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Doctors highlight need for locum reforms

By Catherine Reilly - 14th May 2023


Cost-of-living pressures are placing locum terms and conditions under the spotlight, but the HSE is promising revised hourly rates. Catherine Reilly reports

The “low” locum rates and prohibition on trainees doing locum work is worsening the cost-of-living crisis for many doctors, according to Train Us for Ireland.

Some doctors are providing locum services in Northern Ireland for approximately double the pay, Dr Liqa ur Rehman, President of Train Us for Ireland, told the Medical Independent (MI).

The group is calling for a review of locum pay rates and flexibility for trainees, who are not eligible to locum under current rules. In addition to financial pressures, the group stated that some doctors who have gained a place in GP training are keen to retain skills in their original hospital-based specialty through locum work.

Dr Liqa ur Rehman

Dr Rehman told MI the current medical locum policy dated to 2017 and was due to be updated. He said there were many issues that needed to be addressed in a new policy.

He said locum work enables flexibility and financial stability for healthcare workers and “emergency and immediate relief” to an inadequately staffed system. 

Currently, he said, there are restrictions on which doctors can do locum work, the scales are “outdated”, rates are “low” and not linked with current inflation levels, and “travel expenses cannot be claimed”.

He stated that locum pay scales do not reflect a doctor’s level of experience. For example, there is only one rate for ‘registrars’ providing locum services, whereas the HSE staff pay scale provides six points on the pay scale of a registrar and separate pay scales for specialist registrars and senior registrars.

Dr Rehman added that doctors in training schemes have no access to locum work whereas trainees in the NHS are permitted to undertake a capped number of hours.

Asked about the issue of appropriate rest for doctors working full-time in health services who wished to locum, Dr Rehman said it was a matter of “balance”.

During annual leave or where the doctor was not rostered at weekends, for example, “there is no harm providing an eight-hour shift on a Saturday.” However, in periods where a doctor was very tired or very busy, this was not the best option, he added. Dr Rehman emphasised that cost-of-living pressures are making life in Ireland unsustainable for many doctors.

Training access

To date, Train Us for Ireland has primarily campaigned for greater training access for international doctors. It has welcomed the recent policy changes that have facilitated speedier access to ‘stamp 4’ residency and recognised that all stamp 4 holders are equivalent to Irish/EU candidates during the training application process. However, the improvement in access to training has brought other matters, such as the locum policy, to the fore.

Dr Ali Raza, Vice-President of Train Us for Ireland, told MI he was among the “lucky ones” who successfully gained entry to specialist training after receiving stamp 4 status. He has secured a place in GP training.

Dr Ali Raza

“I think that was a groundbreaking step in retaining the foreign medical doctors in the country. In the past many of them got disappointed after some time when they didn’t see their career progression and moved to another country. I can now see positive thoughts in many of my colleagues working here, they are hopeful now, and many of them want to stay and work in Ireland. It has helped a lot.”

The new campaign on locum policy had a number of key points, he continued.

“One of them is to allow the trainee doctors to work as locums, I think that is very necessary. We are already facing a huge shortage of doctors in Ireland…. It has become exhausting for the doctors who are already working.”

According to Dr Raza, many international doctors who have gained entry to GP training have “a lot of [other] specialty experience”. He has worked in paediatrics for seven years, for example, and wished to maintain his paediatric skills (ie, as a special interest within general practice). He said this could be facilitated by a permitted level of locum work.

In addition, inflation and the housing crisis were causing a major financial strain on many doctors working in Irish healthcare, he said.

“The other point is that the rates for locums in Ireland haven’t been revised in probably the past five years. If you look at other parallel countries, like the UK, Northern Ireland, Australia, [the rates] have been updated.” In the UK, for example, an ST6 trainee receives £100 an hour for locum work and the usual rate in Ireland is €45-55 an hour, he outlined.

A HSE spokesperson said doctors on the trainee specialist division of the Medical Council’s register may only practise medicine in their training post and there were no plans to review this policy. 

An ICGP spokesperson commented: “The College advises trainees that GP training is demanding, but deliverable, based on 100 per cent time commitment to training, and their clinical training post. Cost-of-living pressures can be solved by increasing training salaries.”

Medical/dental agency expenditure in HSE statutory services rose from €94,653,000 in 2020 to €119,038,000 in 2022 (the latter figure is draft only and subject to change). These figures, which were provided by the HSE, include expenditure on locum consultants and NCHDs.

According to the HSE: “There is a procured framework in place for the supply of locum (temporary) medical/dental staff; these are agency staff supplied via a recruitment agency. The delivery of a 24-hour 365 days a year service requires safe staffing levels. This means sourcing additional recruitment solutions to meet unexpected shortfalls, as well as surges in service demand. The current framework is temporarily extended under existing terms and conditions. However, a new invitation to tender will be advertised… in line with EU Directive 2014/24/EC and HSE Financial Regulations.”

The invitation to tender and draft service level agreement will outline the terms and conditions that will apply to this contract, including “revised competitive hourly rates for consultants and NCHDs”.

The spokesperson for the HSE said it could not provide further information on revised rates “as this information is commercially sensitive”.

According to the HSE, available supply in the labour market for healthcare professionals continues to be a challenge. “This is not unique to Ireland, but rather a global health workforce challenge. Recruitment and retention of clinical, nursing, and other key staff is a constant challenge and impacts adversely on the ability to maintain safe and effective services.

“Therefore, as part of the HSE’s overarching resourcing approach whereby direct employment does not meet the needs of service delivery requirements, agency staff are utilised. This can be for a variety of reasons, including sick absence replacement both long- and short-term, replacing vacancies currently being actively recruited, replacing maternity leave, etc.”

More recently, the Government’s reversal of the Haddington Road Agreement regarding working hours had resulted in additional resourcing requirements, with the replacement of lost hours in critical service areas a priority. “In advance of the filling of these hours via direct employees, there is a need to prioritise critical services for replacement through agency and overtime.”

The majority of agency spend is on salary and statutory pay costs, such as PRSI, holiday allowance, etc. In line with the Protection of Employees (Part-Time Work) Act, agency staff have the right to the same basic employment conditions including basic pay, shift premiums, unsocial hours, and Sunday rates, stated the HSE’s spokesperson.

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