Feather in the Price Caps
Response to the proposal from Monitor and TDA on capping the rates for agency staff.
Recently Monitor and TDA published a joint consultation on the proposed price caps for all agency staffing in the NHS, including all clinical and non-clinical positions. The initial, November, caps are apparently based on the median rate payable on frameworks for these staff types (though I can't say I've seen frameworks offering these rates!), with them all then gradually moving down to become inline with Agenda for Change rates plus 55% - worked out to cover NI, WTD and any agency commission.
From a Procurement perspective this is an excellent step in the right direction, assisting us in attempting to control a growing issue within our Trusts, millions of pounds per year are being spend on Locum Drs, Agency Nurses, AHP and HSS and non-medical/non-clinical staff – especially at senior levels. However the bigger picture we should be considering is the potential impact these rate caps could have to our front line services, and how (if?) Trusts can implement plans to address this whilst still adhering to the caps themselves.
Before writing any more I’d like to point out that I am completely in agreement that some control needs to be exercised on this market, and I do support the proposal of caps in general - there is clear wriggle room in the charge rates of many agencies that we can affect positively with these. However, I feel that the plan is flawed on two major levels:
- By a lack of underpinning legal compliance and contractual agreements. At present the agencies are signed up to frameworks with agreed rates and caps that are set well above the proposed levels, unless the NHS stand as one organisation to enforce these new rates, there will be little to no compliance from the agencies; and as soon as one Trust folds as it ‘needs Mr x to consult in radiology’ then the rest will ripple and fold with it.
- On top of this, the behavior of the Doctors, Nurses and Interims who work through agencies, and indeed their own Ltd companies, needs to be addressed as at the end of the day it is ultimately their decision which rate they accept. With the lack of skilled and qualified individuals affecting the NHS on a day to day basis unfilled shifts may rise, and patient safety may well be affected, our back line services may also fail to support these with many senior positions in IT, HR and Procurement being held at an Interim level (myself included!) People working these shifts and positions need to learn to lower their expectations - joint communications from GMC and NMC may help this message to across to the medical and clinical community (although will be in direct contrast to the message from agencies which is seemingly – hold out for the higher rates!) The worst effected area that I have seen in this consultation is Junior Drs, this comes at a time when they are already at loggerheads with the Government on their change of contract, this will likely make them even less enamored with the profession and could even lead to more of a shortage.
Without a backbone of hard policies, compliant contracts and the NHS working in total and complete co-ordination, these issues will likely continue to affect us.
At the end of the day, patient safety needs to be NHS's number one concern and bearing in mind the current landscape, the capped rates are unfortunately likely to be exceeded on a frequent basis as Drs and Nurses hold out for higher rates themselves, though I do think that it might attract more back office staff back to their substantive posts.
It would be interesting to understand how Monitor and TDA propose to staff their monitoring and mentoring of Trusts who have difficulty in maintaining these caps, as they will be very busy.
I would be really interested to hear YOUR views on these caps, so please comment below!