In a bid to target NSW’s workforce crisis, the state is investigating a plan to centrally manage locum allocation and develop a national price, raising alarm bells for some.
Suggestions of a national locum price from NSW’s health minister have raised concerns from a workforce “running on fumes”, and will likely be “ineffective” if rural work is not suitably incentivised says the AMA.
In May 2022, the NSW government was issued a scathing report of the state of health services in rural, regional and remote areas, with an unsurprising takeaway: the problem lies with workforce shortages.
As the rollout of the state’s 2022-2032 workforce plan – which was released in May 2022 – continues, NSW Health Minister Ryan Park is promising to make workforce a priority.
“We’re not going to be able to build our way out of this with new facilities and new services,” Mr Park told the ABC on Saturday.
“We have to focus on developing, retaining and attracting the workforce.”
However, one of the state’s proposed initiatives is raising concerns among doctors: a national price for locums.
Speaking to the ABC, Mr Park said NSW Health secretary Susan Pearce was spearheading a program to investigating a national price for locum doctors.
Mr Park said the move might manage the “distortion” of locum fees, heighted by the bidding wars between local health districts.
“In some communities we’re paying of the order of around $5,000 for locums,” Mr Park said at Budget Estimates earlier this year.
“It’s a challenge.
“We are looking at a piece of work—it is not yet ready to be presented to the cabinet—around whether we can manage locums centrally, internally, through NSW Health.”
Mr Park told the ABC that a “definitive decision” had not yet been made about the proposal.
But the idea is already raising alarm bells for some doctors.
In an open letter to NSW’s health minister and health secretary, published on LinkedIn yesterday, locum doctor Dr Josh Case raised “great concerns” over the proposal.
“Instituting a ‘national price’ for urgent healthcare vacancies is a short-sighted approach that will accelerate the collapse of our workforce in the long term,” he wrote.
“You can only ask your workforce to do more work for less pay for so long before you force them to move overseas or exit the healthcare industry altogether.
“Our public health systems have depended on the goodwill of the individuals who work in them for too long.
“And now they’re running on fumes.”
Dr Case labelled NSW Health’s monopolistic move, as the biggest employer in the sector, to restrict wages “grossly anticompetitive” and said it would not be tolerated in any other sector.
Dr Case flagged unpaid overtime, wage theft, workplace bullying, “the rampant credentials arms-race to bypass training bottlenecks” and lack of flexibility as more pressing issues deserved of funding.
“If all of our hospitals offered flexible, safe and well-supported employment, perhaps we wouldn’t have to spend a fortune to convince someone to work there in the first place,” he said.
“Particularly for doctors, who are at the mercy of hospitals administrations and specialist colleges, who conspire to dictate when, where and how they work.”
When asked about national pricing for locum doctors by Health Services Daily, a spokesperson for the AMA said that while the association “supports mechanisms to address locum arrangements”, “without addressing the factors driving doctors to become locums, these measures are unlikely to be effective”.
“There is a need to address the terms and conditions to make it more attractive for doctors to choose to live and work in rural and regional areas.
“This includes not only remuneration but ensuring that doctors are valued.”
An NSW-wide project to create a casual/locum medical pool has been trialled before and failed.
In 2008, Sydney West, Sydney South West, South Eastern Sydney, Illawarra, Northern Sydney and Central Coast area health services developed a program, which was extended statewide, to document a pool of non-specialist locums to match against vacancies with agreed locum rates across metro facilities and increased by rurality.
According to the Budget Estimates Secretariat, the project failed due to a lack of planning and resourcing to manage the change, inability to attract locums to the pool and out-bidding from agencies.
“Hospitals were not able or willing to hold back on escalation of shifts and rates offered to agencies, making the casual pool ineffective as locums could wait and get better rates through the agencies,” reads the paper.
The state has also started the roll out of the first phase of its deal with the Nurses and Midwives Association promising one nurse to every three patients in hospital emergency departments.
The reform faced some initial “teething issues”, according to Mr Park, causing delays to the roll out in Sydney’s Liverpool Hospital’s emergency department (ED) and Royal North Shore Hospital. However, other wards are due to follow suit in the future and the reform should be rolled out in rural and regional EDs by the end of this year or early next.