Rate Cuts & Rota Shifts: The Locum Love-Hate Relationship

Can hospitals survive whilst cutting locum rates?

Last month, University Hospitals Birmingham Trust dropped a bombshell: starting November 11, agency staff cover and enhanced bank rates for locums will be phased out. Predictably, the immediate response has been, "No pay, fine, end up with rota gaps" The assumption, naturally, is that dropping the rates will mean locums won’t show up to fill the gaps. Time will tell if that’s true…

So, what’s behind this decision? The trust argues that some permanent locums are pulling in hefty paychecks for output that doesn’t quite stack up against those on training pathways who are often slogging for half as much. Fair point or a fictional spin? Probably a bit of both. Sure, there are cases of “high-paid, low-output” locums, but let’s not forget that many long-term locums know the hospital inside and out. They’re the ones who can get a discharge letter done at the last minute, keep patients from falling through the cracks by booking effective follow-up, and navigate the maze of NHS paperwork like second nature. In other words, the system needs them as much as they need the system.

But, yes, there is a valid question here: how much should they be paid? A locum’s life isn’t all high rates and hospital familiarity; it also comes with job insecurity, a lack of benefits like sick pay, and let’s not forget, they’re often called in at a moment’s notice. So a higher pay scale seems justified—but how much higher is fair? Some say let the market decide, but this is a debate no one has the answer to just yet.

And then there’s the argument that productivity is selected for amongst doctors on speciality training pathways who have continuity of care in that particular department. That’s certainly a claim to consider, but unless there’s solid empirical evidence to back it up, it’s still just that—a claim.

Now, to tackle the question no one’s asking but should be: could hospitals actually manage with lower locum rates? Many trusts seem to think so, betting on the fact that shifts will still be picked up by those who, despite rate cuts, find the NHS’s rates competitive, especially if they’ve come from abroad. Sure, reducing locum pay might put some off, but others, particularly international physicians, might still see it as an upgrade from options back home.

And for those suggesting we could simply reduce international recruitment (or increase the bar to entry) like the American or Australian models—well, we’d have to brace for the possibility that the government could consider cheaper, non-doctor roles to fill those rotas instead. Trained quickly, non-rotational… It’s a tempting prospect for budget-conscious administrators.

Lost in Translation: The Curious Case of the ‘Clinician’

This week, our Health Secretary Wes Streeting fielded questions in Parliament about the national scope of practice for our physician associate colleagues. In his response, he referenced the term “clinician time.” Which got us thinking: what exactly do we mean by clinician, and what does it actually contribute to the conversation?

Imagine this from a patient’s perspective. They’re told they’re being cared for by “one of the clinicians,” and you can practically see the question marks forming over their heads. Is it a doctor? A nurse? A physician associate? A physiotherapist? An alien in scrubs?

At what point does this abundance of terminology stop clarifying roles and start muddying the waters? What value does “clinician” add that plain, specific titles like “doctor” or “nurse” can’t deliver?

We can’t help but borrow a line from Practice Nurse Jane Warner, writing in the Nursing Times: if all else fails, just greet your patient, tell them who you are, and what you do. Sometimes, simplicity is the best medicine.

Location Location Location: The Impact of Rotational Training

Is a Cap on Rotations the Cure for the NHS’s Retention Woes?

Ah, rotational training, that perpetual merry-go-round where every few months, you’re off to a new hospital, a new team, new ID badge, and yes, yet another login you’ll promptly forget. We’ve all heard the critiques: rotational training may be one culprit in the rise of non-doctors offering NHS services, not to mention its impacts on housing, relationships, new staff, new geography and the endless parade of new protocols. The On-Call team know every problem needs a closer look, so let’s dive in.

Sure, rotation has its perks. It broadens horizons, exposing us to the DGH and tertiary world, diverse populations, and the many versions of “regional guidelines.” Being stuck in one trust's way of doing things is far from ideal, but when did a healthy dose of variety turn into a full-blown dizzying spin? Maybe we don’t need a whirlwind tour of ten hospitals in the nation; sticking to 2 to 3 trusts should cover the bases.

But what if we stopped rotational training cold turkey? Well, some argue we’d need to offer incentives to lure trainees to less 'competitive' or 'attractive' regions —perhaps a “non-urban” pay scale for those in rural or coastal areas. Now NHS England disputes this, In a 2023 document they stated that as competition for posts is currently so high, posts all across the country are filling but hinted at pilots to cap rotations and suggested setting out years in advance where a trainee might rotate, limiting the chaos.

In the end, while we may not be at the brink of halting rotations altogether, a little rebalancing might just keep everyone grounded—literally.

“Invest in all the 7-day consultant ward rounds you want. Ultimately you still say “PT/OT, med fit, await discharge dependent toilet roll holder” because the H in NHS stands for “hotel”.

“8:10 Gen Surg ward round, come to adjust the trolley and smashed into the consultants ‘family jewels’ as he called it. Now I am not allowed to move anything until I’ve loudly declared what I am doing”

“Chaperoned a colleague to do a PR and it got me thinking: which finger does everyone use? I personally go for middle (for some extra reach). Is there a right answer?”

Email us to share what’s on your mind in our next issue!

Weekly Poll

Last week’s poll:

What is the maximum time you would be willing to commute to work?

Have an idea for our next poll? Let us know!

Application season is here again, which means it’s time to reconnect with our old frenemy: Oriel. For many in our community, this means carefully crafting self-assessment answers, pouring over each detail with surgical precision—only to find, hours later, that Oriel has logged you out.

Why can’t Oriel save your progress automatically, you ask? A question for the ages. (If anyone finds out, please let us know!) Until then, this is your annual PSA: write your answers in a Word document first. Then copy, paste, and triple-check as you go.

Double-check you’re pasting under the right heading. Every year, some unfortunate souls become sacrificial offerings to the Oriel gods because their answers end up in the wrong boxes. Let their stories serve as your warning.

Good luck, and may the Oriel odds be ever in your favour!