Does the NHS really have its ‘cap’ in hand?

Our latest annual Taking the Temperature report into temporary staff spending in the NHS indicates that NHSI rate caps may not be achievable by the majority of NHS trusts across England as they struggle to fill the workforce gaps.

In an effort to reduce and standardise temporary staff pay rates, since July 2018, NHS trusts are required to obtain Chief Executive sign off on all shifts over £100 per hour and report these to NHSI on a weekly basis. Prior to July the hourly rate was £120.

Our research shows that 59% of bookings for temporary General Medicine Consultants were at total pay and commission rates of between £100 and £119 per hour and 23% of bookings were over £120 per hour.

All Consultant specialities saw an increase in the average hourly rate when comparing rates year on year. Overall, average pay rates rose by £6.83 per hour whilst average commission fell slightly, by £0.29 per hour.  The largest increase was in Obstetrics & Gynaecology, where pay rates increased by £14.35 to £93.20 per hour in 2017/18.

The highest pay rates for Consultants were across General Medicine, at an average of £107.09 per hour and escalated to £156.15 per hour, rising by 10.1% from Q1 to Q4.

Radiology Consultants also commanded high average pay rates of £103.65 per hour. Pay rates were as high as £160 per hour – more than double the core price cap of £76.10, which also includes commission.

Commission rates for Consultants vary from an average rate of £6.35 per hour in Psychiatry to £9.74 per hour in Pathology. In some instances, hourly commission rates reached a maximum rate of £20.01 per hour, which was seen in Paediatrics.

The average total hourly rate booked was £142.91 per hour for Consultants via Standard Placement, 35% more than the average Agency Direct Employment rate of £105.95 and 43% more than the average Bank rate of £99.64. Had the Consultant hours booked via both Standard Placement and Agency Direct Employment during 2017/18 been booked at the average Bank rate, the annual saving on this staff group could be in excess of £10m.

Shortfalls in specialisms remains the main reason for overriding hours and rates.  Almost two thirds (60.4%) of hours overridden were due to the need for a specialist locum, showing an annual increase of 9%. Bookings made at very short notice accounted for around a quarter (22.9%) of escalated hours. In 2017/18, 266 locums booked to work at 46 trusts had total hourly rates of £120 per hour or more.

Across the top ten highest earning locums (based on hours x hourly rate) during 2017/18, the annual cost to the NHS was £3.2m for the equivalent of almost 15 Whole Time Equivalent employees. Equally revealing is that of the top ten ‘temporary’ consultants, nine have worked consecutively for a year or more, with four having worked in their post for more than two years.

It’s clear that NHS trust CEOs can benefit from switching to an increase in own trust bank staff and collaborative banks as well as sharing booking rate data.  Liaison Workforce is currently working with a number of trust CEOs to trial an anonymised data sharing tool.  Early indications are promising: potential savings may well run into hundreds of thousands if adopted across the whole of the NHS.

Our TTT data has highlighted and pinpointed some of the core issues the NHS is currently struggling with around workforce including controlling agency spend, workforce effectiveness and adhering to NHSi rate caps.