Health New Zealand spent just over $216 million on locum doctors last year - the most it’s spent since the organisation was formed.

Figures released to Newstalk ZB under the Official Information Act show that’s up from the nearly $209 million spent in 2024, and just over $186 million in 2023.

Lakes District had the biggest jump, from $5.6 million in 2023, to $12.2 million in 2025, which is just shy of the $12.5 million spent in the Auckland DHB area last year.

Robyn Shearer, Health NZ’s executive national director people and culture, health and safety, said locums play an important role in maintaining continuity of care and ensure safe staffing levels, particularly in hard-to-staff specialties and regions.

“Locum work is an important factor in supporting hospitals facing acute staffing shortages and providing cover for areas where we continue to have gaps in hard-to-recruit locations or specialities, or when we need to support doctors to take their leave.”

Shearer said clinicians stepping into locum roles often help sustain services that would otherwise be at risk.

“Our aim always is to ensure we continue to prioritise recruitment for our permanent staff, but locums do have a place in the health system to cover for these circumstances.”

The Association of Salaried Medical Specialists (ASMS) Executive Director Sarah Dalton said while there’s always going to be some need for locums, it shouldn’t be to the extent of current spending.

“What we know is that Health New Zealand would get better value for money out of making more permanently appointed doctors, but they persist with FTE caps even in services with an established need for more staff.”

Dalton said even when a service knows there’s more work than they are able to do on current staffing levels, they are not being approved for that extra staffing.

Shearer said decisions about staffing levels are made based on a range of factors, including patient demand and service levels.

She said they are continuing to work closely with clinical leaders and districts to ensure services are appropriately staffed and to balance immediate service pressures with longer-term sustainability.

However, Dalton said when services are short-staffed and can’t cover gaps, that adds to the need for locums.

“The cost for employing locums is much higher...than if they got ahead of things and proactively appointed more staff.”

Dalton said the smaller hospitals are really exposed as they run small services and don’t have the “luxuries” of large teams.

“If they get one resignation, another retirement or someone falls sick, their services can be smashed. They’re incredibly vulnerable, they have a heavy reliance of locums and in fact, traditionally, have often had to have a partial reliance on locums even to staff their core rosters, or after hours and weekends.”

Late last year, Health Minister Simeon Brown sent a letter of expectation to Health New Zealand, outlining a priority for the organisation to “monitor and prioritise shifting away from dependence on locums to recruiting permanent

Senior Medical Officers to vacancies - with an initial focus on regions that have high dependency on locums”.

Brown told Newstalk ZB his priority is making sure patients receive the care they need, when they need it.

“That means locums will always have a role in our healthcare system. However, our long-term goal is to build a stronger, more stable workforce with more permanent staff delivering care across the country, and I have made that expectation clear to Health New Zealand.”

Shearer said Health New Zealand was also taking a range of actions to strengthen the permanent workforce and reduce the need for locums over time.

“This includes ongoing international and domestic recruitment, expanding training pipelines for domestic medical students, improving retention through workforce initiatives, and supporting more flexible models of care to better match staffing with demand.”

Health New Zealand is taking steps to better monitor and measure the locum spend and will be looking at further measures this year to shift from using locums to recruiting more permanent staff, Shearer said.

“Government investments in a new medical school, and in greater capacity for existing medical schools, will strengthen our home-grown medical workforce for years to come.”

The ASMS said the Government and Health New Zealand need to come to the party and put some “hard to staff” rural allowances in place.

“It’s a harder sell sometimes, they’re worried about where their partner is going to work, or where their kids are going to school, or what the opportunities are in those smaller areas,” Dalton said.

The type of work was also relevant, she said, with senior doctors and dentists sometimes having to do the tasks a registrar might do in a larger hospital, and that needs to be recognised.

Danica MacLean is an Auckland-based news director and senior reporter for Newstalk ZB, with a focus on health stories. She joined NZME in 2017, initially working for the Northern Advocate before switching to radio. She has previously worked for Stuff in Northland.