Hospitals that rely heavily on locum doctors are “undoubtedly” putting patient safety at risk, according to a study of NHS practice.
While temporary staff are a “vital resource” to fill gaps in the workforce, issues such as unfamiliarity with protocols and procedures mean they “pose significant patient safety challenges” for the NHS, experts say .
The report warned that many felt isolated and stigmatized by resident staff, creating a “hostile environment”.
According to researchers, this has led to a “defensive” culture in the face of errors, which has hindered improvements in care.
Calling for greater oversight by inspectors, NHS leaders must rethink how these professionals are supported and used, the authors said.
While temporary staff are a “vital resource” to fill gaps in the workforce, issues such as a lack of familiarity with protocols and procedures mean they “pose significant patient safety challenges” for the NHS.
Researchers at the University of Birmingham wanted to examine whether substitute work arrangements impact patient safety or quality of care.
They interviewed locum doctors, agencies, permanently employed doctors, nurses and patients in primary and secondary care settings between March 2021 and April 2022, in what has been described as the largest study of its kind.
Temporary doctors described how they often worked in unfamiliar environments, sometimes with minimal induction and varying levels of support.
They admitted that ignorance, lack of access or other restrictions to IT systems, policies, procedures and buildings meant they could not always do their jobs safely, productively or effectively.
Respondents said high levels of substitutes were detrimental to quality of care and safety.
Focus groups and surveys found that they were more likely to have their clinical competence questioned and their decision-making power taken away.
Meanwhile, other staff members felt that some locums simply avoided work and shirked responsibility to patients by imposing the work on others or the future.
Departments that relied disproportionately on them were often perceived to lack clinical leadership and direction, meaning quality improvement was slower or less likely.
“Our findings provide deep and worrying insights into patient safety and quality of care,” the authors wrote in the British Medical Journal.
“The way organizations recruited, onboarded, deployed and onboarded and supported substitutes certainly affected quality and safety.”
They added: ‘Our findings indicate that, regardless of their level of experience, locum doctors were unlikely to be able to function optimally in unfamiliar environments; and organizations that had poor support infrastructure and governance mechanisms for locums were less likely to provide high-quality, secure services.’
The stuttering NHS workforce and the growing trend of doctors choosing to be locums rather than a more traditional career path have seen the number of locums more than double since 2009.
In a linked editorial, Professor Richard Lilford, of the Institute of Applied Health Research at the University of Birmingham, said the findings suggested that “the life of a locum is difficult and lonely, opening many pathways to unsafe practices.”
Comparing it to airline pilots, he suggested that staff would benefit from standardized practices (such as how the first aid kit is stocked) to minimize errors.
Staffing agencies should receive routine feedback from employers and substitute staff to improve patient safety, he said.
He added: ‘Inspection processes could monitor the use of medical locums and push hospital managers to shape their workforce needs to find the optimal balance between substantive and temporary positions.
“Since substitutes find it difficult to adapt to different procedures and protocols, organizations could be incentivized to standardize.”
Meanwhile, an independent study, published in the journal BMJ Open, examined the retention of NHS staff.
Efforts to keep staff in place varied by age and profession, rather than applying a “one-size-fits-all approach”, according to the research involving more than 70,000 senior doctors and almost 450,000 nurses working in the NHS. .
A spokesperson for NHS England said: “All temporary NHS doctors go through strict employment checks and are supported with induction programs so they can start working when they start a shift.
‘As part of the NHS Long Term Workforce Plan, the NHS will reduce reliance on temporary agency staff by almost doubling places in medical schools and nursing training, as well as offering better staff support so that up to 130,000 people stay working in the NHS for longer.’