The Use of Locum Doctors in the NHS: Understanding and Improving the Safety and Quality of Care

BACKGROUND The numbers of doctors working in temporary positions (known as locums) in the NHS has doubled in recent years, and there are widespread concerns about the quality and safety of locum practice and the way NHS organisations use locum doctors, though there is little empirical evidence on differences in practice or in the quality and safety of care. AIMS AND OBJECTIVES The overall aim of this research is to provide evidence on the extent, quality and safety of medical locum practice and the implications of medical locum working for health service organisation and delivery in primary and secondary care in the English NHS. RESEARCH QUESTION Our three main research questions are: RQ1 What is the nature, scale and scope of locum doctor working in the NHS in England? Why are locum doctors needed, what kinds of work do they undertake, and how is locum working organised? RQ2 - How may locum doctor working arrangements affect patient safety and the quality of care? What are the mechanisms or factors which may lead to variations in safety /quality between locum and permanent doctors? What strategies or systems do organisations use to assure and improve safety and quality in locum practice? How do locum doctors themselves seek to assure and improve the quality and safety of their practice? RQ3 How do the clinical practice and performance of locum and permanent doctors compare? What differences in practice and performance exist and what consequences may they have for patient safety and quality of care? METHODS This study will consist of four main workpackages designed to address these research questions, as follows: WP1 (RQ1 and RQ2) will involve a national survey of medical directors/medical staffing leads in all NHS trusts and Clinical Commissioning Groups (CCGs) to examine the nature, scale and scope of locum doctor working, why locums are needed, what work they undertake and how their work is organised. WP2 (RQ1 and RQ2) will involve four largely qualitative case studies in selected NHS organisations of locum doctor working arrangements. These will focus on understanding how locum doctor working may affect the safety and quality of care and what strategies or systems organisations use to assure or improve quality and safety. WP3 (RQ1) will involve the collection and analysis of existing/routine quantitative data sets on locum doctor working in primary and secondary care to quantify the nature, scale and scope of locum doctor working in the NHS and how it has changed over time. WP4 (RQ3) will involve the collection and analysis of existing/routine quantitative data sets on doctors' practice/performance which identify whether doctors are locum or permanent staff and so allow us to compare the practice/performance of locums and permanent doctors. The study will take place over 24 months. ANTICIPATED IMPACT AND DISSEMINATION This study will provide an important empirical foundation for policy and practice on locum working in the NHS. It has letters of support from NHS England and Health Education England, and strong interest from a range of stakeholder represented on our project advisory group. The proposal has been developed with patient and public members, who will join our PPI Forum and be represented on our project advisory group. We have plans for disseminating findings to key audiences through seminars and presentations at key forums such as NHS England's responsible officer networks