Hospital Dr News

Managers take risks with dodgy locum agencies

Patient safety is being compromised by “unscrupulous” employment agencies who trade on NHS managers’ desperation to fill shifts with locum doctors, a report has revealed.

Trusts’ failure to manage their need for locums results in agencies charging premium rates and encouraging managers to accept reduced safeguarding checks.

Last minute recruitment of locums on evenings and at weekends, when shifts most often need filling, often means that inductions are not carried out properly because the relevant staff or systems are not available.

The report, Medical locum expenditure: treating the disease, not the symptoms, is an account of a round table discussion of senior NHS managers and clinicians organised by NHS Professionals, the largest supplier of temporary staff to the NHS.

“At the heart of the round table participants’ concerns over employment of medical locums was the risk to patient safety by their mismanagement,” says the report.

Professor Chris Ham, chief executive of The King’s Fund, who chaired the discussion, warned: “If bad things happen in the NHS because use of locums is not watertight the public would be outraged.”

The report says all the participants had experience of bad behaviours by agencies and felt that lack of regulation in relation to either price or quality has created a sellers’ market.

It also criticises trusts whose workforce planning is so poor that they do not understand whether they need locums to cover holidays or to plug longer-term gaps in the workforce. In some extreme cases they may not even know how many locums they have working for them.

Locums also suffer because managers taking short cuts often fail to comply with agency worker and part time working regulations which deprive them of important employment protection rights such as pension entitlement.

Exacerbating these issues is a disconnect between workforce planning and medical education, with deaneries failing to communicate effectively and make timely changes. On a practical level the gaps left in junior doctor rotations expose trusts to costly locum placements to meet staffing levels. If notified in good time the vacancies could instead be filled by fixed term substantive appointments.

The report says employment of medical locums is the largest area of uncontrolled spending. Managers need to get a grip on this in order to meet a government target of saving £300m on temporary staff by 2014.

It says is the responsibility of trust boards to devise strategies which will drive down demand and costs and to avoid putting patients at risk.

NHS Professionals also recommends that trusts develop long term relationships with locums rather than regard them as a commodity.

Shehnaz Somjee, chair of the Locum Doctors Association (LDA), said the report failed to tackle the key problems, none of which were the fault of locums.

“If trusts negotiated terms and conditions with the LDA many of these problems could be resolved. We are better value than people think because trusts don’t have to pay for the cost of our appraisals, CPD, study leave and they can hire and fire us with very few costs,” she said.

The failure to ensure inductions were carried out was a key concern for locums. If a locum turned up and did not have an induction all they could do was to warn their employer they had not seen the patient before.  But if they refused to treat the patient they could be sacked.

She also pointed out that it was mostly substantive doctors who made the headlines for harming patients, not locums.

“Managers need to build good relationships with locums. We would be very happy to enter into a collaborative, productive partnership with them. If trusts can’t be good employers paying good salaries, the supply of locums will dry up,” she warned.

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4 Responses to “Managers take risks with dodgy locum agencies”

  1. Olly says:

    The reality is, post MMC, with abysmal career prospects in most hospital specialties, no one is going to do dead end non training grade posts at any level (HO/SHO/F2/reg). Therefore if you need eight to ten people to fill a rota tier, you’re stuffed. Overseas medics were sent home or elsewhere in the world with the collapse of HSMP around MMC and they are not coming back. So yes, locum agencies charge what they like. And the few locums who are around are not going to work for peanuts.

    So if you want to save on locum costs then it’s back to one in one and one in two on call. Good luck trying to find anyone willing to work those hours in this day and age. NHS workforce planning has been beyond a mess. Massive expansion and over training in the wrong specialties. SpRs now staring at a brick wall. Youngsters both here and abroad have wised up to the reality of the NHS. Maybe you can convince the expected unemployed CCT holders across specialties to go back to the junior ranks after 15 odd years of gruelling training and appalling quality of life in the name of the greater good. Good luck!!

    Chickens are coming home to roost.

  2. Malcolm Morrison says:

    I thought that locum agencies were supposed to be responsible for vetting the doctor’s credentials and. so, responsible for their eligibility for a post. Trusts should have a list of ‘preferred provider’ agencies they can trust. Ideally there would be a ‘Register’ of ‘approved’ agencies that would guarantee standards.

    Certainly it would appear that, as with most cases of problems, complaints or scandals, the main problem is ‘communication’. Obviously, there can be emergencies such as when a doctors is taken ill or is injured; but the majority of absences should be foreseen – and, therfore, should be ‘manageable’.

    I am sure the EWTR does not help; but managers, politicians, and the leaders of the profession should have foreseen the problems they would cause – they were warned!

  3. joshek says:

    here is an example of how trusts go about inductions: a few years ago, i accepted a locum assignment. the induction consisted of a consultant of the department presenting me with a document of many pages – the first of which read: “i hereby declare that a consultant of the deprtment has gone through this document with me and explained the issues covered” – however, the said consultant just demanded it to be signed there and then without being read. she was flabbergasted when i told her that she has the choice to either do with me as the document said or not have it signed. so much for how seriously trusts take induction. they shouldn’t be trying to blame locums for the mess their institution is in.

  4. ????? says:

    I have been doing locum work for many years and had been inducted only ONCE!!! You have to beg to receive a password to consult X-Rays and blood results. In some hospitals were you cover cardiac arrest calls, you are not given a swipe card which allows you to enter a ward!!! Most locums cover night and week end shifts in very busy units alone while they have two to four trainees during the day. Of course, it is always easier to go to the weakest link rather than to address your own failures.

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