Perverse behaviours – and perverse incentives. This is partly what drives doctors away…

The nature of the behaviours and the incentives in the English Health Service in particular is becoming more perverse. GP locums do get large salaries, but they are working in a market created and controlled by government. Successive Governments have ignored the longer term, and the result is what is in the news today. Perhaps this doctors never refers! (BBC News 2nd October – GPs being paid to cut patient referrals). He certainly does not want to rescue one of the increasing number of failing and closing practices. Perhaps he has signed Pulse’ petition (Stop Practice Closures). The perverse activity comes from administrators wriggling on the hooks of financial constraints and quality control… There is no answer except rationing overtly, and the covert incentives to restrict referrals is immoral.. Even the United Nations and the Kings Fund agree.. Such behaviours and schemes reduce a doctor’s self worth, and can drive them abroad.

Chris Smyth in The Times 2nd October reports: Doctor paid £500,000 as costs soar for the NHS

Britain’s best-paid locum doctor is to earn nearly half a million pounds from the NHS this year, The Times can reveal.

The earnings, which are the highest known for a hospital doctor working shifts to plug shortages in the health service, emerged as figures showed that the NHS bill for temporary staff had soared to £1 billion.

Patient leaders said it was unacceptable that at least eight locums were paid more than £250,000 last year. Growing numbers of doctors were tempted to become “permanent temporary” staff because they could earn so much more than in full-time jobs, they warned….

…This summer Jeremy Hunt, the health secretary, announced plans to set maximum hourly rates and limit the amount each hospital could spend on agency staff, saying that “taxpayers are being taken for a ride”.

However, Mark Porter, the chairman of the British Medical Association’s governing council, said last night: “With the NHS relying on locums more and more, the government’s policy is unlikely to have any real impact. In fact, clamping down on the market runs the risk of leaving hospitals with further shortages, putting patient care at risk.”

He said that stress and gruelling workloads were deterring staff from joining the front line, warning: “In some specialities, especially emergency medicine, this has contributed to a recruitment and retention crisis and the increasing need for locums.”

Earlier this year, The Times reported how hospitals were routinely paying stand-in A&E doctors almost £2,000 a day because staff refused permanent jobs in “war zone” departments. Some staff have been paid £3,500 a shift.

The Department of Health said: “Having the right number of staff is vital so we have prioritised and invested in the front line by employing 20,600 extra clinical staff since 2010 and committing to 5,000 more doctors in primary care by 2020. We are also supporting the NHS to employ the staff it needs at a fair price by introducing cost-control measures to clamp down on extortionate agency rates.”

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