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Trusts spend over £100m covering doctor shortage

BBC Health - 1st July 2011 11:46 am

Local health trusts have spent over £100m in the past four years covering the shortage of doctors in hospitals.

A report by the Northern Ireland Audit office into the use of locum doctors says annual savings of up to £5m could be made if the system was managed better.

They are in demand due to changes to immigration law and European legislation on working hours.

Hospital managers have said that sometimes they have no other choice but to turn to agency cover to ensure patients are managed safely. Such practice is, however, landing the health service with an excessive bill.

According to the NIAO, more than £100m was paid out to locums in the past four years in order to fill gaps in hospital rotas.

Last year alone, £22.5m was spent - 8% of the total spend on medical staff.

The Western and Northern Health Trusts are singled out for their spends which are 11% and 17% respectively.

Locum consultants must be qualified, RCS says

By Mike Broad - 19th May 2011 3:55 pm

The Royal College of Surgeons has warned trusts not to fill locum consultant positions with doctors ineligible to be called a consultant.

It blames the European Working Time Regulations saying trusts are struggling to find appropriately qualified locums to plug the many rota gaps created by a 48-hour week.

All patients should be able to expect the same standard of care whether they are treated by a locum surgeon or a permanent member of staff, the RCS says.

Only surgeons who are on the specialist register, or those within six months of completing recognised surgical training, are suitably qualified for locum consultant positions.

New guidance recommends that trusts do not extend locum surgeon appointments for longer than a year, as long-term cover is best provided by fully qualified surgeons working in permanent posts that provide stability to a department.

Mr John Black, president of the Royal College of Surgeons, said: “Locum surgeons are supposed to be employed to cover short-term absences in hospitals, but with the added pressure on surgical rotas caused by the European Working Time Regulations, the NHS is being forced to seek out alternative solutions in order to plug long-term gaps. The result is that some NHS hospitals are being staffed by inappropriately qualified or inexperienced, locum surgeons.”

Building on existing guidance, Locum surgeons: Principles and Standards, outlines what the RCS expects of both the trusts who employ the services of locums - either directly or through agencies - and of the locum surgeons themselves.

Employers have a responsibility to check the qualifications and skills of locum surgeons and ensure that individuals are aware of local policies and procedures.

Mr Chris Milford, author of the standards document and RCS council member said: “Locum surgeons perform an essential role within the NHS, covering periods of expected and unexpected leave or high demand to ensure that patients are provided with surgical care. This guidance reminds trusts, locum agencies and, locum surgeons that they should be complying with standards the RCS expects of all surgeons, including participating in outcome reporting and preparations for revalidation.”

Read the standards.

Tags: Locums, Surgeons, WTD
Posted in Hospital Dr News | 1 Comment »

Armageddon for out-of-hours rotas finally arrives

By Caroline Whymark - 23rd February 2011 12:08 pm

It has finally arrived - the staffing crisis that has long been threatening to hit out-of-hours rotas.

The crisis has been coming such a long time that you would have thought a plan for managing it would have been put in place. We thought it would arrive in 2007 when MMC restricted training numbers. We then thought it would arrive in 2009 when the 48-hour week finally became law. But only this year, has push really come to shove.

When will those at the top of the decision-making tree actually listen and take heed of the day-to-day difficulties currently facing clinicians?

Money has been found here and there and diverted from many pots to fund a couple of extra consultant jobs (which to date don’t solve the first on rota problem).

As trainee numbers have dwindled the unused salaries have been identified and made available to be used for specialty doctor posts. But that solution doesn’t work in practice. There are fewer and fewer applications for our almost continually run specialty doctor advert. This is largely because there are no such doctors out there anymore. They are either in Specialty Training or in Australia.

Nor are there any locums. Since the ‘lost tribe’ found other sources of employment and other doctors were refused entry to the country, there is no pool of locums. Trainees are limited to a 48 hour working week. They cannot readily do the locums shifts even when extra money is available.

