The use of locum doctors in the NHS – results of a national survey of NHS Trusts in England

Abstract

Background Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used. Methods An online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis. Results Most NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal. Conclusions Locum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.

Factors that influence locum practice in public and faith-based hospitals in Malawi

“…When induction is inadequate, the locum healthcare worker is more reliant on the other permanent staff available on the shift even for very simple activities. This can lead to inefficiencies and compromised patient safety if the ward or department is too busy (Stringer et al 2023 ). Therefore, the orientation or induction to the protocols and procedures is critical for all external and internal staff to reduce potential risks to patient care (Borek et al 2022 ).…”

“…According to DeCapua ( 2016 ), locum tenens is a Latin word that is translated as ‘one holding a place’ and refers to anyone who temporarily fulfils the duties of another (DeCapua 2016 ). Healthcare workers are recruited through agencies (externally) and sometimes directly (internally) by a facility that requires the service (Stringer et al 2023 ). Locum healthcare workers may be hired on daily or weekly basis leading to challenges with continuity of care (Salloch et al 2018 ).…”

“…Although the use of locum healthcare workers in hospitals ensures the availability of staff, continuity of services, and improved quality patient care, there are also challenges related to the use of locum staff. The practice is associated with compromised patient safety because of increased workload on permanent staff, increased costs, reduced team function, and suboptimal quality of services (Ferguson & Walshe 2019 ; Miseda et al 2017 ; Stringer et al 2023 ; Xue et al 2014 ), among other challenges. The literature shows that challenges can be reduced by placing guidelines in place for the appointment and assessment of locum staff to safeguard the quality of care (British Medical Association 2018 ; Keelson & Dodor 2014 ).…”

The future of the NHS depends on its workforce

“…5 The strategy of shoring up workforce shortages through overseas recruitment is unsustainable, especially as attention is drawn to its moral and ethical problems. So too is the increasing reliance on temporary staff, which is not only expensive-the annual cost of using locum, agency, and bank staff in the English NHS rose to £10.4bn in 2023 6 -but also introduces other risks, 7 such as those linked to lack of familiarity with local policies and environments and disruption of team bonds, and might not be positive for patient experience or outcomes. 8 The NHS Long Term Workforce Plan, 9 published in June 2023, offers some welcome commitments to workforce planning and development.…”

A healing challenge: examining NHS staff sickness absence rates

“…Insufficient medical and nursing coverage is associated with risks to patient outcomes. 1 Sickness absence within the NHS can impact services, patient care and costs, 2 and has an impact on workforce retention, which feeds back into staffing shortages. 3 Exploring the data provided by NHS Digital on sickness absence rates among NHS staff reveals trends that may have implications for workforce well-being and healthcare delivery.…”