Scotland needs tighter controls on locum doctors, audit shows

Robust reporting arrangements are needed in Scotland to ensure that poorly performing locum doctors are identified and action taken to reduce potential risks to the safety of patients, a new report says.

A report from Audit Scotland is critical of the lack of formal arrangements for pre-employment checks, induction, supervision, and performance management of locum doctors, which could allow bogus or poorly performing doctors to continue working.

Spending on locum doctors in Scottish hospitals almost doubled from 1996 to 2008, with the greatest demand occurring in rural areas, where numbers of vacancies are highest. The report says that employing locum doctors who may be unknown to local hospitals and unfamiliar with existing policies and practices presents a potential risk to patients’ safety.

Audit Scotland’s analysis of the use of locum doctors shows that a lack of formal policies means that pre-employment checks may not be completed at all times, it says. Induction and supervision arrangements vary between hospitals, and it is not possible to check the total number of hours worked by locum doctors.

Although it acknowledges that serious performance issues will be reported to the General Medical Council, there is no mechanism for reporting concerns about less serious performance issues and sharing them with other NHS employers. It recommends that the Scottish government update the national Locum Code of Practice and, within that, specify arrangements for reporting poor performance.

The demand for locum doctors has grown because of difficulties in filling vacancies and the effects of European legislation that has reduced junior doctors’ working hours. However, Audit Scotland says that in many cases NHS managers are not always clear about why locum doctors are being hired and how long they are using them for. The report concludes that better planning and recruitment could result in savings of around £6m (€7.2m; $9m) a year in Scotland, 15% of the total spent on locums.

Most requests for locums are for covering vacancies and planned absences such as annual leave and study leave. Audit Scotland recommends that better information on the use of locums should be collected to allow managers to identify areas for improvement. It emphasises that controlling the additional costs of using locums is particularly important in the current economic climate.

Robert Black, Scotland’s auditor general, said, “Locum doctors have an important role in ensuring hospitals are adequately staffed and provide good quality patient care around the clock. Health boards need better information about why and when they use locum doctors, the grades and specialties of doctors they are hiring as locums, and whether locum doctors are existing employees or from agencies. With better information, boards could improve their workforce planning and use locum doctors more cost effectively.”