Trust moves away from ‘disturbing’ agency doctor model

A major acute trust says it plans to move away from its significant use of agency doctors from overseas, who have been reported to be working on terms and conditions far below their NHS-employed counterparts.

East Kent Hospitals University Foundation Trust has a contract with the NES Healthcare agency to supply 47 “resident medical officers” across its three main sites to cover trauma and orthopaedics, medical and surgical rotas.

Employment practices for overseas agency RMOs have been the subject of concerns reported in recent weeks in relation to their work at many private hospitals.

However, it has now emerged that NES is also contracted by East Kent to provide dozens of RMOs, and HSJ has been told of concerns that they too report substantial overworking, and poor terms and conditions, although some of these claims are disputed by NES.

RMOs do similar work to junior doctors, and the East Kent trust started to use them in 2017 when medical trainees were withdrawn from the Kent and Canterbury Hospital by regulators because of quality concerns. Since then, its reliance on them appears to have grown.

However, East Kent chief medical officer Rebecca Martin has now told HSJ: “The well-being of all our colleagues is one of our top priorities and we are working with the agency about how they cover the rota safely.

“We are committed to providing a safe workplace environment, where RMOs feel comfortable communicating their feedback and we review working patterns to ensure adequate rest periods between shifts. We are actively working to use substantive staff to fill vacancies, and have already been able to offer some of those positions to current RMOs.”

HSJ has seen 24 responses to a survey, carried out by the British Medical Association, from doctors – overwhelmingly from West Africa – who say they either currently work at East Kent, or have done previously, via NES Healthcare.

NES Healthcare recruits the doctors from overseas and arranges their travel then work in the UK. Other agencies – mostly with nurses – do so, but this is normally to find staff to move into NHS trusts’ direct employment.

One doctor said: “They exploited us due to the desperation to have a better life… the treatment I received for 18 months would probably leave me scarred for life.”

 The responses state that:

• Doctors saying they had to opt out of the 48-hour working week which applies to employed NHS staff. Some doctors report working excessive hours, including 87 hours in a week in one case and 20 out of 21 consecutive days. Three-quarters of the 24 respondents, asked how many hours per week they were required to work, selected more than 70.
• Concerns about safety risks for both doctors and patients from the hours worked. Several doctors said they worked seven consecutive night shifts (the current juniors’ contract only allow for four).
• Doctors have been required to cover for their absent colleagues when they are not due to work, in what are called “standby weeks”.
• Very limited sick pay – even if the doctor was off with covid. One survey respondent said: “Most of us stopped testing for covid because, if confirmed positive, the pay for 10 days was cut automatically.”
• Doctors having to fund courses such as advanced life support, and appraisals, themselves – in some cases costing them more than £1,000.

NES says its terms and conditions are completely transparent and fully compliant with UK law. It says that the opting out of the 48-hour week is voluntary, and the requirement for RMOs to be on standby is subject to a cap on the total number of hours which they can work.

In a statement, a NES spokesman said: “The findings of the BMA’s small survey do not correspond with our experience at all. Feedback from our doctors is extremely positive.

“Overseas doctors are vital for the NHS, and NES provides those people who want to work here with a safe and supportive route to pursue their career choice in the NHS and in the UK healthcare system more generally.”

Some respondents were happier with their treatment and support, however, with seven of the 24 respondents reporting a good experience, and one saying it gave them the opportunity to work in the UK.

But BMA Council deputy chair Emma Runswick said: “The testimony we have seen from RMOs employed at EKHUFT is highly disturbing. We and Doctors’ Association UK put out this call for evidence to RMOs across the UK, and East Kent showed the most reports of deductions from pay, impossible rota expectations, miserly leave entitlements and general poor treatment of any trust we saw.

“RMOs at East Kent, fully trained doctors, have worse conditions than the trainees they work alongside, and far worse than the NHS standard. The kind of testimony we have seen, showing dangerously long hours and exhausted doctors, is in no one’s interest, especially not the patients who may be put at risk by doctors who are asleep on their feet.

“This has got to stop. We have been attempting to work with East Kent, and other trusts using agency RMOs, to improve conditions. These trusts need to get their act together and ensure the standards offered are brought up to that of NHS doctors. We will continue to support RMOs with our contract checking service and our anonymous support channels, in East Kent and across the country.”

Although RMOs are widely used in the private sector, and some other NHS trusts are believed to make limited use of them, HSJ is not aware of another NHS trust which is dependent on them in the same way as East Kent.

In the past six months, East Kent paid just under £2m to NES Healthcare, which supplies it with RMOs, according to published spending data. This may cover other services, too.

A report to East Kent’s most recent board meeting said the trust recognised RMOs’ working patterns were not in line with other junior doctors and the trust planned to review that “current working arrangements and rest periods are safe for patients and doctors”.

It said that ultimately it wanted to move to a “sustainable substantive junior medical workforce”. It indicated this would cost more but that there were “significant quality benefits of a directly employed workforce”.

NES Healthcare, which supplies doctors on fixed-term contracts, said it recruits, assesses and trains the doctors before they start work. It added it organises holiday cover and emergency replacements for sickness.