NHS hospitals heavily reliant on locum doctors charging up to £850 per shift are ‘undoubtedly’ risking patient safety, study warns

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Written By Rivera Claudia

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Hospitals which rely heavily on locum doctors are ‘undoubtedly’ risking patient safety, a study of NHS practice found.

While temporary staff are a ‘vital resource’ to plug workforce gaps, issues such as unfamiliarity with protocols and procedures mean they ‘pose significant patient safety challenges’ for the NHS, experts say.

The report warned many were left feeling isolated and stigmatised by resident staff, creating a ‘hostile environment’.

This has led to a ‘defensive’ culture over mistakes, hindering improvements to care, according to researchers.

Calling for greater monitoring by inspectors, NHS leaders must rethink how these professionals are supported and used, the authors said.

While temporary staff are a ‘vital resource’ to plug workforce gaps, issues such as unfamiliarity with protocols and procedures mean they ‘pose significant patient safety challenges’ for the NHS

Researchers from the University of Birmingham wanted to examine whether locum working arrangements impact on patient safety or quality of care.

They interviewed locum doctors, agencies, permanently employed doctors, nurses and patients in primary and secondary care settings between March 2021 and April 2022, in what has been described as the most extensive study of its kind.

Temporary doctors described how they often worked in unfamiliar environments, sometimes with minimal induction and varying levels of support.

They admitted unfamiliarity, a lack of access to, or other restrictions on computer systems, policies, procedures and buildings meant that they were not always able to do their job safely, productively, or effectively.

Respondents said high levels of locums was detrimental to quality of care and safety.

They were more likely to have their clinical competence questioned and disempowered to make decisions, the focus groups and surveys found.

Meanwhile, other staff felt that some locums were simply avoiding work and evaded responsibility for patients by pushing work onto others or into the future.

Departments that were disproportionately dependent on them were often perceived to lack clinical leadership and direction meaning quality improvement was slower or less likely to happen.

‘Our findings provide some profound and concerning insights for patient safety and quality of care, wrote the authors in the British Medical Journal.

‘The ways in which locums were recruited, inducted, deployed and integrated, and supported by organisations undoubtedly affected quality and safety.’

They added: ‘Our findings indicate that regardless of their level of experience, it was unlikely that locum doctors would be able to function optimally in unfamiliar environments; and organisations who had poor supportive infrastructure and governance mechanisms for locums were less likely to deliver high-quality safe services.’

The stuttering NHS workforce and growing trend in doctors opting to be locums rather than a more traditional career pathway, have seen locum numbers more than double since 2009.

Writing in a linked editorial, Professor Richard Lilford, of the Institute of Applied Health Research at the University of Birmingham, said the findings suggested ‘the life of the locum is a difficult and lonely one, opening up many pathways to unsafe practice.’

Likening it to airline pilots, he suggested staff would benefit from standardised practices – such as how the medicine cabinet is stocked – to minimise mistakes.

Agencies providing staff should be given routine feedback by employers and locum staff, to enhance patient safety, he said.

He added: ‘Inspection processes could monitor the use of medical locums and nudge hospital managers to model their workforce requirements to find the optimal balance between substantive and temporary posts.

‘Because locums find it hard to adapt to different procedures and protocols, organisations could be incentivised to standardise.’

Meanwhile a separate study, published in the journal BMJ Open, examined retention of NHS staff.

Efforts to keep staff in post varied by age and profession, rather than applying a ‘one-sized fits all approach’, according to the research involving more than 70,000 senior doctors and almost 450,000 nurses working in the NHS.

An NHS England spokesperson said: ‘All temporary NHS doctors go through robust employment checks and are supported with induction programmes so they can hit the ground running when they start a shift.

‘As part of the NHS Long Term Workforce Plan, the NHS will reduce the reliance on temporary agency staff by almost doubling medical school and nursing training places, as well as offering better support for staff so up to 130,000 people stay working in the NHS for longer.’

BirminghamNHS

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