The Market works – or is it just unprofessional?

The NHS is involved in a standoff with many of its locum staff – doctors, nursing and non clinical staff such as IT contractors.

There has been a change to tax rules,  -IR 35  -which means that staff who are not regularly employed but are contacted  with  “off payroll” , – have  to now pay the same tax and national insurance contributions as employed workers. this means there take home pay will drop -though most are still paid far more than the regular salary for that job, if they work as Agency staff. The NHS didn’t make the tax rules  but is having to deal with the consequences.

A number of staff, notably doctors, have abruptly withdrawn their availability for shifts, some at very short notice – less than 24 hours -unless the employer pays an increased rate to make up for the tax changes. This has meant that hospitals have had great difficulty in covering those rota gaps at short notice.  and some departments such as A and E have been threatened with closure. In my own Trust, we have a heavy reliance on locum doctors to staff A and E as we have not been able to recruit permanent staff, so our A and E has been badly affected.

it was hoped that all employers would” hold the line,” but some Trusts have agreed to pay the higher rate. So staff have moved to work with them, rather than the employer to which they had committed.

So is this reasonable action by locum staff , who can sell their services to the highest bidder? The law of supply and demand is  working well, one could say.

However, the medical regulator makes it clear that reasonable notice should be given if doctors are not available for agreed shifts.

The General Medical Council has warned that any locum doctors engaging in “unreasonable withdrawal” from work could exacerbate pressure on health services and potentially risk patient safety. This is against the professional code of conduct.

It remains to be seen if the action of some doctors will be judged to be “unprofessional” -i t depends on what you think is” reasonable notice”.  It is worth noting that some of these doctors have a long term relationship with certain Trusts -they may be employed on an ongoing basis. What price loyalty?

My hunch is that the Trusts will cave in and pay the higher rates, as they have to have continuity of safe services (with more strain on the budgets) . But it is an unedifying tale -and I  personally would say  we are seeing  “unprofessional behaviour”

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