The Use of Locum Doctors by Northern Ireland Hospitals

A report published today by the Comptroller and Auditor General, Kieran Donnelly, examines the effectiveness of management arrangements over the use of locum doctors in Northern Ireland hospitals. Locums are doctors of any grade or specialty who provide temporary staffing cover at any time and they play an important role in ensuring hospitals can maintain services through adequate staffing and the provision of good patient care around the clock. In recent years the demand for locum doctors has risen due to workforce issues such as increased difficulty in filling vacancies through changes in immigration law and the impact of European legislation governing working hours (see Note 1).

In the four years from 1 April 2007 to 31 March 2011, hospital medical costs were £1,360 million of which £109 million was paid to cover short term absences or vacancies within hospitals. Around £74 million (two thirds) of this was paid to external recruitment agencies while the remaining third (£35 million) was paid to doctors employed by Trusts but working hours additional to those stated in their contract.

The cost of locum doctors equates to around 8 per cent of overall spending on medical staff. Within two Trusts, the Northern and the Western, the percentage cost is substantially above the regional average (11 per cent and 17 per cent respectively) due to challenging local circumstances. We estimate that, if it were possible for all Trusts to contain locum costs to the regional average of 8 per cent, then over £5 million might be saved each year.

Through the Business Services Organisation, all Trusts have contracts in place with a number of agencies for the recruitment of locum doctors. However, the report found a wide variation in the hourly rates agencies charge for locums, while internal locums often seek to barter for rates above those approved by the Department. Trusts acknowledge that regional collaboration in relation to the appointment of locums could lead to greater efficiencies. To that end, Trusts have developed plans for a Regionally Managed Medical Locum Service. To be successful, it is essential that the new system is supported by robust, comprehensive management information on all aspects of locum use.

The report noted that although individual Trusts collect information, to varying degrees, on the usage and cost of hospital locum doctors, the information collected is not comprehensive nor, is it yet brought together in a systematic manner to provide the basis for analysing the most appropriate way to use locums throughout the sector.

The report found inconsistency in the way Trusts screen and induct locum doctors and the way they manage their employment. For example, payment arrangements for locums vary across Trusts, pre-employment checks are not always formalised and the appraisal of locums’ performance is often overlooked (see Note 2).

Although the use of locum doctors allows hospitals to maintain appropriate and safe staffing levels, it also creates potential risks. Locum staff may be unfamiliar with a hospital or its procedures and may not be in a position to offer continuity of care. Other significant potential disadvantages for doctors who choose to work on a locum basis include the lack of on-going education from patient follow-up; the absence of a mentor or peer support; and inadequate supervision of adherence to conditions of the European Working Time Directive.