Title: The use of locum doctors in the NHS: understanding and improving the safety and quality of care
Funder: Department of Health and Social Care

Abstract: WHY THIS RESEARCH IS IMPORTANT_x000D_ Increases in the numbers of temporary doctors (usually known as locums) working in the NHS and some high profile cases of very poor quality care by locum doctors have led to concerns about the quality of care, patient safety and value for money. As well as being costly, locum doctors are often thought to be at greater risk of causing harm to patients than permanent doctors employed in the NHS. This might be because locums don’t know the patients as well as permanent staff, or are new to the teams/organisations they are working in, or are less familiar with systems and guidelines such as those for ordering tests and prescribing medicines. Locum doctors may not get a proper induction to show them how to work safely when they are new to an organisation, and may get less supervision from senior medical staff than permanent doctors. We know that patients are more likely to complain about locum doctors than about permanent doctors, and that national guidance about locum employment and practice isn’t always followed, which means that locums don’t always get the support they need to work safely. If there are problems or concerns related to a locum doctor, they may not be investigated or dealt with properly, and the locum doctor may then just go and work somewhere else. _x000D_ _x000D_ Very little research has been done about locum doctors, so we don’t really know whether or why there are differences in the quality and safety of care between locum and permanent doctors, or why patients are more likely to complain about them. It is clear that a better understanding of the quality and safety of locum doctors working in the NHS is needed, and could help to find ways to improve the working arrangements for locum doctors and the quality and safety of patient care that they provide. _x000D_ _x000D_ WHAT WE PLAN TO DO_x000D_ Our research will find out where locum doctors work in the NHS in England, what kinds of work they do, and how the use of locum doctors is organised. We will use some existing data sources to compare the work of locum and permanent doctors and to see what differences in quality and safety may exist. We will survey all NHS organisations and then study a number of organisations in detail to explore how the use of locum doctors may affect patient safety and the quality of care, and what NHS organisations can do to try to ensure safe, high quality care for patients. _x000D_ _x000D_ We will also establish a PPI forum which will include 1-2 members from existing groups at each case study site. The PPI forum will be involved regularly the design, data collection and sharing of the study findings. The experience of the PPI participants will be monitored throughout to make sure their training needs are met and the impact of their involvement fed back to the forum members. _x000D_ _x000D_ _x000D_ HOW THIS RESEARCH WILL HELP_x000D_ NHS organisations need the flexibility and staffing capacity provided by using locum doctors, and our research will help them to understand how best to use locums, and how to ensure that locum doctors can provide safe, high quality care. _x000D_ _x000D_ We will share our findings both during and after the project with key stakeholders including NHS England/NHS Improvement, Health Education England, the General Medical Council, the Care Quality Commission, medical Royal Colleges and our own Patient and Public Involvement Forum, and with NHS organisations and networks such as NHS Providers and the NHS Confederation.

Lay abstract: BACKGROUND_x000D_ 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._x000D_ _x000D_ AIMS AND OBJECTIVES_x000D_ 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. _x000D_ _x000D_ RESEARCH QUESTION_x000D_ Our three main research questions are:_x000D_ 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?_x000D_ 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?_x000D_ 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?_x000D_ _x000D_ METHODS_x000D_ This study will consist of four main workpackages designed to address these research questions, as follows: _x000D_ _x000D_ 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._x000D_ _x000D_ 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._x000D_ _x000D_ 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._x000D_ _x000D_ 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. _x000D_ The study will take place over 24 months._x000D_ _x000D_ ANTICIPATED IMPACT AND DISSEMINATION_x000D_ 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

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE