The amount of money spent on temporary doctors to plug gaps in the health system has hit a new high, topping $200 million for the third year in a row.

Health NZ says it's working hard to recruit permanent specialists and has even cut the budget for locums for the next financial year.

But, others in the health sector say more drastic action is needed to bring the spend under control and incentivise doctors to stay on our shores.

Locums have a place

Dr James Irwin recently resigned as the last full-time permanent gastro specialist at Palmerston North Hospital, a service now staffed by locums and fill-ins from other districts.

He's seen the positive and negative side of using locums.

"In a a department, where you've got a full department and then someone is sick or goes away for a period of time, getting a locum is great because it helps fill holes and helps get work done.

"You have an expectation that you're going to have a full department going forward to deal with all of the long-term stuff and all of the departmental planning, and so forth."

Dr James Irwin.

RNZ / Jimmy Ellingham

Reliance on them, however, was less satisfactory when it became more of a medium-term arrangement, or longer.

"As a longer-term employee you're then the one that's dealing with all of the chronic disease management and planning for the department."

In the 2025-26 financial year, Health NZ spent about $220m on locums, up from about $208m in 2024-25 and $209m in 2023-24. The bill was $168m in 2022-23, Health NZ's first year of operation.

Irwin said constantly changing faces had an effect on continuity of care for patients too.

"It's a consequence of the transactional model of healthcare.

"If you employ a locum and pay them money to do something for six weeks, they come and do that, but they're not going to want to take on additional responsibility that continues after they finish," Irwin said.

"You need to be employing people in a situation where it's clear that they're going to be providing long-term care. That requires a long-tern appointment."

He said that's why permanent appointments were needed.

Budget trimmed after spend increases

Health NZ national director of people, culture, health and safety, Robyn Shearer, said the organisation was recruiting overseas and working with medical schools to get more doctors long term.

"It's a global challenge. It is hard to get all the doctors we need," she said.

"Locums play a really important role for us in maintaining continuity of care and staffing, particularly in specialities and regions which are harder for us to staff.

"They're an important part of how we fill and manage short-term gaps in our rosters and provide cover for our permanent doctors, in particular, to take a break."

New Zealand was competing against other countries for specialists, so Health NZ worked hard to promote the country as a great destination.

"We are in a competitive market, there's no doubt about it, and we have to be prudent financially," Shearer said.

"There is always a balance around what we offer, but we do look at, certainly, what New Zealand has to offer, and you'll have probably seen we've had an influx of doctors in the South Island from America who are promoting New Zealand as a great place to work and live."

She said health authorities had always used locums, but more were required as the demand for health services increased, putting pressure on the workforce.

However, Health NZ was looking to bring the cost under control, cutting the budget for the 2026-27 year to $179m.

"We are deliberately looking to have a decrease in our spend. What we are supporting districts and regions with is how we can given them information so they have more awareness of locum use and spend."

Shearer said Health NZ regions could look at alternatives, drive recruitment and look at "alternate workforce ways of working" such as using nurse practitioners.

Minister orders reliance to end

Executive director of senior doctors' union, the Association of Salaried Medical Specialists, Sarah Dalton, said locums did quality work, but permanent staff provided better value.

"When you're relying on locums to help run a service, anything from the complete collapse of the gastroenterology service in Palmerston North through to another service in another part of the country that needs locums on a regular basis to fill gaps in rosters, it is a cost to patients and to colleagues."

Association of Salaried Medical Specialists' Sarah Dalton.

RNZ / Jimmy Ellingham

Patient Voice Aotearoa's Malcolm Mulholland had another idea to try to hold on to doctors, rather than use more expensive locums.

"I do not for the life of me know what Health NZ aren't coming up with a better plan - something along the lines of getting our best and brightest when they graduate from med school and bonding them in hard-to-staff areas.

"[Health NZ] could say as part of that bonding, 'We're also going to take care of your student loan.'

"To my mind it would still be a cheaper option than looking to employ locums left, right and centre."

Simeon Brown.

RNZ / Louis Dunham

Health minister Simeon Brown has written to Health NZ's chairperson, saying he expects the organisation to move away from depending on locums.

"As a priority I expect you 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," he wrote.

The minister's office told RNZ locums would always play a role, as the minister's priority was to make sure patients received the care they needed, when and where they needed it.

"However, the long-term goal is to build a stronger, more stable workforce, with more permanent staff delivering care across the country, and the minister has made that expectation clear to Health New Zealand."