Perverse incentives and unintended outcomes and consequences – an ironic, confounding and idealistic volte face. Short term policies are dominating. Knee jerk responses and rationing will follow..

NHSreality cannot think of them, but there must be unintended outcomes and consequences from today’s new ruling which caps locum fees. In a country which believes in open market philosophy, and has control of the number of doctors in training, this represents an ironic, confounding and idealistic volte face. Short term policies are dominating. Knee jerk responses and rationing will follow.. The situation in General Practice is at least honest, as the state has no influence over what practices agree to pay locums. The “last man standing” is a risk for all Drs in partnership: the young could abandon the old, or the old and experienced could depart into “locumland”…

The Kingdom of the blind

BBC News reports today 23rd November: NHS England cap on agency payments comes into effect

A cap on spending on NHS agency staff comes into force in England on Monday, to save £1bn over the next three years.

By April, NHS trusts will not be able to pay agency staff, such as doctors and nurses, more than 55% more for a shift than a permanent member of staff.

Agency spending is one of the biggest costs to NHS trusts and is putting increasing pressure on the health service’s finances.

The health secretary said it would stop agencies “ripping off the NHS”.

But agencies complain they are being demonised when the problem lies in a shortage of trained staff.

And some hospitals are likely to struggle to meet the targets they have been set.

The government in England set out plans on how agency spending was to be capped in June before setting out the details of how it would work last month.

The cap comes following reports of agencies being paid thousands of pounds to supply nurses and doctors for shifts.

Figures show that NHS trusts in England have overspent by £1.6bn so far this year (2015-2016), an increase on the £930m deficit in June.

‘Extortionate rates’

From Monday, there will be a limit on the amount companies can charge per shift for providing all staff, including doctors and non-clinical personnel.

Health Secretary Jeremy Hunt said for too long staffing agencies have been able to “rip off the NHS by charging extortionate hourly rates”……….

The FT has alluded to these issues in several articles:

You cannot put a cap on NHS spending unless you can curb future 20th November 2015

Not what the doctor ordered 13th November 2015

and the Daily Mail is tuned into the Perverse Incentives inherent in the proposed new contract for juniors:Health Secretary Jeremy Hunt savages striking doctors ……

Free markets in health workers distorted – a perverse incentive created by politics

Staff shortages blamed as stand-in NHS doctors are paid …..

Diagnosing the problem with locum doctors 4th Nov BBC News

Grieving for the NHS. The softer specialities and locums. Ration for higher earners, and where insurance could cover.

Doctors quit NHS to work as £1,800-a-day locums

Who will be the “last man standing” in your practice? Changing the rules of the game

A&Es use locums to fill a quarter of senior posts

A third of A&E doctors leaving NHS to work “in a non toxic environment” abroad

Health services are “vacant” – and have many GP vacancies despite oversubscription to Medical School over many years


This entry was posted in A Personal View, Political Representatives and activists, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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