Doctor, Guest blog, Locuming, Nurse, Opinion piece, Pharmacist

The rise of the modern locum.


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Before I became a locum, I had been working as a clinical rotational band 6 hospital pharmacist and often found enjoyment from quizzing new locums in the department about their experiences in different locations. “Is the pay good?”, a question that almost all locums have faced at some point, was usually followed by “Which is the best hospital you’ve worked at?” Given my affliction to lunchtime specials, a personal, favourite question of mine was “But, which hospital has the best canteen?”

These questions all did the job of building rapport with the locum until I could ask them the questions that I really wanted to know answers to; ‘Are all hospitals like this? How are you treated by the hospital and your agency? Will you always locum or will you return to full-time employment?” These questions gave such varied and detailed answers that they played a huge part in deciding the next step in my career. 

There was a time that while NHS employees faced cuts, pay freezes and extended working hours, locums were enjoying the dividends (literally) of working for themselves. But the golden years were soon to come to an end. Pay caps on hourly rates and the infamous IR35 took a massive toll on locums, some of which claimed to lose an astonishing 35% of their take-home pay.

For a long time, this didn’t phase me much. After all, I love the NHS and as the newspapers, news and pretty much everyone else is quick to remind me, Locums are draining the NHS coffers. But, after some reading, workplace experiences, and very polarising conversations, my views and actions took an unlikely turn. I decided to start locuming.

The reasons? simple. I walked into work, fresh and full of beans, with a few ideas that I thought would be beneficial to a number of colleagues. They were only small at the time, but the small differences could have been more efficient. A simple suggestion of moving a checking table or a process change such as prescription workflow were looked at with equal measure – as ideas to be instantly dismissed.  I began working later into my days, staying late to help colleagues and while I knew overtime was a long shot, the expectation rather than appreciation from management soon made me realise that departments were in need of change. And if departments couldn’t change, then I would need to change my department. 

I started locuming after IR35 and pay caps had come into effect and even so, I saw a modest increase in my take-home pay. Of course, I had a few other headaches to get rid of, like how I was going to pay myself and how I could improve my job security. But those problems were outweighed by the choices. For me, Locuming gave me the opportunity to experience how different hospitals operated, the different pressures facing each one, the novel solutions being tested, as well as, the usual reasons like the flexible working lifestyle and so forth.

I then became subject of the ridiculous questions I used to ask the locums that once worked with me. I found the usual jibes of being a “millionaire” off the back of a broke NHS tolerable at first, but soon it got tedious. I asked detractors of the “Locum lifestyle’ if they thought they were paid fairly working for the NHS. If they thought they were valued and if they had noticed a trend in their working hours and job satisfaction. If you’re an NHS employee, you’ll likely all have the exact same answers as the people I asked those questions too, many moons ago. 

What is wrong with wanting to pay a ‘fair’ wage and have the flexibility to work when you want? Why would anyone not choose that lifestyle and why would one berate professionals who chose the locum lifestyle over job security and longevity? Sure, many locums will be paid more than their salaried counterparts, but one month of illness can completely change that calculation.

In 2016, nursing salaries dropped 14% below inflation, causing many salaried nurses to turn to agency shifts to make ends meet. A year later, health secretary Jeremy Hunt raised the prospect of an NHS worker pay-rise being conditional on a “boost in productivity.” As a healthcare professional with good knowledge of your local service, is there more you can do without extra resources? 

During the same year, over £2.5billion was wasted on unused medications. Money that for all intents and purposes is sunk. Wasted medications do not provide a service, nor can they be used to treat patients. The NHS spent an estimated £3 billion on locums in 2016-2017, around 2.4% of its annual £120(odd)billion budget. A lot of this money went to healthcare staff that in my eyes, deserve to be paid more and much of which went straight back into the economy and in most cases (since IR35) straight back into government coffers.

Of course, some of the £3billion went to lining the pockets of agencies brought in by the government to supply on demand healthcare staff. I guess that’s what gets everyone so irate about locums but, can you really blame a locum for that?

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