Locum Staffing and Medical Staffing

Evgenia Galinskaya, Stage 3 Cambridge Undergraduate
Almost every day, the national media broadcasts reports in one way or another inferring that
doctors are becoming greedy and focused on maximising income rather than patient care. Being a medical student, I feel I am in a unique position to discuss whether doctors are indeed becoming greedy. On one hand, I consult doctors as a patient. I also sit in with doctors during their consultations and observe what goes behind the scenes in the GP surgeries, outpatients
departments and on the wards. Thirdly, I will be a doctor next year.
As a patient…
As a patient, I am bombarded with strong anti-doctor messages from the media. I question the
fairness of the General Practice abandoning the out-of-hours service yet being rewarded with a
good pay rise. Whilst GPs may not govern their pay structure, it is the NHS and those of us who
use it, who pay for any increases, albeit indirectly (1). I can only sympathise with the general public in their feeling of alienation when getting the messages from the media that some doctors are apparently earning up to £250,000 a year whilst hospitals are closing wards, British nurses leave for Australia and women in labour are left to cope on their own due to lack of staff. What is the general public supposed to think when they read a report that “Half the new investment in the NHS hospital budget in the past year has been spent on higher pay for staff” (2)?
As a student doctor…
As a student interacting with doctors on a daily basis, I mostly see doctors who are highly
committed to patients, who are diligent, selfless and hardworking. I meet some doctors who would do their job for half their current salary and would still be happy (3). I also see the chaos created by the numerous managers and politicians who seem to be at the heart of the National Health Service’s misfortune and doctors’ frustration. As someone who will soon be working in the NHS, it truly hurts me to see doctors being vilified as money grabbing fat cats who are apparently thinking only about their next BMW. Of course I am all for doctors being adequately paid but I believe that pay rises should mean correspondingly more services to the patients.
Who is at fault?
Most doctors just want to concentrate on their patient’s care. Most patients appreciate this. Yet
time and time again there springs a question of doubt: “Are doctors becoming greedy and focused on maximising income rather than patient care?” As Elizabeth March (1) points out, “the fact that this is an issue at all reflects a deeper undercurrent of dissatisfaction” with and within the NHS. If we were just after cash and the GPs indeed were earning what the media reports, surely, there would not be a potential shortfall of 1,200 GPs predicted for 2010/11 (4)!
Personally, I do not think that doctors should be blamed for taking what is already on offer. It is only a human nature to desire more money for less or easier work. I cannot imagine anyone in the right mind saying: “Please would you stop giving me more money. I don’t know what to do with the last lot”. The question is whether those making the offers are competent in what they do. I cannot comprehend why, for example, completing a cremation form pays over £60 for 20 minutes of work that I thought is one of doctor’s every-day jobs? Equally, I don’t quite see why junior doctors, who would like to pay off their mortgage, would refuse this “cash for ash” when it is already in place. So please don’t call them greedy.
Getting the balance right I want to be honest. Perhaps like you, when I am offered a good salary, I am not going to say “no”.
Call me naïve, but I would like to think that come the time when I earn £100,000, I would give back to the community by supporting a hospice or a school for the blind. I bet many young doctors have equally deserving aspirations. So it hurts me when doctors collectively, as a profession, are referred to as greedy. Individual doctors should not be blamed for the glitches in the system, regardless of how much they earn. Of course, there should be a balance between furthering the welfare of the medical profession and improving services to patients. Those who are in charge of the distribution of NHS services and approving doctors’ salary should be the ones who oversee this balance. When patients start to feel they are getting a fair deal for the tax they pay, doctors won’t be picked on as being “overpaid”. Until then, we will remain the workforce of the NHS trying to act in the patient’s best interests. Despite hurtful labels, we will be doing our best to overcome the obstacles created by the ever-increasing influences of bureaucracy and the media. Most of us are caring, noble and altruistic. We need to unite as a profession to protect this image.
REFERENCES:
1. Marsh, E. Remuneration of GPs. BMJ 2007 [cited 2007 Feb 2]; 334. Available from: URL:
http://www.bmj.com/cgi/eletters/334/7587/236#156652. Accessed 25th March 2007.
2. O'Dowd, A. Half of extra money for the NHS has gone on pay rises. BMJ 2006;332:319. Available from:
URL:
http://www.bmj.com/cgi/content/full/332/7537/319?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fullte
xt=money&searchid=1&FIRSTINDEX=10&resourcetype=HWCIT. Accessed 25th March 2007.
3. Needham, G. ‘Money for something but the kicks are fab.’ BMJ 2006 May [cited 2006 May 14];
332. Available from: URL: http://www.bmj.com/cgi/eletters/332/7549/1096-c#133707. Accessed 25th March
2007.
4. GP shortage greater than DoH predictions. Health care republic the home of primary care. 12 Jan 2007.
Available from: URL: ttp://www.healthcarerepublic.com/news/GP/626740/GP-shortage-greater-DoHpredictions/.
Accessed 25th March 2007.
*Eugenia Galinskaya , a Stage 3 Cambridge Undergraduate won 2nd Prize in a Medical Women’s
Federation Competition with her essay .. The Editorial Board is grateful to the Federation for
permission to publish it and congratulates the author on her success.

