Over the past couple of weeks BBC News has been focusing attention on locum doctors, reporting information which they have gained based upon freedom of information requests which they submitted. Here’s a quick bullet point summary of the key financial points raised by these reports:
– Almost one in four A&E departments in hospitals in England fill more than 25% of their senior staff vacancies with agency doctors or locums.
– The reliance on freelance staff to fill senior posts costs hospital trusts more than £120m a year.
– NHS Scotland spent a record £82m on locum doctors last year, an increase of £18m on the previous year
– Western Isles and Shetland spent a third of their entire medical staff budgets on locum doctors.
These issues are related to the challenge that bodies NHS are facing increasing difficulty in meeting their financial targets.
Concern is also raised about the direct impact that locum doctors can have upon patient safety, particularly when unknown to the organisation employing their services and working in an unfamiliar environment. Prof Suzanne Mason, of the College of Emergency Medicine, is quoted: “They often will provide different levels of care and perhaps not such high-quality care as we would come to expect as a specialty. That may be due to a lack of knowledge of the local systems but it may also just be due to just a general lack of clinical experience.”
Most sectors of employment have the need for a quality flexible workforce and healthcare is no different. Locum doctors are essential for continuity of care to cover vacancies, holidays, maternity cover, secondments and unplanned absence being the key drivers. In keeping with the majority of other sectors there are always geographic areas or particular specialities where these challenges are greater than others.
Where the government estimates the vacancy rate for consultants is 7%, the BMA puts this figure at 11%. The challenge for NHS management is to strike the right balance between flexible and permanent staff and to make their vacancies attractive to the appropriate doctors.
There are numerous reasons why a doctor might choose to undertake work in a locum capacity. But what of the previously mentioned negatives and concern expressed, in particular the issue of patient safety.
So what should any doctor working, or planning to work as a locum should bear in mind?
I discussed the topic with ID Medical, the award winning supplier of locum doctors to over 90% of NHS hospitals and private medical sector organisations. Their advice is that you need to take many factors into consideration when choosing to locum, but fundamentally these should all revolve around professionalism, from selecting the correct jobs to ensure your own safety and that of your patients, to selling yourself and showing all you have to offer.
You should select an agency which is on the national framework, regulated and audited on compliance documentation who will offer you the opportunity to build a strong relationship with a named agent. When working as a locum the most important priority should be your safety and the safety of your patients, not your bank balance. This means that you should think very carefully about which jobs you volunteer for. How can you care for patients if you don’t know the system for checking their blood results or ordering investigations? You can make life easier by choosing sites at which you currently work or have worked previously, where you understand and have access to the systems. Alternatively report early to your post to make time for the person you are taking over from to explain these systems to you.
In addition to the technical skills required the meet the requirements, the very best locums have excellent team communication and time management skills. Such doctors can fit into the team effectively and efficiently, providing continuity of care, rather than being a hindrance or posing a risk, so attention should be given to the development of these skills.
Ultimately, with careful thought and planning, locuming can be one of the most enjoyable moves you will make in your career, offering variety, flexibility, and fun – as well as ensuring the essential continuity of care which patients require.
