Reply to: Locum doctors

[Aceofgas]

Guys, something important to keep in mind, most of the experienced Locum will stop working for at least two months. After this some will take permanent positions and some will be working some hours but they won't be killing them selfs to travel miles , to do nights or weekends; simple math you get payed 50£ , you'll be taking home 25; oh and you are going to say, yeah but it's more than what a trainee gets' correct! But then you need to pay indemnity, training, appraisal etc.
So nce again, nights? , bank holidays? , last call shift? Neeeh

I am sure NHS will clench their buttocks; but for how long? I am sure they will do their best to state they can survive without agencies and Locums ;

I doubt NHS Trusts are going to flood the job market with permanent medical posts to recruit people from the full time locum market. This may leave the NHS with the same supply/demand problem. What I can see is the loss of market share for agencies. If the NHS Trusts are unwilling to negotiate a rate rise this will leave the locum doctor to pay employer/employee NIC and PAYE from the already established rate. The agency margin is ( guessing ) about 15-20%. To reduce the effect of you being held responsible for employers NIC you may wish to consider direct contracting with the NHS. In other words you may be able to negotiate on the agency margin with them.

[Moumunne]

Main problem will be when trusts will put pressure on their trainee doctors. At this moment I am filing the gap as Locum for a trainee position, will be unable to remain with the trust because its faraway from my home though they have offered. I've given a fair notice but they are unable to fill in the position so my colleagues will be in trouble. And unfortunately I am not the only one leaving the trust.

[Moumunne]

Trusts won't blink.

Mate works in the finance department of the local Trust, pointed out to me locums have been taking the piss big time. It's not just locums he rails against, junior doctors and consultants are equally as bad. Reports abuses he finds, nothing gets done.

You can't generalise! Of course you can have rubbish Locum doctors, working on low rates as well because hospitals won't keep them; but you can also have Locum doctors doing the work for 3 doctors and never leaving the ward until jobs are done. I've been a Locum for quite a while and always working for the same hospitals and always been offered training speciality positions but kept doing Locum work because up till now it worth from money point of view; obviously considering the new situation I will probably accept this time. It's probably difficult for you to accept but sometimes you'll find Locum doctors highly skilled within certain specialities , compared to a trainee.

[perplexed]

I think most people on here know that and have known that weekends and holidays are going to be a nightmare for months.

The only thing that matters now is who blinks first - the trusts by increasing payments or the doctors who accept lower pay.

Trusts won't blink.

Mate works in the finance department of the local Trust, pointed out to me locums have been taking the piss big time. It's not just locums he rails against, junior doctors and consultants are equally as bad. Reports abuses he finds, nothing gets done.

[Moumunne]

Once again, with the benefits given as trainee doctor you will get almost the same at the end of the year, especially if you are on specific specialities as Oncology. So it doesn't make sense to work as Locum. The principle is " the more you work the more tax you pay"

[eek]

I think most people on here know that and have known that weekends and holidays are going to be a nightmare for months.

The only thing that matters now is who blinks first - the trusts by increasing payments or the doctors who accept lower pay.

[Moumunne]

Locum doctors extinct species

Guys, something important to keep in mind, most of the experienced Locum will stop working for at least two months. After this some will take permanent positions and some will be working some hours but they won't be killing them selfs to travel miles , to do nights or weekends; simple math you get payed 50£ , you'll be taking home 25; oh and you are going to say, yeah but it's more than what a trainee gets' correct! But then you need to pay indemnity, training, appraisal etc.
So nce again, nights? , bank holidays? , last call shift? Neeeh

I am sure NHS will clench their buttocks; but for how long? I am sure they will do their best to state they can survive without agencies and Locums ;

[Carl10]

Yes!

Local Collaboration, as yet, has never happened in the NHS.

An example of this is, I have been working on waiting lists initiatives, some trusts will approach me when their list tips 32 weeks (300+ patients) others 40 minutes away will, when their list is 3 weeks (25 patients). The individual circumstances of that service ( private companies circling, "at risk" services, threat of closure) determines the need and the rate.

Jim will have to have a very cunning plan to make it happen now.

I do agree with you. Patient safety risk first. I'm Sure some key locum contractors will be offered a bespoke solution to stay out of the scope of IR35. Otherwise the NHS will collapse.

[LoughriggFell]

Of course the only way that works is if you can ensure different trusts do not compete against each other by raising rates which is why https://jumpshare.com/v/Et8z2DADOzCYGTJDFmHo and explicitly why the following bit



is so important.

Local Collaboration, as yet, has never happened in the NHS.

An example of this is, I have been working on waiting lists initiatives, some trusts will approach me when their list tips 32 weeks (300+ patients) others 40 minutes away will, when their list is 3 weeks (25 patients). The individual circumstances of that service ( private companies circling, "at risk" services, threat of closure) determines the need and the rate.

Jim will have to have a very cunning plan to make it happen now.

[eek]

The overarching idea is the contractor will bear the cost of all this. From the contractor's perspective one way of dealing with this mess may well be direct contracting with multiple NHS establishments directly and perhaps that may help agencies feel the pain a little bit.

