Back to Blog


Why the “Break Glass” Clause is Necessary

Since November 2015, there has been a cap on the hourly rate that can be paid to locums in the NHS. The limit applies to agency-supplied doctors and nurses, and other clinical and non-clinical staff. It began at the normal rate of pay plus 150% for junior doctors and 100% for other staff, and has been steadily reduced until, as of 1st April 2016, it sits at the normal rate of pay plus 55% across the board.

At first glance, the obvious cost savings might seem like a good thing, but are they? The NHS Improvement oversight organisation reports mixed results…

Is the Locum Salary Cap Working?

On the one hand, it claims that the cap has so far saved the NHS a massive £300 million. On the other, a recent survey reveals that the number of unfilled shifts has either stayed the same or increased. With patient safety being of paramount importance, it would seem the cap hasn’t helped.

And while Health Secretary Jeremy Hunt has boasted that the cap has allowed the NHS to “turn the tide” on agency spend, a survey conducted in April found that three quarters of shifts worked in the ten weeks after the cap was introduced breached it – tellingly, this is due to there being provision built in for the cap to be breached – the so-called “break glass” clause – if patient safety is deemed to be at risk.

Locum Nurses are a Vital Resource

The reason for the rise in the use of agency nurses was twofold: first, the need to have more nurses on wards in the wake of the Stafford Hospital scandal, and second, because of a shortage of student nurses. NHS Improvement reports that hospitals in England are 15,000 nurses short of the number required to ensure patient safety.

Janet Davies, chief executive of the Royal College of Nurses (RCN), says: “Agency cap breaches are a barometer of the scale of the NHS’s workforce problem, and it shows clearly that the problem is getting worse. NHS Trusts are unable to recruit nurses and are rightly prioritising patient safety over sticking to the cap. This is a workforce planning issue. The number of nurses being trained in the UK has been reduced, for short-term financial reasons.”

The Public Accounts Committee also supports this view: “The NHS will not solve the problem of reliance on agency staff until it solves its wider workforce planning issues.”

“Break Glass” is Essential, Not a Rip-off

While the use of agency staff might not be seen as ideal, with a chronic shortage of staff overall it seems essential. And the fact is, agency and temporary locum staff have been relied upon within the NHS for decades. Would removing the cap help?

It would arguably mean unfilled shifts could be reduced, as the cap inhibits the ability to recruit enough staff to meet patient demands in an understaffed sector. In addition, as the cap needs to be routinely broken, there’s a case for arguing that it is both ineffective and set at the wrong level to start with.

Would the inflated costs associated with triggering “break glass” be somewhat reduced if the locum pay cap was relaxed s0 “break glass” needn’t be triggered so frequently?

The underlying issue of too few staff being trained undoubtedly needs to be addressed. However, while there is a lack of staff available, agency staff are essential to ensuring patient safety, and a cap on locum pay would seem to be counterproductive to this aim.

Are you an NHS manager with experience of the “break glass” clause? We’d love to get your opinion on the current system and whether you feel it’s working, so please leave a comment or message us via Facebook.

Image source

Carry on reading