But, crunch time is here. Forty per cent of our trainee cohort are about to leave the programme due to a variety of bona fida reasons: a year abroad, a specialist fellow post, an inter deanery transfer, a maternity leave. These leave unfilled and unfillable posts.

Unfortunately, it feels like no-one is really listening. Perhaps we are our own worst enemy by continually coping with such staff reductions. But the slack in our system has run out. We will no longer be able to run our rotas.

What’s the solution? The number of man hours available within the system is finite.

We could waive the working time regulations, and revert to an on call system with more hours in hospital, but recognising that all of them are not spent working.

The other option is to merge sites and reduce the number of rotas to maintain current out-of-hours staffing and services. This would undoubtedly be unpopular. Smaller hospitals would close, MSPs would lose their seats, the public would lose their local hospital services and have to travel further afield for treatment.

But, is this a bad thing? Maintaining medical staffing on a wing and a prayer is not a success at any level.

The hope is that we will struggle on managing in the short term. In 2012, a bulge of trainees will finish their training culminating in the CCT and entry to the specialist register. They will be consultants in all but name or pay (status went a long time ago). There will be plenty of them, desperate for any jobs with which to pay the mortgage. The old rules of supply and demand will force them to take the jobs on offer and, lo and behold, we will have specialists to deliver the service.

But we can’t wait for them. Our out-of-hours Armageddon happens before then. Our workforce is annihilated now and trainee numbers continue to be reduced.

There will be a gap, and this sort of gap will threaten patient care. The radical and unpopular decisions that are needed will be postponed until after 5 May, the date of the next Scottish parliamentary election. And there’s a danger that they’ll be postponed until after the next one, and the next one…

Tags: Locums, Workforce, WTD
Posted in Caroline Whymark | 7 Comments »

Healthcare Locums suspends its founder and FD

Telegraph - 26th January 2011 11:54 am

Kate Bleasdale, the colourful entrepreneur who won a record sexual harassment case, has been suspended from the medical recruitment company she set up.

Healthcare Locums suspended executive vice-chairman Bleasdale and finance director Diane Jarvis on Tuesday amid allegations of “serious accounting irregularities”. The company also suspended its shares and warned financial performance for 2010 could be materially below expectations.

Although the company would not give details, the investigation is expected to look back to March 2010 when Healthcare Locums’ shares plunged 30% after it restated the prior year’s accounts. With Bleasdale at its head, Healthcare Locums has been one of the most closely followed companies on the Aim market. A steady stream of acquisitions pushed the shares up from 127p at the start of 2009 to 282p a year later. Since then they have fallen back to 112½p, where they were suspended.

Spending on locums rockets due to EWTD

By Mike Broad - 12th November 2010 12:04 pm

Spending on locum doctors by hospitals in England has rocketed in the past two years, figures show.

The cost of hiring locums in 2009/2010 was £758m the Royal College of Surgeons has learned and it blames the introduction of the 48-hour week for juniors in August last year.

Figures obtained from 96 trusts under the Freedom of Information Act show that annual spending on all hospital locum doctors has increased by almost £200million in the past year alone and has almost doubled since 2007.

The RCS estimates that since the introduction of the EWTD in the UK the NHS loses more than 400,000 hours of surgical time a month while still managing the same workload. This escalation in locum costs is because hospitals have to fill rota gaps created by the reduced working hours of staff, it said.

RCS president John Black said: “It seems ridiculous that at a time of economic crisis, with wide-ranging cuts to services across the board, we are seeing astronomical sums of money being thrown at locum doctors in order to prop up services that are only falling apart because of an ill-conceived European law.”

The RCS says the units providing 24-hour acute care, where staffing requirements are high and complex, have been worst affected. Trusts have had to employ staff already working for them to fill gaps. So-called ‘internal locums’, cost the NHS £206m in 2007/2008 rising to £311m by 2009/2010.

The largest increase in costs, however, has been in the amount paid to external locum agencies as the NHS is forced to seek doctors from all over the world on highly paid short-term contracts as the supply of available UK doctors runs dry, the RCS says. Costs rose from £174m in 2007/2008 to £467m in 2009/2020.

