NHS pays £1.2m a year for pair of locum consultants

THE NHS in Scotland is spending more than a million pounds a year to employ two locum consultants, an employment tribunal heard.

The bill of almost £1.2 million is for a pair of senior psychiatrists to cover the Western Isles and is an increase of £100,000 on the previous year, according to figures presented to the hearing.

The Isle of Lewis-based health board told the tribunal it struggles to fill the positions with permanent doctors and that overspending on temporary staff, who are looking to “maximise” earnings, has an impact on other patients’ care.

A locum can cost the health service £600,000 a year compared with £200,000 for a doctor who takes on a permanent role, the hearing was told.

The disclosures were made during a case involving Denitza Mihaylova, a consultant psychiatrist who was sacked after she fell ill and was unable to fulfil her on-call commitments at night.

Over almost two years, the NHS paid locums to cover her while she was off sick, but sacked her after concluding that funding this was “no longer viable”.

Ms Mihaylova sued the health board for disability discrimination and unfair dismissal, but her case was rejected after the tribunal found the health board had to manage its budget respon- sibly. The hearing in Stornoway was told Ms Mihaylova started work for the Western Isles NHS in September 2020 as one of two specialists providing 24/7 psychiatric services. This involved an on-call rota and regular visits to Uist and Barra as well as home visits to patients in crisis on Harris and Lewis.

“The second full-time permanent consultant psychiatrist had retired in 2018,” the tribunal was told. “[The health board] had been unable to recruit a full-time replacement.

“Between 2021 and 2023 the vacant post for a consultant psychiatrist was advertised eight times with no applicants. Accordingly, that post was filled from 2018 with locums.”

The tribunal heard that although there are agreements with some agencies to supply locums at a capped cost, because of the difficulties in finding doctors, health boards have to go “off framework” and recruit using other agencies at higher costs.

The projected cost of employing two locum consultant psychiatrists employed since Ms Mihaylova’s dismissal was put at £1,179,076.

“The requirement to secure locums... creates significant disruption with impact on both inpatient and community care,” the tribunal was told.