Locum costs stretch health board’s resources

NHS Shetland chief executive Ralph Roberts.

NHS SHETLAND is continuing to struggle to fill a slew of GP and other vacancies as it strives to bring its £1.7 million bill for temporary staff down amid unprecedented financial pressure on its resources.

That also happens to be the estimated sum the health board needs to find to bridge the funding gap it faces in 2018/19.

The use of temporary, or locum, staff has more than quadrupled in the past four years. In 2017/18 GPs will account for around half of the overall bill, which has mushroomed from £386,950 in 2014/15 to an estimated £1.7 million this year out of a £55 million budget.

Chief executive Ralph Roberts acknowledged at a board meeting on Tuesday morning that NHS Shetland is not yet in a position to set a budget with fewer than six weeks remaining until the new financial year begins.

He said it felt like possibly “the most challenging year that we’re going into” and if locum costs cannot be addressed “that will make next year even more difficult in terms of sustaining services with locums and then having to make other decisions to cover it”.

Board members heard from human resources director Lorraine Hall that NHS Shetland has redoubled efforts to attract staff to live and work permanently in the islands in recent months.

It has enlisted the help of a specialist agency and has also attended recruitment fairs on the UK mainland. There has been “no interest” in terms of general physicians, but on the plus side there has been “enough GP interest that would cover the vacancies that we have” if those individuals ended up coming to Shetland.

NHS Shetland's human resources director Lorraine Hall.

In addition to the obstacle of being located in the middle of the North Sea, there is a nationwide shortage of GPs and other medical practitioners.

Hall said there were “just not enough doctors in the system across the UK to fill the gaps that we have”. At present there are 18 anaesthetic consultant posts, 29 general physician and 123 GP vacancies across Scotland – all three areas Shetland is seeking to recruit in.

She said NHS Shetland was “remote, rural, island, and a generalist provider” and feedback from many doctors included concerns about “on-call, out-of-hours requirement and the range of duties that they might have to deliver”.

Hall said there was “some reticence” among European colleagues as a result of Brexit and “probably we would, at this time, have had more interest from potential European counterparts, and that is taking longer to come through” amid uncertainty over what the UK’s exit from the EU will ultimately mean.

NHS Shetland is bringing prospective doctors to the islands for a visit, to meet people and “understand the whole remit of the role”, she continued.

Board member Shona Manson said there was an “incredible amount of work going on” against a backdrop where there is “simply a lack of people”.

She added: “That personalised aspect of recruitment is really important, so let’s just hope we get results.”

Speaking about the health board’s financial health more generally, Roberts said there was still a gap for 2018/19 of £1.7 million that “we haven’t yet identified plans for”.

Over the next five years savings of nearly £10 million will have to be found as demographic pressures and demand for healthcare continue to grow. As part of that effort, NHS Shetland last month launched a three-month “scenario planning” exercise

“I think the message still needs to be a recognition that we are going to face some very significant choices about a sustainable service model in the future,” Roberts said.

The Scottish Government has indicated it will cover the cost of a pay award for “agenda for change” staff, which Roberts said might leave NHS Shetland facing an added £100,000 bill to cover a wage rise for any staff not in that category.

Roberts said the health board had a “good record” in making efficiencies, while NHS Shetland accountant Colin Marsland said around £18 million had been found in the past six years.

Following further talks with the Scottish Government in early March, Roberts said he was hopeful the board would be able to agree a financial plan for 2018/19 at its next meeting on 20 April.   

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