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Little evidence over poor quality of GP locums

Study finds growing use of locum doctors

Adrian O'Dowd

Thursday, 14 November 2019

A study has found very little hard evidence to support the widely held perception that locum doctors present a greater risk of causing harm to patients.

The new research* published by the Journal of the Royal Society of Medicine found that use of locum doctors including those in general practice is rising, despite limited evidence on quality and safety.

Numbers of temporary workers in the medical profession are rising and locum doctors are generally considered to be essential for maintaining continuity of service to help cover gaps in rotas due to absence or recruitment and retention problems.

Locums are sometimes perceived to present a greater risk of causing harm to patients than permanent doctors due to their lack of familiarity with local teams, processes, and practices; that locum doctors receive less oversight from supervisors and employing organisations; and data from the General Medical Council (GMC) showing that locum doctors are more likely to be the subject of complaints.

There have been some high-profile locum failures in practice over recent years highlighted in the media.

Researchers from the University of Manchester reviewed the evidence from 42 research papers to establish what was known about the quality and safety of locum medical practice.

While the research highlighted a number of factors that may affect quality and safety, the authors said a better understanding was needed of the differences between the practice and performance of locum and permanent doctors.

In response to growing concerns about the quality, safety and cost of locum doctors among policymakers, employers, regulators and professional bodies, organisations including NHS Employers and NHS England have produced guidelines for organisations using locums, locum agencies and locums themselves.

The authors said: “Our review suggests that there is relatively little empirical evidence to support assertions about the quality and safety of locum practice, and to provide an evidence base to support the development of such guidelines.”

Lead author Dr Jane Ferguson, said: “There are a number of factors which plausibly may affect the quality and safety of locum practice, many of which are really about the organisations who use locums and the ways in which they are deployed and supported.”

Some of the factors include the need for organisations to ensure that locums were fully included in systems for clinical governance including clinical audit, continuing professional development and appraisal.

Policies and procedures should be fit for use by locum doctors as well as permanent staff and should not presume knowledge of or familiarity with local processes.

Dr Ferguson added: “While it is clearly reasonable to expect that locum doctors take personal responsibility for their own professional development, and display the same commitment to the medical profession as other doctors, it seems likely that the quality and safety of locum practice is fundamentally shaped by the organisational context in which they work.”

Dr Ben Molyneux, British Medical Association sessional GPs committee chair, said: “Locum doctors are highly-trained healthcare professionals and undergo the same level, depth, and intensity of training as any permanent doctor.

“In fact, locum doctors often work in a variety of medical disciplines, further broadening their knowledge base and the quality of care they can give to patients."


*Ferguson J and Walshe K. The quality and safety of locum doctors: a narrative review. Journal of the Royal Society of Medicine. Volume: 112 issue: 11, p: 462-471. DOI:10.1177/0141076819877539

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