Working arrangements for temporary doctors in NHS ‘can pose patient safety risk’

The way many temporary doctors are expected to work in the NHS can pose a risk to patient safety, a new study suggests.

Temporary doctors, also known as locums, are used in the health service to fill staffing gaps.

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

They conducted in depth interviews with 88 people including locum doctors, locum agencies, permanently employed doctors, nurses and patients.

Locums described “often working in unfamiliar environments, sometimes with minimal induction and varying levels of support”, the authors said.

But the researchers said the lack of familiarity “could at times be beneficial” as locums can come in with a “fresh perspectives” on patient treatment, management or organisational cultures.

Locum working sometimes created extra work for permanent staff, they found.

They also pointed out how some locum doctors were “stigmatised, marginalised and excluded” by permanent staff.

And some locums felt they were more likely to be “scapegoated” if things went wrong, with some describing “defensive practice” in order to avoid such situations – including avoiding making high risk decisions or ordering extra tests or referrals.

The authors said that temporary doctors recognised that having “an NHS run by locums was detrimental” and that many avoided working for organisations that were “locum dependant”.

“Our findings show that the way in which doctors who worked on a temporary basis were integrated into organisations posed some significant challenges and opportunities for patient safety and quality of care,” the authors wrote in the journal BMJ Quality and Safety.

“Our findings are a call to action for organisations to take stock of how they engage, support and work with locums, and asks both locums and organisations to reflect on whether their practices support a collective approach to patient safety and quality of care.”

In a linked editorial, Professor Richard Lilford, from the Institute of Applied Health Research at the University of Birmingham, said that the study “suggests that locum doctor arrangements are unkind and unfair, and potentially harmful to patient safety” and he suggested that the paper should be a “considered as a call to action by senior policy makers”.

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

“The NHS faces great challenges in retaining valuable staff amidst high turnover, ageing demographics and growing care demands,” academics from the University of Surrey wrote.

“With doctor trainee retention rates plummeting over the past decade and over half of consultants anticipating early retirement, this analysis sounds the alarm on unsustainable workforce dynamics that may jeopardise NHS future functioning.”

They examined information on more than 70,000 senior doctors and almost 450,000 nurses working in NHS trusts in England between 2009 and 2014.

The research team tracked these people to March 2020 to evaluate levels of retention.

They found that efforts to keep staff in post varied by age and profession, rather than applying a “one-sized fits all approach” to staff retention.

They point out a number of specific findings, including:

– Black nurses working in hospitals were more likely to leave their trusts compared to white peers.

– Part-time work was “positively associated” with nurse retention.

– This was not the case for doctors, among whom part-time work was negatively associated with retention.

– As doctors approached retirement age, the probability of staying in the same trust decreased significantly.

– And “limited evidence” shows that other organisational factors like communication or recognition improve retention.

The authors said that their work “reinforces calls for healthcare organisations to develop more effective reward systems aimed at increasing staff retention”.

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.”