Tough checks on locum doctors

Dr Elwood tried to conceal his identity from the press

There are to be more stringent checks on freelance doctors working in the NHS after an investigation into the mistakes of one elderly pathologist.

The government's standards watchdog, the Commission for Health Improvement (CHI), examined a series of mistakes in cancer tests alleged to have been made by Dr James Elwood, a locum doctor.

Some women were wrongly told they had cancer, or given the all-clear when they had the disease.

Dr Elwood, 79, had been employed by four hospitals who failed to make proper checks into his background, said CHI.

The watchdog also called for annual healthchecks for locums over the normal retirement age - and tests to make sure their skills were up to date.

Trusts should take this report as a wake-up call

Dr Peter Homa
CHI chief executive

Swindon and Marlborough NHS Trust, which employed him 22 times over a four year period, was strongly criticised for allowing him back, even though they knew his work had been investigated by another hospital.

CHI said that current Department of Health checks on older doctors currently simply "rubber-stamped" their appointment.

It called for more "robust procedures" for the employment of locums, and said many trusts were failing to comply with a 1997 code of practice for employing locums.

And it suggested locums should have a "passport to practice" - a smart card which would record their qualifications and employment history.

Dr Peter Homa, chief executive of CHI, said the hospitals investigated had improved their systems, but warned the same situation could occur elsewhere.

"The failures to check where Dr Elwood had worked before and whether he was up to the job are shocking.

"The continuous failure by hospitals across the country to follow basic procedures in appointing locum consultants must, inevitably, raise concerns about patient safety.

"These need to be addressed with urgency and determination.

"Trusts should take this report as a wake-up call."

The department has promised annual appraisals of all locums - not just those over retirement age - in the NHS from next year.

The official code of practice for locums would also be strengthened, it said, and there will be guidance on how the new checks would apply to older doctors.

'Workforce pressure'

CHI's report said that the NHS relied too heavily on locums because of poor planning on how many doctors were needed.

And it said fields such as histopathology, in which Dr Elwood worked, also suffered from a shortage of qualified doctors.

Dr Elwood: defended his record

Concerns about Dr Elwood came to public attention last summer, when a review of 7,079 patients at the Swindon trust found in seven cases, patients had suffered serious consequences from errors after incorrect readings of samples.

One woman had her breast removed unnecessarily. Another was left in a "life-threatening" condition.

In 215 more cases, histology reports were found to have less serious errors.

But in 1997, the Royal United Hospital in Bath carried out a review of 1,400 reports, which consultants at the Swindon trust were informed off.

There was found to be "no major cause for concern". Swindon began its own checks on cervical biopsies in 1999.

Dr Elwood also worked as a locum at the Mid-Sussex Trust and Frimley Park Hospitals Trust.

Peter Homa: 'Concerns about patient safety'

Because he removed himself from the medical register in January 2000, no action can be taken against him by the General Medical Council.

But CHI made clear its report was not into Dr Elwood's competence, which it was said was not within its remit.

Mistakes 'regretted'

Last June, when the potential scandal was revealed, Dr Elwood defended his record, and said he regretted any mistakes he had made.

"Many of the errors in diagnosis, or the disagreements in diagnosis, were not cancerous patients."

Dr Richard Fieldhouse is chairman of the National Association of Non-Principals, which represents freelance doctors working in primary care.

He told BBC News Online either the hospital itself, or the agency providing the locum had to carry out checks on the doctor's background and training.

But he said: "The Department of Health and the government know that there are doctors working as locums, however it does absolutely nothing to provide support, education, welfare or occupational health for these doctors.

"If it finds that there are failings, then how can it be surprised?"

In April 1999, the Audit Commission published a report which said the NHS was over-reliant on locum doctors, and that only 10% of trusts checked locums' qualifications.