In my last blog I looked at the challenges facing locums, agencies and ROs – and what implications they have for Trusts.
Now I’d like to look in more depth at how we can support locums and at the same time provide Trusts with the information and data which enables them to make informed decisions about which locums they engage with. Core to any consideration must be patient safety and processes need to demonstrate that locums meet compliance standards and have role specific competencies. At the same time there may be opportunity to develop and enhance pathways for locums to transit into substantive posts if that is a route they wish to take.
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.
Locum doctors must have a right to work, be licensed to practise by the GMC and engage in appraisal and revalidation process. Guided by GMC ‘Supporting Information for Appraisal and Revalidation’. To revalidate all doctors must carry out a multisource feedback (MSF) of patients and colleagues once in the five-year cycle.
Many locums have difficulty getting paid study leave, in gathering supporting information, colleague and patient feedback for MSF as well as performance feedback by senior or supervising clinicians on completed locum sessions. Many also experience deferral of their revalidation because ROs may have difficulty making a recommendation for someone for whom they have. Inadequate supporting information and only short term connections. In addition to all this, there is the cost of appraisals.
There is currently little or no support structure, and no clear path to career development or training in new competencies, for locum doctors. They have no permanent base, few role models, are often excluded from normal networking facilities and may feel isolated and unsupported.
Such a hub could serve as an access point for sharing information between Trusts and locums. All locums could be registered through one organisation and a single data base could cover, for instance….
I propose that this would be a permanent base where locums can be supported. They would have a facility where they would be able to update work experience, references and educational and training updates. This information would feed into compliance maintenance and act as a reassurance to Trusts on hub locums.
Bringing all this information together and providing a clear and solid structure for employment and career progression would solve many of the problems locums currently face.
A central data base would bring many benefits for Trusts too – not just by providing information to help them access the right locums with the right competencies and specialisations for the roles they are looking to fill.
It would also help Trusts reduce costs by streamlining processes, centralising back office functions relating to locum recruitment, overcome geographical problems and helping to flag up problems and conditions.
I believe that NHS Professionals are ideally qualified and positioned to create and deliver such a hub as part of the locum recruitment and quality assurance process (I’ll be covering that in my next blog). It would also provide a way of tackling the underlying need to enable the transition of those locums who wish to become substantive staff into full time roles by gaining the training and qualifications which are currently difficult for them to access.
Let the debate begin!
Helen McGill, Medical Director and Responsible Officer at NHS Professionals
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.