Where else is the money going to come from? Remember the previous statement said

"Our NHS clients and the Frameworks have also said that they expect to see support in ensuring that overall rates do not increase due to these changes coming into effect."

which leaves the only people able to pay being the agency (already restricted by previous changes into fairly low commission rates) or the contractor. So the contractor it will be as that is the only give left in the situation...

Of course the only way that works is if you can ensure different trusts do not compete against each other by raising rates which is why https://jumpshare.com/v/Et8z2DADOzCYGTJDFmHo and explicitly why the following bit

Local CollaborationNHS

I continues to identify significant differences in the rates paid by providers in the same local workforce market, particularly around escalation rates (‘break-glass’ rates). This must be tackled on a collaborative basis. Therefore, the NHSI agency intelligence team will be working with you to make the rates paid more transparent and agree local escalationrates that all trusts locally should support and stand firm on.

is so important.

[Aceofgas]

The new world of post IR35 is outlined by locum agencies and NHS hospitals

The NHS and agencies are forming partnerships or at least the agencies are used to leak information from NHS Trusts to describe how the new world of post IR35 is going to look like.

Below is a link to Holt Doctors' article which describes this new world from the agencies' and NHS hospitals' perspective.

IR35 legislation - changes for PSC workers April 2017 - Locum Doctor Jobs - Holt Doctors - UK Locum Agency


"Our clients will be issuing amended Direct Engagement candidate terms and conditions to you for assignments to reflect the new processes and deduction of employment taxes and NI (including employer’s NI which will also no longer be payable to PSCs)."

Based on this quote I think they want to give us the impression that even after implemeting a IR35 changes by the NHS Trust it is still the contractor responsible for the employers NIC. You are taxed as employee when it comes to employers NIC you are still Ltd ?

Another interesting point they wanted to make:

"Our NHS clients and the Frameworks have also said that they expect to see support in ensuring that overall rates do not increase due to these changes coming into effect."

Agencies in the NHS market will not have to change a lot around these changes beyond relaying the new rules onto the workers and re-writing the contracts. As long as the worker continues working with them they have a constant stream of income unchanged.

The overarching idea is the contractor will bear the cost of all this. From the contractor's perspective one way of dealing with this mess may well be direct contracting with multiple NHS establishments directly and perhaps that may help agencies feel the pain a little bit.

[Moumunne]

yup. Nice one! There is an excess of doctors and GP practices in the UK so my only guess is that they to get rid of as many as They can


Waiting 4 hours in the A&E it is going to be a Fairytale

[LoughriggFell]

BMA have issued their guidance regarding GP Practices - taken from BMA website.


From 6 April 2017 these obligations transfer to a public sector body (or recruitment agency where it uses one) which engages a worker through a PSC. For these purposes, a public sector body is defined as a "public authority" under the Freedom of Information Act 2000 or its Scottish equivalent, which includes not only NHS England, clinical commissioning groups (CCGs) and NHS Trusts, but also GP practices providing GMS and PMS services.

A locum GP contracting via an intermediary

Where a locum is contracting with a client or recruitment agency via an intermediary (such as a PSC), IR35 may apply. From April 2017 where a public sector body (including a GMS or PMS practice) engages a worker to personally perform services under arrangements involving an intermediary, the obligation to determine whether IR35 applies and, if so, account for the relevant income tax and NIC will be on the public sector body (or agency if it uses one). Previously these obligations were on the PSC.

[Aceofgas]

How about substitution ? Locum doctors are working anyway under "substitution" as in for example if unable to go to work your agency would send someonelse. So with with a legal substitution contract should be outside IR35

All Locums I know will take time off from April; I can only presume NHS will need to find alternatives. Getting payed as PAYE it gets you with half of the rate earned plus you can't clame expenses not to mention courses, apparaisels etc. So it's no point working as a Locum doctor since the only reason for getting yourself into this hassle is earning extra money.

It's been mentioned about CAP rates, that was only something that mostly agencies have taken advantage of it l have not been payed less after the CAP came up.There is no transperances in regards to the earnings and contracts so Locum Agency is simply your God. And this thing with Umbrellas Com it's a mit, it won't save you more money. Who is going to get out of his home weekends and nights and bank holidays for just couple of pounds extra comparative to a trainee doctor? Who is going to travel miles and miles away from home paying loads on petrol, car breakdown and putting up with all the rudeness a Locum doctor usually takes?

Good thinking but you need to argue these points with NHS hospital HR and procurement managers. In the end they are going to classify you and me and everyone else as within IR35 since they do not wish to take any risks.

I agree with you there is going to be a little down time for some of us come April. Your agency may be your God now however this might be changing in the future: you can contract directly with hospitals ( aka bank doctor ) and the pay may be similar.

An umbrella may just be a requirement of your agency and truly when any of these companies are claiming they save money for you this clearly is not the case.

The expense of appraisal and training is not accounted for yet and I think the ensuing rates after April may help with this. ( I am guessing a lot here.)

[northernladuk]

How about substitution ? Locum doctors are working anyway under "substitution" as in for example if unable to go to work your agency would send someonelse. So with with a legal substitution contract should be outside IR35?

That's temping. YOU have to source and supply the substitute. Plenty of articles on what substitution is so I suggest you have a look.