THREE A&E locum consultant posts have cost the NHS more than £1m over the past year due to staff shortages - a bill that a senior health official has criticised as "excessive".
The Irish News has learned the Northern health trust has paid £365,000 a year to cover each of the stand-in doctors it has required to staff the Causeway hospital emergency department in Coleraine due to its inability to attract permanent staff.
Dr Seamus O'Reilly, who is the trust's medical director, hit out at the salaries and warned how the NHS has become increasingly reliant on costly recruitment agencies to maintain safe staffing levels in emergency care.
While private agencies get a percentage of the £365,000, it is understood the doctor takes home around £300,000.
Dr O'Reilly confirmed that the Causeway hospital in Coleraine has been reliant on three stand-in senior A&E consultants for the past year - despite repeated recruitment drives.
Only one trust-employed A&E consultant is based at the Causeway and has been there since 2006, earning around £120k a year.
"Locum consultants do provide a very valuable contribution...but are they worth the £300k? ... I don't think so," said Dr O'Reilly, who has 20 years' experience working as an emergency consultant.
"We have created a market out there because of shortages and doctors have rightly or wrongly benefited. The amounts of money being paid are not appropriate.
"On the surface the financial awards appear to be attractive and there is significant earning capacity but the benefits of being in a substantive (staff) post mean you get sick pay, holiday pay and paid study leave.
He added: "I would be a fool if I didn't admit the (locum) amounts are excessive."
When asked if he thought the higher rates being paid to medics to to provide temporary cover was unfair on the one permanent consultant at the same hospital, the health chief replied: "I'm sure if you were that member of staff you would feel aggrieved."
The Causeway, which sees over 40,000 A&E patients a year, is funded to ensure that four consultants man the department.
Up until two years ago, the Coleraine department had three permanent consultants and one locum in place.
Like Daisy Hill A&E in Newry, both hospitals have struggled to find full-time staff replacements and there has been intense speculation about their future to function as 24-hour facilities - particularly the Co Down unit which was under threat earlier this year due to staff shortages.
The issue of locums also hit the headlines in August when the Department of Health ordered £70 million in budget cuts to be made across the health trusts - with the bill for temporary medics and nurses the main target.
Dr O'Reilly said the lack of workforce planning across the the entire healthcare system "had created the situation we are in".
He also insisted that Causeway hospital's A&E was "very important" but had become over-reliant on locums.
"Our locums are highly trained doctors providing good levels of care. I have no concern about the clinical side of things as these locums have been there for some time."
He added that the problems in hiring staff could be linked to the hospital's 'rota intensity' - senior doctors in Coleraine are on-call more often at night - as well as its geographical location.
"When you go to a bigger unit such as Belfast there is more cover and better work-life balance. We are never going to match any of the bigger hospitals...but we have changed our rotas to make it less onerous.
"The Causeway by and large has been unsuccessful in recruiting ED (Emergency Department) consultants...and when you need a department to open, one way of safely staffing it is through locums."
A spokesman for the Northern trust confirmed it has advertised six times for ED/A&E consultants and 'speciality doctor' positions over the past two years. A new recruitment drive is currently underway.
He added that a new A&E consultant locum began work on Tuesday, October 31 - replacing a 'permanent locum' who had been there for two years.
A second locum A&E consultant has been in post for the past year while a third took up the role six months ago.
"£365k is the average cost over the past 12 months of employing a locum consultant through an agency in Causeway ED. We contract with agencies to supply all of the locum consultants so the 'cut' the agency takes is between them and the locum consultants themselves," said a spokesman.
"The number of consultants in ED at Causeway is four - currently one permanent and 3 locums employed through agencies. That has been the case for some time and is the minimum number required...The four provide the required cover 24/7 and 365 days a year."
