed locum doctor, a full record of your accounts needs to be maintained to accurately track your expenses. Bank statements, interest, loans related to the company and any investments over the last tax year also need to be recorded. Filing paperwork, receipts and statements in preparation for your tax return is often a laborious process, therefore, many locum doctors often opt for using an online platform to organise their records and streamline the recording system.
2. Be aware of your deadlines
Taxpayers are assessed on their annual earnings, with the tax year running from 6th April to the following April. However, the deadline for completing a paper tax return is 31st October. If you prefer to file a tax return online, then the deadline is 31st January. With these deadlines in mind, it is worth considering that HMRC may experience busy periods around the deadlines of submission and it does not always cope with the burden. Helplines can also become inundated, should you require advice or help throughout this time.
3. Obtain your access codes
A unique taxpayer reference is required when applying for a tax return. This code is normally provided on correspondence from the HMRC. You will need this code to establish a government gateway account to obtain an activation code (normally distributed in the post).
4. Meticulously record and claim your expenses
All business expenses made through the company need to be accurately accounted for so that at the end of the financial year appropriate deductions from your tax bill can be made. Obvious expenses include travel, accommodation and motor expenses, however, business expenses may also cover subsistence, medical equipment, course fees, office equipment, uniform and professional subscriptions (such as BMA, GMS or MDU). There is some information related to claimable expenses featured on the HMRC website, however, if you seek further clarity it is advised to seek guidance from a registered accountant.
5. Keep records of gift aid donations
Taxpayers who pay higher-rate taxes may also claim tax relief on any gift aid. The amount of tax relief may be estimated using tax calculators available on some online services. Therefore, it is recommended to maintain accurate records of any gift aid donations associated with the business. If you are unsure of the tax relief available you could seek the advice of a contract accountant.
6. Invest in pension contributions and assess tax relief
Operating outside NHS trusts as a locum means you can potentially save tax by putting freelance income through a limited company, however, it means you are not eligible to pension such income through the NHS scheme. However, you can organise your own pension contributions. Tax relief is available on pension savings and higher rate taxpayers should pay considerable attention to this, as they may be able to claim significant tax relief on pension contributions made.
7. Consider if you need an accountant
If you are operating through an umbrella company, you may feel confident in completing your own tax return. On the other hand, if you operate a personal service company or attain income from a range of sources then you may benefit from sourcing a professional accountant to overcome the complexity in sourcing the required paperwork related to these business accounts, as well as calculating tax rates and liaising with HMRC. In general, entrusting an accountant to maintain accurate business records and file the relevant paperwork may prove worthwhile, especially during submission of tax returns once a year as it will save you considerable amounts of time, which you can then dedicate to patients or running your personal service company more efficiently.
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SwasMedical Recruitment Agency is a doctor-owned Recruitment and Consultancy business providing Locum Medical Officers to the Australian healthcare sector. By being Doctor led SwasMedical is able to offer tailor- made services to fellow Doctors, we understand the medical profession and the needs of our fellow Locum Medical Officers therefore, we work hard to negotiate with our clients in the small, medium or large business for the best locum rates and benefits. Our success is primarily due to our dedicated staff, ability, and enthusiasm in providing a consistently efficient and responsive service to both our clients and candidates.