Dr Richard Marks, head of policy of Remedy, said: “All of this was so depressingly predictable in advance. The rigid rotas from the EWTD and the inflexibility of annual recruitment were both led by the people who don’t need to foot the locum bill themselves. The costs have increased and the standard of locums is highly variable.”

Regionally, the spending on locums was highest in 2009/2010 in London with £187m, followed by the North West with £130m, and the West Midlands with £92m.

Health secretary Andrew Lansley said the increases were “unacceptable” and acknowledged the negative impact of the EWTD. He recently said he would be supporting the business secretary in re-establishing the opt-out for NHS workers.

In terms of roles, the most (£309m) was spent on locum consultants, followed by CT/FY trainees (£137m), then SpRs (£126m) and finally staff grades (£91m).

Dr Shree Datta, co-chair of the BMA’s junior doctors committee, said: “This is not just the result of the WTD, but also the financial pressures on the NHS. Many hospital departments across the country are experiencing staffing problems as recruitment freezes are imposed to save money. As they become increasingly desperate for cover, they are likely to be forced to pay locum agencies at higher rates than if covered internally.”

Tags: Cuts, Locums, WTD
Posted in Hospital Dr News | 5 Comments »

15% could be saved on locums in Scotland

By Mike Broad - 26th June 2010 8:05 am

The NHS in Scotland could save almost 15% of the money it spends on hospital locums - or £6m a year - through better planning and procurement.

An Audit Scotland report, Using locum doctors in hospitals, says health boards spend around £47m a year on locums. This spending has doubled in the past decade but, in many cases, health boards are not always clear about why locum doctors are being hired and how long they are using them for.

Auditor general for Scotland, Robert Black, said: “Locum doctors have an important role in ensuring hospitals are adequately staffed and provide good quality patient care around the clock. In recent years, the demand for locum doctors has risen due to workforce issues such as increased difficulty in filling vacancies and the impact of European legislation governing working hours.

“Health boards need better information about why and when they use locum doctors; the grades and specialties of doctors they are hiring as locums; and whether locum doctors are existing employees or from agencies. With better information, boards could improve their workforce planning and use locum doctors more cost-effectively.”

The report also says the NHS needs to get better at managing the potential risks to patient safety of using locums. This is particularly important for locums hired through private agencies as they may be unknown to the board and unfamiliar with the hospital in which they are working.

Health boards across Scotland need to be consistent in the way they screen and induct locum doctors and the way they manage their performance. For example, pre-employment checks are not always formalised, induction arrangements are variable across different health boards, and feedback on locums’ performance is mainly verbal, with few written assessments or records. There are no formal systems for sharing information about individual locum doctors between boards.

Read the full report.

Tags: Locums
Posted in Hospital Dr News | 1 Comment »

Safety fears as European doctor numbers revealed

The Telegraph - 7th September 2009 12:30 pm

Of more than 20,000 EU doctors registered to practice in this country, 4,061 have arrived since safety checks were removed five years ago.

The figure comes amid increasing concerns about the lack of scrutiny of medics who migrate to this country.

Figures from the General Medical Register show that among the foreign doctors registered to work in the UK, more than 5,000 are from former Eastern bloc countries.

Of those, the greatest exporter was Poland, which trained 1,800 medics now on the British register, followed by Hungary, which sent more than 1,000. More than 700 came from the Czech Republic and almost 800 from Romania.

Under an EU directive passed in 2004, doctors who qualify in any EU state can move to work in any other member state without tests of their language skills or clinical competence - even though experts last night warned that there is little consistency in the medical training, treatments and medications used across Europe.

Crack down on incompetent European doctors

By Francesca Robinson - 27th August 2009 10:35 am

The GMC is calling for all doctors coming to work in Britain from Europe to undergo tests to prove they are fit to practise in this country.

The issue is being raised with European Commission following the case of a German doctor who killed a patient after giving him an overdose of a painkiller on his first UK weekend shift as a locum GP.

Last week Hospital Dr reported the concerns of consultant anaesthetist Dr John Hutchinson who is campaigning for a new agency to be established to monitor foreign locums and provide them with professional support when they are in the UK.

