Trust reveals 'extraordinary measures' after IR35 causes locum shortage

United Lincolnshire Hospitals Trust (ULHT), currently in quality special measures, laid bare the impact on its emergency departments after unfilled hours on doctors’ rotas soared tenfold, from 16 hours a week to 166 last month.

HSJ was told the trust’s main A&E at Lincoln County Hospital was just hours from closing, and hospitals in the East Midlands stepped in to provide staff when locum doctors pulled out of shifts after IR35 regulations came into force on 6 April.

The regulations changed the tax arrangements governing temporary staff and caused disruption across the NHS.

Now the trust, which runs Lincoln County Hospital, Pilgrim Hospital in Boston and Grantham Hospital, has revealed the “exceptional but unsustainable actions” it was forced to take to keep its emergency departments open.

“Extraordinary measures” included:

• The declaration of a critical incident between 5 April and 19 April
• A&E consultants staying overnight in Lincoln County and Pilgrim Hospitals to act as middle grade doctors
• Drafting two surgeons including an orthopaedic surgeon, a paediatrician and physician into emergency departments to provide additional cover
• “System wide support” from NHS Improvement and neighbouring trusts less affected

In the trust’s board papers last week interim medical director Dr Neill Hepburn confirmed the introduction of IR35 had a “profound impact” on the recruitment of locums and the trust’s ability to “maintain a safe level of service in A&E”.

He stated in a report: “Coincidently and perhaps as a consequence, many locums and agency medical staff have become ‘unavailable’ for employment since early April.

“This has had a profound effect on many NHS organisations that employ locum medical staff. ULHT and in particular our A&E departments rely very heavily on these staff. Therefore, the change to the taxation rules has had a disproportionate effect on the running of our A&E departments.

“At present, it remains unclear for how long the pressures on medical locum staffing will continue.”

The new regulations shift the responsibility to pay tax for “off payroll” workers in the public sector to the employer. Some temporary staff have expressed anger over the changes, which increase the tax liability for those who had previously used personal service companies to manage their locum work.

ULHT had already restricted opening hours at Grantham’s A&E, now extended for a further three months, because of shortages of emergency doctors before the IR35 regulations came into force.

Dr Hepburn said significant recruitment for emergency doctors had been under way across ULHT for “a considerable amount of time”, with two recently joining the trust. However, they will only join the middle grade rota after four months on the junior doctors’ rota.

He said: “It is important…to be aware that the recruitment of trained medical staff of appropriate seniority and the provision of 24/7 A&E services remains very fragile.

“The recruitment of middle grade doctors to ULHT remains particularly challenging and volatile.”