HCL 240,000 temporary doctor pay caps broken in three months
English hospitals are regularly relying on emergency "break glass" rules to meet pay demands from locum doctors, according to an investigation by Sky News. On 241,195 occasions in three months, hospitals notified the NHS that they had breached an hourly capped pay rate. At Great Ormond Street Hospital in London, the average hourly rate was £225 ($281), three times the National Health Service's maximum limit. NHS Improvement, which is responsible for cutting spending on agency labour, has calculated that if temporary staff were paid no more than the capped rate, every hospital in the country could pay for 30 more consultant shifts each week.

Hospitals are regularly resorting to emergency "break glass" rules to meet soaring pay demands from temporary locum doctors, Sky News can reveal.

Under an NHS clampdown on exorbitant agency workers, hospitals should only exceed an agreed "capped" hourly pay rate in exceptional circumstances when an unfilled vacancy for a doctor would put patients at risk.

But our investigation shows that hospitals in England notified NHS Improvement that they had breached the cap on 241,195 occasions in just three months.

A further Freedom of Information request revealed that the breaches are being made for every grade of doctor.

Image: NHS Improvement wants price agreements rolled out across the health service

But the problem is most acute with locum consultants.

Of 61 hospital trusts able to supply data, 56 exceeded the average hourly pay cap of £76.10

At 10 trusts the average hourly rate was more than twice the cap.

And at Great Ormond Street in London a consultant was paid an hourly rate of £225 - more than three times the maximum amount set by the NHS.

Some doctors are earning huge sums from the unbridled pay rates - one doctor at Colchester Hospital raked in £128,790 in just three months.

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Image: Doctors have warned that hospitals are being 'played against each other'

NHS Improvement, which is responsible for measures to cut spending on agency workers, admitted far more needs to be done.

It wants hospitals to target the highest earning locum doctors and has appealed to medics to do their bit to ensure the NHS is not overcharged.

Dr Kathy McLean, NHS Improvement executive medical director, said: "It's really about changing the culture.

"We know that if staff are having to work alongside others who are earning a lot more that doesn't feel right or fair.

"It's also not good use of taxpayers' money. It should be spent on other aspects of care for patients."

Image: Nursing agency prices have fallen 18% in a little over a year

The NHS spends £250m a month on agency workers.

But while nursing agency prices have fallen 18% in a little over a year, the costs of locum doctors are rising.

Paul Da Gama, human resources director at Watford Hospital, said locums are playing trusts off against each other to drive up pay.

"It's basic market dynamics in play," he told Sky News. "We all have a real need to fill shifts, because if you don't it has patient safety issues.

"So often what we are doing is inadvertently competing with each other and that's driving up rates."

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Watford Hospital has now agreed hourly rates with neighbouring hospitals to stop locums holding out for more money - a tactic that has saved the NHS around £7m in a year.

NHS Improvement wants similar price agreements rolled out across the service.

It calculates that if locums were paid no more than the capped rate every hospital in the country would be able to pay for an extra 30 consultant shifts every week.

"It's a vast amount of additional possible healthcare that could go into looking after patients," said Dr McLean.

However, the Locum Doctors Association said the capped pay rate is not enough to pay for medical insurance and other professional fees that run to thousands of pounds.

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LDA chair Shehnaz Somjee said: "They could have five to six job offers in a day and they'll choose the best.

"They don't have to work if they don't want to because it's a loss to work at the capped rate.

"It's not the locum's fault. If (the NHS) wants to maintain the same system then tough.

"Patients will either suffer or they'll have to pay more."

Hospitals paying the most to a locum doctor (July-Sept 2016)

:: Colchester Hospital University NHS Foundation Trust - £128,790

:: Frimley Health NHS Foundation Trust - £105,564

:: Royal Cornwall Hospitals NHS Trust - £104,000

Hospitals with the largest number of shifts over the price cap (July-Sept 2016)

:: Barts Health NHS Trust - 5202 shifts

:: East Sussex Healthcare NHS Trust - 5105

:: Sherwood Forest Hospitals NHS Foundation Trust - 5092

Maximum hourly rate paid to fill a consultant shift

:: Great Ormond Street Hospital - £225

:: Sherwood Forest Hospitals NHS Foundation Trust - £204

:: Penine Acute NHS Hospital Trust - £200