GMC chief executive, Finlay Scott, told The Guardian that the current system did not guarantee the level of patient safety that the UK required. He is calling for European doctors to undergo the same stringent language and clinical knowledge tests that are required of doctors from outside the EU before they can work in the UK.

“We have to persuade the EU to change its long standing policy so we can test knowledge and skills at the point of first registration,” he said.

Dr Hutchinson, head of the department of anaesthetics at Hereford County Hospital, has written to the Royal College of Anaesthetists outlining his experience of employing two foreign locums whom he had to swiftly sack because of their clinical incompetence.

One of the doctors was a young paediatric neuro-anaesthetist from Eastern Europe who had poor standards in both spoken English and clinical decision-making.

He said he and many of his colleagues have frequently had to reject locums applying for posts following conversations about their competence with previous employers.

“If my experience is reflected across all acute specialities around the NHS, there is a colossal clinical governance issue,” he warned.

Dr Hutchinson is proposing that an agency should be set up by the royal colleges, the Department and Health and NHS Employers to provide foreign doctors with advice on how the NHS system works before they leave their home countries. It could also give them an objective assessment of their clinical competencies and provide those whose skills are not up to scratch, a period of clinical attachment prior to starting paid work.

“I appreciate that this is a major undertaking and will require funding but I believe that it is overdue,” said Dr Hutchinson.

A Department of Health spokesperson said: ”In line with European policy the UK is required to recognise professional qualification of EEA nationals throughout the European Union.

“NHS organisations have a legal duty to ensure that all doctors are fit to practice and deliver services to the required standard. To do so they would be expected to look at professional experience to ensure that an individual would be fit for the role not just their qualifications.”

Tags: Locums, Overseas recruitment
Posted in Hospital Dr News | 4 Comments »

Row over competency of overseas locums

By Francesca Robinson - 20th August 2009 9:32 am

A row has erupted over the competency of foreign locums after an outspoken consultant claimed that some of them are clueless about what is expected of them by the NHS.

Dr John Hutchinson, head of the Department of Anaesthetics at Hereford County Hospital, made his comments in a letter to The Times because he is concerned that locums are falling through the net of regulation.

But Miss Shehnaz Somjee, chair of the Locum Doctors Association (LDA) accuses Hutchinson of unfairly stigmatising locums.

Hutchinson argues that there is an urgent need for locums new to the NHS to undergo a short period of clinical assessment and familiarisation of UK medical practice.

In anaesthetics, there is a shortage of experienced locums to meet demand. This means agencies have to recruit doctors from abroad who are on the medical register and regulated by the GMC, but lack professional support within the UK. These doctors have “absolutely no idea what is expected of them by the NHS” complained Hutchinson.

“Although there are many excellent locum doctors there are some who cannot adjust rapidly to UK practice despite the best efforts of employing NHS trusts,” he said.

If some of these locums were sacked, they could go on to get work at another trust which would be unaware of any previous problems because references are desirable but not essential for employment, he claimed.

Hutchinson is calling for increased monitoring of the clinical workload of locums and for them to be provided with professional support in the same way that UK trainees are. This would have the added benefit of ensuring that locums comply with the 48-hour working week.

But Somjee said locums already face much tougher scrutiny than substantive doctors.

Locums have to undergo Criminal Records Bureau checks for every job and provide recent references. “Locums need references all the time and one small word against them can be enough to destroy their employment prospects,” she said.

Health checks can also be more stringent. Some agencies have been requesting additional tests for HIV and MMR, which are not a requirement for employment.

Most trusts now provide inductions for locums and if posts are longer than three months should be offering appraisals where any problems can be picked up and addressed. Trusts should also ensure that consultants offer support to locums, argued Somjee.

Agencies frequently put on extra courses to update locums’ skills in areas such as advanced life support and the LDA provides additional advice and support.

“The fact is locums are under the microscope from the first minute of the first day that they arrive at a new hospital,” said Somjee.

Tags: Locums
Posted in Hospital Dr News | No Comments »