A recent Freedom of Information Act request by the BBC has revealed that almost a quarter of A&E departments in English Hospitals fill over 25% of their senior staff vacancies with locums or agency doctors. This reliance on such staff costs hospitals over £120 million each year.
Worryingly, three English Trusts have over half of their senior vacancies filled by locums and agency doctors, with one trust using such staff to fill 69% of its senior staff vacancies.
However, it is not the case that there are insufficient doctors in the country to fill these positions, it is that there is an ever increasing amount of paperwork to contend with. Dr Jim Butler, Consultant at the A&E department at North Manchester General says, “I was doing admin all week last week, and in the past I’ve had periods where I think I went a month without seeing a patient because I had so much admin to do.” He estimates that he only spends 30% of his time caring for patients.
Whilst locums are seen to be beneficial to hospitals as they offer a flexible workforce which can be managed in line with demand and they can spread best practice and up-to-date knowledge from other departments, there are problems with relying so heavily on locums. A&E consultant Prof Suzanne Mason, of the College of Emergency Medicine, says, “They often will provide different levels of care and perhaps not such high-quality care as we would come to expect as a specialty. That may be due to a lack of knowledge of the local systems but it may also just be due to just a general lack of clinical experience.”
The problem is that hospitals have to fill their rotas and so have little choice other than to use locums according to the NHS Employers organisation. Hospitals have to try and fill their rotas with the best quality of people available. However, it is important for the hospitals to ensure that they really are recruiting the best quality people and paying them the right wage – things which hospitals are currently struggling with.
A spokesperson for the Department of Health in England said, “A&E doctors are at a record high in the NHS, with 1,187 more than in 2010, including 420 more consultants. We’ve given the NHS £700m this winter to help it respond to the pressure of an ageing population with more doctors, nurses and beds, and plans in every area to manage extra demand.”
However, Andy Burnham, shadow health secretary, said, “David Cameron has trapped A&E’s in a downward spiral and, as doctors leave in their droves, the problems are only getting worse. He must urgently get to grips with the A&E crisis, take action to bring down the bill for locum doctors and ensure all hospitals have enough doctors to get safely through the winter.”
Patrick Oliver, Senior Associate and Head of Clinical Negligence at Swain & Co Solicitors LLP says, “It is important to ensure that patient safety and care standards are being maintained where many locums are employed in a department. Locums are an important part of the healthcare system, but patient safety should not be compromised due to circumstances in staffing.”