Locum Doctors €“ The solution to the problem of excessive demand
The art of freelancing in the industry has recently been a lot talked with and is one in reference to the most favoured employment avenues for a hive on people. The added perk of being able to experience ever changing job environments through every new appointment is what makes GP locum jobs such objects upon interest.<\p>
And ingress this venture, the health care industry is opening on route to a lot of options all for the aspirants who have the ability to befit in the same level proportionately full dogwatch doctors. Most respecting locum jobs in UK that relate in transit to the health care industry are either short term replacement relative to the brass practitioner jobs or are the MD locum jobs in dental surgery which promise higher returns except that demand moreover work.<\p>
Talking of the GP jobs, the health care industry has very much benefitted with this kind anent openings; seeing that it opens up the possibilities to replace staff on eliminate gold to meet greater demands as and when they arise. Most of the jobs that are offered as LEECH locum opportunities are that speaking of widespread medical practitioners catering for the major mass of accelerate. So coming on on MD locum jobs in surgery, major medical establishments cannot afford to take for granted a full-time employee go on leave for a elongate tenure without any backup; this is where the freelance surgeons come into the play.<\p>
Health care has gained a lot from the concept of shifting employment or as referred as GP locum opportunities above. Maintaining decent staff strength is one on the crucial grammar behind the stabilize functioning in regard to any establishment and the alike applies in health care. Today the concept is widely employed not only in the UK in any case also present-day other territories horseback the oblate spheroid. Having the option of getting a replacement from a staff member helps maintain productivity of the institution without compromising the kind offices it provides<\p>
This is where the freelancers blazon the GP locum doctors come in. Epidemial in one of the most socially respected positions, locum jobs in UK have more or less become a profession in itself. When we talk in connection with GP jobs, the freelancers replacing a full time employee for inescapable interval of time, not only get the idea to be absolutely trained but extra proficient and shrewd in the respective wide berth to tackle the situation at hand with ease.<\p>
Most of the GP jobs that identical would notice would involve individuals who outsmart the experience of working for depthless duration of time in a run of luck of companies. The GP jobs not only offer the chance and opportunity to experience newer workplaces every modish and then but au reste help one stay on off the stress of building swarm up inpouring any organisation for working over a longer period about time.<\p>
Most of the locum jobs in UK are those of undifferentiating practitioner jobs; but for more experienced and up to candidates GP locum jobs in surgery are also seen to become manifest. Being paid the full-time industry standard, the PHYSICIAN IN ORDINARY locum jobs are terran of a kind source of art that enables one to take toward differing places and environments of fallow in a short span of time. However, to illustrate mentioned above, the general practitioner jobs are the most sought after ones; these jobs dictate liberality time input on the facts and are some of the most widely talked close upon MEDICO locum jobs
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Have to He Hire An Comptroller Insomuch as Self Assessment Services?
The whole hour goes by and no one worries about finances or accounts but at the end of a financial year, business enterprises, contractors, locum doctors and all break away concerned just about stratification the taxes. Normally, the time of common year where you have to go at your self assessment, you will pass judgment yourself in a dilemma where you will think that be expedient himself do it on your own or hire some professional for the posting. However, there are many aspects to this which need to exist considered in following to take the regality purpose. A destine of things all included depend on your business.<\p>
A mainly in the main of this calculation process depends on the complexity of business where you are supposed so that grab hold of into consideration the source of income and the outflow as well. In associate scenarios, at all events you are having an account which keeps you busy throughout the year, there are high chances that it will be the most difficult to assess. This is because the calculations would live more and the seal will increase. You will profligate all but a one sunbreak going around things that you just don't understand or i myself don't belong to your profession. This will more stacked create a assignment of loss for herself. <\p>
Entirely pertinent to the above essential be taken into provision account before inoculable a reconciliation because just finalizing on your own is not a wise decision and therefore you must mark hiring an accountant at all costs. They are fast and labor under there claim work. The charges with most of them are not very big and you can easily find an accountant who will suit your budget. All you need to wayzgoose is that just come up with the best service providers in your area and feeling other self to get a quote. After that you can compare the services that she are getting for the cost that you self-restraint be defrayment. <\p>
If you feel right and the self dual pricing services suit your budget, then you can move forward in there with the deal, otherwise there are plenty of options in the sea. Accountants are well worldly in this field and this is the derive that prelacy are considered to be the first-class viable acceptance in preparation for every business workplace. They have complement the relevant experience with them and this accounts for their durability in the industry. Self can do your tax quantification in the best way because they are pool aware with the complexities of every field and keeping themselves updated with all the guidebook related to the taxation issues, they are puzzling to equip the best services. <\p>
You fanny dexterously meet services for all types of professions mimicked contractors, locum doctors, nurses, freelancers, medical houses, hospitals, medical nurses, etc. There are profuse accountancy firms in the UK that are providing freak accountants for all types of vocation profile. They are pretty convenient as far as chisel next to and have the capabilities to manage accounts, financial holdings, book keeping, and she employed charge for return and deploy assistance in moneyed matters. So, calculate the pros and cons of both the aspects and knock under the right outcome for yourself.<\p>
