Jonathan Boyce of the Audit Commission explains why hospitals use locums

The Audit Commission says NHS trusts are relying on locums as stop gaps to fill vacant posts.

But trusts could save money and improve on the quality of patient care by ensuring that they have sufficient permanent staff.

They are also failing to carry out proper checks on the validity of locum qualifications, or the possibility of past criminal convictions.

Despite tougher regulations introduced two years ago, less than 10% of trusts check a locum's qualifications and only one in five ask about criminal convictions.

Only 35% of hospitals check references and more than 30% do not check a doctor's registration with the General Medical Council.

The Audit Commission report, Cover Story: the use of locum doctors in NHS Trusts, says that on most days around 3,500 locum doctors work within NHS trusts in England and Wales, at an annual cost of £214m.

The report calls for a national system of accreditation to ensure the quality of locums.

Poor training

It also criticises the induction and training of locum doctors, which was found to be poor in half of the trusts looked at by the report's authors.

Locums are not given information about where to get help, given tours of the hospital or training about clinical protocols and systems.

One in five locums reported poor or non-existent induction procedures in hospitals.

Half of personnel directors interviewed for the report said they felt the work of consultant locums was not properly monitored. Many locums work at night and at weekends when senior staff are unlikely to be there to help if things go wrong.

And only 36% of trusts have arrangements to review the performance of locums, despite guidance from the NHS Executive that such a system should have been in place by the end of 1997.

One in five locums have not had a permanent job for more than two years, making it difficult for them to keep technical skills and knowledge up to date.

More than 70% of long-term locums have qualified overseas and the majority of them are working as fill-ins because they are unable to find a post.

The majority of UK-qualified locums cited family commitments as the reason for opting for their particular line of work as it is more flexible.

The report found wide variations in payments to locums, with private agencies charging more than NHS services.

Trusts should negotiate better deals with agencies, the report says.

Greater controls are needed over payments to agencies to stop fraud and mistakes.

Performance review

Dr Peter Hawker says locums often want a permanent job

The report says trusts should appoint a senior doctor to take responsibility for the quality of locums.

Locums should be subjected to regular performance reviews and trusts should implement the National Code of Practice for the appointment and management of locums in full.

Andrew Foster, controller of the Audit Commission said: "The cover provided by many locums is vital in ensuring that hospitals are able to meet the needs of patients.

"However, the public must be confident that when treated by a doctor, permanent or temporary, they are receiving a high standard of care."

Andrew Foster and Dr Peter Hawker discuss the issues on BBC Radio 4's Today programme

He added: "To make the best use of money allocated by Government for health care, trusts also need to review their spending on locums and ensure that they are not incurring unnecessary costs."

Dr Peter Hawker is chairman of the BMA's consultants' committee.

He said: "By boosting the number of permanent consultants and by enforcing rigorous quality standards and checking procedures for the deployment of locums, we could get a much better deal for patients, the NHS and locum doctors themselves who are often stuck in a career cul-de-sac with very little opportunity to compete for permanent jobs."

Health Minister John Denham said the report "acknowledges the important patient service that locum doctors provide throughout the NHS".

He agreed that there should be close monitoring of locums' performance, but said that this should apply to all doctors.

"We are interested in quality assurance and support for all doctors, not just locums.

"The Government have already welcomed the GMC's proposals that will require all doctors to demonstrate that they remain fit to practise in their chosen field, which will be achieved by a process of revalidation of each doctor's GMC registration.