Health bosses battle with heavy locum spends amid GP shortages

Hefty locum costs and a shortage of permanent GPs means health chiefs are facing a half a million overspend in primary care.

Members of Shetland’s Integration Joint Board – which oversees health and social care, were told the cost of employing locum GPs was expected to tip £500,000 by the end of the financial year.

This included £67,000 for Bixter, £130,000 for Whalsay, £157,000 for Yell, £137,000 for Unst and £18,000 in Lerwick.

Further costs of £76,000 were expected as part of the transfer of staff at Scalloway.

The board is hoping to make more savings, though members heard that it across all its activities it could overspend by about £2.9 million.

This would be an overspend of almost £190,000 in the council arm of the board’s finances and about £2.7 million from NHS Shetland.

Mental health spending could also be £131,000 more than planned. This is largely due to the presence of consultant locum psychiatrists, booked until the end of November, and possibly longer.

The board was told that it is expected to break even at the end of the year with funds available from the SIC and NHS to cover overspends.

However closed door talks were held about how to address the crisis in funding and how to make savings.

Director of community health and social care Simon Bokor-Ingram also said there could be another pressure on the back of the Scottish government’s announcement it would scrap the one per-cent pay cap on public sector workers.

He said, while there were no details of what the increase would be removing the cap would mean more savings would be needed to provide pay increases.

With multi-million-pound financial pressures for both NHS Shetland and the SIC, board vice-chairman Allison Duncan continued to argue for more funding from the Scottish government.

He said it was clear funding was not forthcoming – either for inter-island ferries or health and social care. This was following recent ministerial visits from transport minister Humza Yousaf and public health and sport minister Aileen Campbell,

The £554,000 predicted overspend in primary care was a “horrendous amount of money”, Mr Duncan said, and he questioned what more could be done to attract GPs to the isles.

“I’ve said it before and I’ll say it again we have to make a case to the Scottish government, because locums are costing us an absolute fortune,” Mr Duncan warned.

He added:”The transport minister… made it quite clear in his visit there will be no more funding for Shetland. He highlighted the fact the [inter-island] ferries were our problem and not theirs.

“There’s a £7 million default there which has to be sorted out.”

Mr Duncan said it was “quite clear” the Scottish government was “wanting us to use our reserves”.

“That’s quite clear to me now and I’ve evidence-based that in the council and I will say it here.

“This [pressuring the government] is what we have to do because if we don’t, with the cuts that have to come in future years, it’s going to be catastrophic for Shetland.”

Members were told the current primary care model was not sustainable.

Lead nurse Edna Mary Watson questioned whether there was a timetable in place to redesign primary care as it was becoming “more and more important” because of the reliance on locums.

Mr Bokor-Ingram said there was “a map and timetable” for primary care and ” a raft of work” was under way.

More advanced nurse practitioners (ANPs) had been used in Lerwick, he said and they were being used in Brae to shore up clinics and support GPs.

“Bespoke solutions” were needed for Yell, Unst and Whalsay, he added, where there were geographical and on-call challenges.

Members were told work is being done to see how services can be provided across the North Isles as an area, rather than looking at individual services.

Mr Bokor-Ingram said GP views were needed on how to redesign services, as well as looking at whether other members of health teams, such as nurses and ANPs could support GPs.

This would involve communities to have their say too.

“We need a level of GP input and that’s what’s proving difficult,” Mr Bokor-Ingram said.

The health and social care boss added: “This is a UK-wide problem but it’s more still in the north of Scotland. The more further north you go in Scotland the more difficult it gets. I think it’s about redesigning as sensibly and quickly as we can.”