On any one day 3500 locums are at work in NHS trusts at an annual cost of £214m ($342m), according to the latest Audit Commission report. The commission suggests that this bill could be reduced by as much as 10%mainly by minimising the fees paid to agencies, but its main concern is the quality of care provided by locums.
Although there have been several reports suggesting that the recruitment and induction procedures for locum doctors need to be improved, there is little evidence of this having happened.
Professional qualifications, past criminal convictions, and references are still often not checked despite a catalogue of high profile cases in recent years in which locums were found to have performed inadequately. Only 36%of trusts have acted on a 1997 NHS Executive report that suggested that all locums should have a structured assessment at the end of each period of work.
Whether this assessment schedule is realistic is open to question. According to the commission, half of all locum episodes are for contracts of 48 hours or less, and half of these take place at night or at weekends when supervision from senior staff is less likely to be available.
“Consultants admitted that they often don’t even meet the locum,” said one of the authors of the report, Anita Houghton, associate director of health studies at the commission, “never mind put themselves in a position to form an assessment of their clinical skill.”
One factor that prevents locums from providing their best care is inadequate induction. Around a quarter of locums reported poor or non-existent induction procedures at the start of a job.
The report, Cover Story: The Use of Locum Doctors in NHS Trusts, is available from the Audit Commission, 1 Vincent Square, London SW1P 2PN or at www.audit-commission.gov.uk.