Use of locum doctors rising despite limited evidence on quality and safety

There is little hard evidence to support the widely held perception that locum doctors present a greater risk of causing harm to patients, according to new research published by the Journal of the Royal Society of Medicine. While the research highlighted a number of factors that may affect the quality and safety of locum practice, the research authors said a better understanding is needed of the differences between the practice and performance of locum and permanent doctors.

There have been growing concerns about the quality, safety and cost of locum doctors among policymakers, employers, regulators and professional bodies. Some high profile examples of poor locum practice have hit the press and media. In response, organisations including NHS Employers and NHS England have produced guidelines for organisations using locums, locum agencies and locums themselves. However, the research shows a lack of robust evidence to support the development of such guidelines.

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

Importantly, say the researchers, organisations have a responsibility if they have concerns about a locum to deal with them fairly, constructively and properly and to liaise fully with both the locum and the locum agency involved and, if necessary, with the General Medical Council.

Dr. Ferguson said: "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."