Article taken from Pulse Magazine:

04 Mar 09
By Gareth Iacobucci
GP recruitment has been completely turned on its head in the space of five years, with four fifths of new vacancies now salaried posts, a Pulse investigation reveals.
There is also evidence that Government attempts to tackle the uneven supply of GPs may have failed, with those partnerships that do exist increasingly in better-off areas.
The figures show the extent of the crisis facing GP leaders, who recently called for the Government to restore central control of GP recruitment in a desperate attempt to arrest the decline in partnerships.
Pulse analysed more than 250 job advertisements in the magazine’s classified section in 2003, and then at intervals from 2007 to early this year.
In 2009, 80% of advertisements have been salaried, compared with just 39% back in 2003 – a dramatic change that has alarmed the GPC.
Dr Beth McCarron Nash, GPC negotiator with responsibility for employment issues said the figures were evidence that the new generation of GPs were being denied any possibility of a partnership.
‘It is an exceptionally difficult time and we need to be careful not to be our worst enemy. I would like to see a long-term strategy based on a partnership model.’
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Dr McCarron Nash, a GP partner in Honiton, Devon, added: ‘We want to see GPs offered an opportunity that is right for them. At the moment, it appears they are not being offered a choice.'
The survey also reveals Government efforts to redistribute GPs to the poorest areas of the country appear to have had little impact, and that the abolition of the Medical Practices Committee in 2004 may even have had an adverse impact.
In 2003, 49% of partnerships were advertised in the most deprived quarter of postcodes, but over 2007 and 2008, just 30% were.
Salaried posts have shifted slightly towards more deprived neighbourhoods, however, with 36% advertised in the quarter most deprived neighbourhoods in 2007/8, compared with 27% in 2003.
Dr Richard Fieldhouse, vice chair of the National Association of Sessional GPs, said the figures demonstrated the struggle salaried GPs face to compete for an ever decreasing number of partnerships.
He said: ‘It’s much more of a bunfight now. It’s not just newly qualified GPs [going for the jobs], but also the salaried GPs themselves. We’ve got a lot stressed out, unsatisfied GPs.’
Key findings
-
2003- 49% of partner jobs located in the most deprived quarter - 17% of partner jobs located in the most affluent quarter- 27% of salaried jobs located in the most deprived quarter
2007/2008- 30% of partner jobs located in the most deprived quarter- 22% of partner jobs located in the most affluent quarter- 36% of salaried jobs located in the most deprived quarter
2003 - 39% of ads were for salaried vacancies2008 - 66% of ads were for salaried vacancies2009 - 80% of ads were for salaried vacancies

Readers' comments
adam pringle - telford 04 Mar 09
So - fewer partnerships are advertised in deprived areas - areas that previously had a high turnover of partners, and now have a high turnover of salaried docs
If 20% of GPs are in salaried posts - and they stay for 2 years on average - and 80% are partners - and they stay for 20 years on average - then 10 job vacancies out of 14 will be for salaried posts - or more if we assume many partnerships will be taken without advertisement by salaried docs in the practice

This is neither news nor a crisis
Dr Patel 05 Mar 09
It is quite obvious that senior partners are becoming increasingly greedy and junior doctors have no future. Without getting involved in practice management and partnership, the future generation of GPs would be nothing but frustrated mechanical doctors who do not know anything except seeing patients. Very bad examples for medical students and for future medical education in the UK.

Bacon vacations are a swine
04 Nov 09
Phil is in a huff and a puff about the swine flu hotline and all the ‘hog holidays’ it has brought.
My patient sounds congested and miserable. ‘So do you think it could be swine flu, doc?’
‘It’s possible. It’s hard to be sure over the phone. I’m pretty certain it’s a virus.’
‘Do you think I should go to work?’
‘I’m not sure that would be fair to your colleagues. Maybe you should take the rest of the week off.’
‘Yeah, but I can’t, can I? I already took my bacon vacation last month.’
The ‘bacon vacation’ – also known as the ‘hog holiday’ – is a recent phenomenon. Indeed, you can date its origin quite accurately... to about half an hour after the Government’s influenza hotline was introduced.
I’m well aware that dealing with global pandemics is not as straightforward as organising a piss-up in a brewery. So it is depressing to find that our Government, which cannot even manage the latter, now thinks the answer to the former is the influenza hotline, with its moronic, unqualified, minimum-wage phone-jockeys. The results are predictable.
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You phone a free number. You speak to some slack-jawed teenager who trails a damp finger down a laminated flow chart while drawlingly asking you a number of questions about your symptoms. If you get it right, you get a prescription and a week off – no sick note, no questions asked (or at least, no questions accurately answered). Then consult Ceefax for a last-minute holiday deal, and you’re away. Tell some lies and win a prize. A porker for Majorca.
In that classic manner that is unique to soulless British bureaucracy, as well as failing to do what it’s designed to do, it also adds an extra layer of cynicism to the souls of everyone involved. With only a little mental rearranging, the concept of the hog holiday has become not an unexpected bonus but a right, something to be planned for. Everyone else is having it, so why shouldn’t I?
In Sunderland, if you don’t work for Nissan, you work in a call centre. Call centres are a big thing in Sunderland. There is some science behind this. Apparently, it is slightly less distressing to be told your electricity is going to be cut off if it comes from a lass with a warm, soothing Wearside brogue.
Strangely, the captive workforce don’t love the call centres as much as they should. Maybe it’s the way their pay is docked if they don’t sell their target amount of useless insurance, or the way they are timed when they go to the toilet. Who can say?
One of my call centre-employed patients, who has an unusual – that is to say, a measurable – amount of work ethic, was disgusted with what happened at her workplace. There were 19 of them in the office on Monday morning. A snivelling, sneezy girl went up to the supervisor and said she felt ill, and that her husband had been given Tamiflu by the hotline. The supervisor sent her home.
Within four hours, six other employees shyly admitted to flu symptoms and were sent home too. On Tuesday, only seven people turned up at work.
At this rate, every worker in Sunderland will have had a bacon vacation by the end of the year, and yet hardly any of them will have actually had swine flu. God help us if we ever actually get a genuine epidemic.
Dr Phil Peverley is a GP in Sunderland