Buying of Medical Locums is a Mess – Advice From Comensura

Of all the procurement categories across the entire UK Public Sector, which one is the biggest train wreck? (I’m talking colloquially, I don’t mean West Coast Rail franchising). We could make a strong case for it being procurement of medical locums – in other words, temporary staffing around nurses, doctors, surgeons and other medical staff.

Hardly a day goes by without another article hitting the press, with a horror story in the Sunday Times this week about a "3,600 shift for a locum surgeon". and a Trust paying £2,00 for s ingle shift from a nurse. Certainly the rates have gone up and up and this has been a major cause of the overall financial problems hitting the NHS and its Trusts. The NHS is now spending some £3 billion a year according to some estimates on temporary medical staff.

Now we know that some Trusts and some procurement departments are working hard in this area, but overall the picture is not good. So some commentary from Jon Milton, a Director at Comensura, issued last week might be timely, and his advice strikes us as very sensible.

Comensura are a vendor neutral managed service provider in the contingent labour market, so they have less “skin in the game” than the agencies who actually provide the staff and of course take their margin on top of the doctors’ fees. That structure in itself means that agencies are incentivised to maximise the hourly or daily rate that their temps charge – as they make a percentage on top.

Comensura tend to be remunerated differently so should work with the interests of their client at heart. (Indeed, in some local authorities they have helped drive down the overall spend on contingent labour very significantly). This is what Milton has to say.

“Panic buying of temporary doctors/medical locums, who have been paid up to £3,285 per shift in recent months, can and must stop ... It’s no surprise that Trusts pay over the odds for locums considering that staff shortages could close wards or put patient safety, quality of care, performance and reputation at risk. But because demand exceeds supply they are left feeling like they have no other choice but to pay extortionate fees, when in reality, they don’t have to pay over the odds.”

As Milton says, Trusts run the risk of acting like panic buyers – scrambling to get whatever is on the shelf, never mind the price or whether they actually need it or not. And some recruitment agencies are very good at exploiting this position, which only perpetuates the problem. Milton’s first point seems to be the most fundamental.

“Plan rather than react to your needs”. Trusts need to better understand what locum staff are bought, why they did so, at what cost and with which agency. These are the things they should be able to answer quickly in order to understand what locums they actually need, over what they think they need.

Milton is right - the scale of this problem means that planning must be given priority here. An opportunity for procurement, HR staff and clinicians to get their heads together? His other points in headline are;

Work with, not against, neighbouring hospitals - hospitals naturally feel that they must compete with neighbouring trusts for locums. But by talking to one another about the problem they can start to work together and dictate terms to the market.

Locum agencies do need your business - it may be a seller’s market but at the end of the day locum staffing agencies need to do business with the NHS and are also competing for candidates themselves. Don’t be pressured; take a step back and look at how you work with these recruiters and how you can help them to compete too.

Give clinical directorates and frontline staff greater support - Clinical directorates need to be given greater accountability of, and responsibility for, their locum requirements. Plus, the people that organise hospital staff rotas need greater support to improve rota co-ordination and buy on a more planned basis.

Work out what you’re willing to pay and on what terms - By stepping back from the edge, understanding your needs, talking to others and reviewing how you work with recruitment agencies, hospitals can take the lead and dictate what terms and pay scales are acceptable to them, creating a stronger basis for negotiation. If the NHS was able to do this on a larger scale it would be in control of the market, rather than letting the market take control.


Of course, Comensura has some interest in this market, and recently won their first contract in this sector with the Harrogate and District Trust, but it does strike us that the NHS needs some help here from people who understand this industry. And unfortunately there is not much evidence that there is a lot of that knowledge within the NHS (or within Crown Commercial Service, whose medical agency framework is flawed too according to industry experts).

But for everyone’s sake, we have got to get to grips with this spend category.

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Voices (4)

  1. Secret Squirrel:

    Must resist CCS comments………must resist CCS commments…….

    Nope. I can’t.

    58 SCS 181 Grade 6s and 7s, 762 staff, 54 acknowledged interims, who knows how many consultants.

    With all that, what do you get for NHS multidisciplinary staffing framework in terms of rigour and commerciality? A four question tender, a pricing structure which sets the bar very low and any provider who scores OK gets in. Well done, chaps. Real commercial value delivered there.

  2. Bill Atthetill:

    Completely agree Peter that something needs to be done. I also agree with Sam (above) but feel that a focus solely upon agency as opposed to ‘workforce’ is flawed. There is hope that Patrick Carter’s programme will help in many ways through new, soon to be published ‘efficiency metrics’. But these will only seek to highlight gaps in trusts’ performance (as comparators) – not provide the solutions to fill them. I recall the DH announcing a ‘national category management’ approach (though I had to read up on this to understand what it was) and ‘agency’ was to be one of the first spend categories to be addressed (Dr Dan Poulter’s request I’m told). Nothing, absolutely nothing. Have they fallen asleep at the wheel?

    The point you make about the Crown Commercial Service is spot on – they need to focus on common products and services (and get those right) before attempting anything remotely clinical. The CCS is a very expensive experiment of Bill Crothers that has fundamentally failed. And now they’re shedding people while employing numerous interims and consultants.

  3. Sam Unkim:

    We really don’t need “help here from people who understand this industry”. We need politicians ( who don’t) to butt out

    It’s the classic supply vs demand model at work here. Training places have been dramatically reduced and pay rates have been static for years. Many nurses can now earn a “weeks” pay working two or three days for an agency further reducing the available pool of labour.
    Of course If Trust’s would pay their substantive staff decent overtime rates “on the bank” much of this crisis would have been averted.

    Also with 1 in 4 new nurses being dragged in from abroad, how long can the NHS carry on acting like a modern day “East India Company” asset stripping third world nations of sorely needed clinical staff.

  4. Nick @ Market Dojo:

    My wife does locum shifts as a paediatric registrar on the odd occasion. It’s normally driven by her hospital (or one nearby) having a critical staff shortage – perhaps due to budget cuts – where the other registrars are off sick and they need to draft someone in ASAP to fill a gap. Unlike many other professions, having a staff shortage really is life-threatening, so it’s no surprise that the locum rates are so high in some cases, especially for a highly skilled surgeon for example. Many other ‘consultants’ earn the same day rate for doing things like running a reverse auction or doing some data crunching. My wife earns £400 a day for her locum work though be nice if she did take home some of the figures quoted above!

    I’ll ask her more about this when I get home, sounds like an interesting area to know more about.

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