Achi news desk-
Are locum doctors an untapped resource or a risk to patient safety? As the NHS spends increasing amounts on ‘freelance’ doctors, it is becoming increasingly important to look at how they are being used, and where improvements are needed.
Quality of care
Research published this week in the BMJ highlighted the risks of a health service over-relying on locum doctors, as well as the “difficult and lonely” life of a locum.
In NHS Scotland, spending on locum doctors has almost doubled, from £67.4 million in 2013/14 to £119.6m in the year to March 2023.
In areas such as psychiatry, one in five consultant doctor positions are filled by locum doctors.
Researchers from the universities of Manchester and Birmingham noted that there was “limited empirically good quality” evidence to confirm widespread concerns that locum working was worse in terms of quality and safety, so they set out to investigate through interviews with locum doctors, patients and permanent employees. doctors.
While their work is carried out in hospitals and surgeries in England, the findings are relevant to the NHS as a whole.
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In interviews, the locum described that they often work in unfamiliar environments “sometimes with very little familiarization and varying levels of support”.
They were “not always able to do their work safely” due to issues such as lack of access to computer systems, and were “likely to be scapegoated if things went wrong”.
Most locum doctors said they faced stigma and “negative attitudes” about their competence.
This was worst for female or ethnic minority locum doctors.
Such discrimination and exclusion were “harmful to morale, retention, and patient outcomes”, the researchers said.
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However, feedback from other healthcare staff highlighted perceptions that some locums “simply avoid work and avoid responsibility for patients by pushing work onto others or into the future”.
Where complaints arose, locums had “often moved on”.
Summarizing their findings, the researchers said there were “some profound and worrying insights for patient safety and quality of care”, adding: “The ways in which locum doctors are recruited, established, deployed and u integration, and supported by organizations affecting quality and safety. .”
Professor Richard Lilford, director of the National Institute for Health Research – which funded the study – said the evidence points to working arrangements for locum doctors which are “unkind and unfair, and potentially detrimental to patient safety “.
His answer? There appears to be “a good case for reducing the market and strongly encouraging all posts to be filled with non-locum staff – less money spent on locum doctors with more money for the permanent posts” .
That is clearly a long-term objective, however.
In the short term, many NHS services would collapse without locum doctors to fill gaps in the rota.
An untapped resource?
A separate analysis suggests that locum doctors are underutilized in general practice.
A poll by the BMA found that locums in England try to work 6.34 sessions a week on average (eight sessions a week is ‘full time’) but they only secure 5.24 sessions.
This was “unconscionable” amid a GP workforce crisis where patients sometimes had to wait weeks for an appointment, the trade union said.
The situation was blamed on the “erosion” in real terms of general practice funding, which has left GP partners with less money available to recruit additional staff.
According to analysis carried out by GP Online, if practices were funded to hire locums to work to full capacity, a general practice in England could have at least 250,000 GP appointments a week.
In Scotland, the number of locum doctors working in GP practices by 2022/23 – 342 – was the highest in at least a decade.
This has coincided with a steady reduction in the number of GP partners, and a growth in part-time working.
Nevertheless, it is reasonable to assume that locum doctors are also used less than they would like north of the border as GP practices here have also experienced a similar erosion in real terms in funding.
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So how much of a difference could an extra 25,000 appointments make here, if the figures were roughly the same?
By January this year, a total of 3.1 million GP consultations were taking place – 2.52m face-to-face and 592,000 virtual – which compares to 2.9m in January 2018.
An additional 100,000 appointments per month would be a 3.2% increase in activity.
Going back to the patient safety issues raised by the BMJ, however, it might make more sense to invest a higher percentage of health spending in general practice in the first place to stop the exodus of GP partners.
