As mentioned in my last blog, locum doctors deployed on a flexible basis by Trusts are a widely varied group of professionals working within different specialities, with varying levels of experience and across many geographical locations. So when a Trust is looking for locums, how can they be sure they select the right person for the role?
With locums moving from job to job and agency to agency up to date information about individuals is often difficult to access. So what are the current guidelines for recruitment – and how the process can be made more effective and efficient?
The NHS Guidelines
In August 2013 NHS Employers issued a Code of Practice for the appointment and employment of NHS locum doctors. It applies to all doctors including directly employed locum doctors, agency locum doctors and locums working through their own limited companies.
Principles for appointment and employment of locum doctors
All locums should:
- Meet the entry criteria for the post
- Be properly experienced and qualified for the role
- Have satisfactory communication skills
- Not be appointed if currently subject to an investigation or if there are concerns
- Not be engaged until all necessary employment checks have been conducted satisfactorily
- Have 6 months NHS experience within the last 2 years
- Carry out NHS Employment checks
- Check GMC registration/licence status and identify any restrictions
- Check appraisal and revalidation status and ideally identify the name of the doctor’s RO
Employment Check Standards required by the NHS cover: identity, right to work, professional registration and qualification, employment history and references disclosure and barring Service (DBS) and occupational health.
Framework agencies are contractually obliged to meet these standards, and their compliance is audited on an ongoing basis. ‘Off framework’ agencies are not covered by this audit.
The big questions are how well are these standards and checks currently being applied, and do they go far enough? Do they ensure that the right locum is appointed for each role, and that – as the headline of this blog questions, are they fit for purpose?
Our belief at Doctors Direct is that it may be far too easy to ‘sign a slip’ and appoint a locum doctor as long as the basic checks are met. Given the pressure on Trusts to deliver services, how does the Trust reassure itself that the locum has the appropriate compliance and, more importantly, competencies to fill a position? If the wrong locum is placed in the wrong role there could be considerable implications for, and potential impact on, patient care and safety.
That’s one of the reasons why we have established Medical Advisory Group (MAG) – a body made up of nine senior consultant clinicians from across England, covering all major specialities, advising Doctors Direct on clinical governance matters as they impact our locum doctor service. It’s a structure which doesn’t exist anywhere else and brings significant benefits for our Trusts and locums. For a doctor to be presented to a Medical Advisor for approval they will have completed all the NHS Employment Check standards including appropriate references.
The role of the Medical Advisory Group in locum recruitment:
- All applicants have their recruitment documents reviewed by one of the Medical Advisors with an aimed 24 hour turn around
- Medical Advisors make the ultimate decision about the grade and speciality the applicant doctor can work
- They can reject an applicant if they feel the applicant is not qualified for the role that they have applied for
- The Medical Advisor reviews and upgrades locums on evidence of work experience, training updates and references where this is appropriate
The benefits of this system:
Through the MAG, Doctors Direct are able to assure itself that our locum doctors are working at the right grade in the right speciality – reassuring the Trusts that they are making the right appointments. It is not possible for anyone other than a MAG, or in exceptional circumstances the Medical Director, to approve a role for a locum doctor. The approval process ensures that locums have the right skills to match the role, and Trusts have the reassurance of knowing all checks have been thoroughly reviewed and signed off by a senior clinician.
Locum doctors also have the opportunity for promotion to higher grades following MAG review of work experience, backed by evidence of competency training and references for the proposed higher grade. In this way locums have the opportunity to work in a wider range of roles and Trusts have the reassurance that locum progress through the grades is being monitored by senior clinicians.
I believe that with the MAG, Doctors Direct has developed a support network of senior clinicians to support the clinical governance agenda of our locum doctors service which benefits both the locum doctors and the Trusts.
In my next blog I would like to consider pathways by which we can reach out to, engage with and support the cohort of doctors who may want to return to clinical practice but for whom this has proved difficult. I am talking here of doctors who have been out of clinical practice for some time for a whole variety of reasons and who may feel deskilled, out of touch and no longer up to date.
Helen McGill, Medical Director and Responsible Officer at NHS Professionals