Europe South Asia Asia Pacific Americas Middle East Africa BBC Homepage World Service Education



Front Page

World

UK

UK Politics

Business

Sci/Tech

Health

Education

Sport

Entertainment

Talking Point

In Depth

On Air

Archive
Feedback
Low Graphics
Help

Wednesday, April 21, 1999 Published at 08:14 GMT 09:14 UK


Health

NHS locums need 'checks and training'

Many NHS Trusts rely on locum doctors

The NHS is over-reliant on locum doctors who are expensive and whose background and training is often not properly checked before they start work, the Audit Commission has claimed.


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


[ image: Dr Peter Hawker says locums often want a permanent job]
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.

"The Department will be working closely with the GMC over the next two years as these proposals are developed."



Advanced options | Search tips




Back to top | BBC News Home | BBC Homepage |


Health Contents

Background Briefings
Medical notes
Internet Links


Audit Commission

British Medical Association

NHS Confederation


The BBC is not responsible for the content of external internet sites.




In this section

Disability in depth

Spotlight: Bristol inquiry

Antibiotics: A fading wonder

Mental health: An overview

Alternative medicine: A growth industry

The meningitis files

Long-term care: A special report

Aids up close

From cradle to grave

NHS reforms: A guide

NHS Performance 1999

From Special Report
NHS in crisis: Special report

British Medical Association conference '99

Royal College of Nursing conference '99