Currently nearly 9000 doctors without substantive NHS contracts serve Trusts across the country through locum agencies. Many register with more than one agency at one time, or move between agencies on a frequent basis. Helen McGill, Medical Officer and Responsible Offer (RO) at Doctors Direct, considers this to be a practice which presents a significant challenge in terms of monitoring their compliance, performance and the levels of patient care they, and the Trusts they serve, are able to deliver.
‘All of these doctors working as locums are connected to a Responsible Officer (RO) wherever they are working through their agency, following the GMC algorithm. However, when they move from agency to agency and Trust to Trust these connections become complex. Despite the RO to RO network and established information flow systems developed by NHS England, the risk remains that transfer of the most up to date information may not be as efficient as best practice aspires to.
This raises important issues for all concerned: Trusts, agencies, ROs and the doctors themselves.
Concerns are increasingly being expressed about how effectively, efficiently, promptly and accurately information regarding locums and their status currently flows between agencies and other designated bodies. Where agency ROs have concerns about locums and incidents, how should they respond – and how can the locum’s activities be restricted if they are working with more than one agency, yet registered with just one designated body? Working this way, are there sufficient checks and levers to ensure that locums are engaging correctly with the appraisal and revalidation process? Can and do problems arise when one RO acts in an outsourced capacity for multiple agencies?’
These are of course key considerations if agencies are to work to the principles of ‘Maintaining High Professional Standards in the Modern NHS’. Helen has pointed out that the issues are double edged, impacting locum doctors too:
‘Locum doctors themselves may find themselves isolated and unable to make professional progress, as without a substantive contact they may lack access to sufficient support. For instance, how can they fund and find study time or leave to prepare for appraisal? What role models can they refer to when they are constantly on the move? What feedback will they receive on issues, concerns, complaints and completion of placements? During those placements they may –as temporary staff – find it difficult to access IT, appraisal and reporting systems, or to gather supporting evidence like feedback from colleagues and patients for appraisal and revalidation. Because there may be insufficient supporting information for the RO to make a positive recommendation. These are important issues if they are to remain compliant and advance their skills and careers.’
Taking these comments from a senior professional and Responsible Officer on board, it appears that the mobile nature of the locum workforce, the myriad of agencies with whom doctors make multiple arrangements, and the outsourcing of many functions of a designated body may be making good governance a challenge – and that’s a major factor for all parties concerned, including ourselves at Doctors Direct, part of the NHS Professionals family.
The question must surely now be: how do we address that challenge? How do we best support locum doctors and ensure that they have the right qualities and qualifications for their placements? We’ve gone back to Helen McGill and asked her for her thoughts…. watch this space for details.