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This guide will help NHS trusts identify the issues that are contributing to their locum use and offer advice on how to reduce both the use of locum doctors and the cost of the locums that are used.
Supply and demand issues
Locum doctors and agency staff have a valuable role to play in ensuring continuity of service provision and can enable organisations to work more flexibly. However, this need to work flexibly must be balanced with offering the highest quality and most cost effective models of care and form part of a planned workforce strategy.
NHS Employers works closely with NHS trusts and it is clear that locum use is a complex subject with many factors contributing to the ever increasing levels of demand and the rising cost of providing locums. Some of the most common difficulties faced by trusts include the following:
- a disconnect between workforce planning and service planning which often fails to effectively feed into the commissioning of medical training and education. This is compounded by a lack of insight on the gap between planned and actual activity delivered, meaning accurate future demand planning is difficult. Combined with demand pressures, this can lead to trusts often having to perform activity that had not been included in plans. In order to perform this activity trusts may have to source temporary staff
- restrictions on the hours that junior doctors are able to work following the implementation of working time regulations
- tightening of rules on immigration has lead to trusts finding it increasingly difficult to cover gaps in junior doctor rotas by directly employing locum medical staff
- poor awareness, planning and management of the leave and absence of substantive staff
- historically, systems for requisitioning locum doctors may have been disparate and therefore not subject to the same rigorous internal controls afforded to other staff groups such as agency nursing. Custom and practice along with the timing of requests for locums often means that requests are not fully reviewed and more cost effective options explored.
Added to these demand pressures are a number of factors restricting and therefore escalating the cost of supply to the market and include the following:
- a shortage of supply within some specialities
- the shortage in supply can often lead to competition between trusts for doctors which in turn can lead to an inflation of prices
- while procurement frameworks are in place to help trusts secure quality locums at suitable prices (including ones operated by the Crown Commercial Service and HealthTrust Europe which are available nationwide as well as several regional frameworks), organisations often encounter difficulties securing staff through agencies on the frameworks. In going off-framework, trusts often end up paying inflated prices and are not given the guarantees (around employment checks etc) that are offered by framework agencies. In using non-framework agencies, often there is no 'shared-liability' should there be a problem with a locum doctor, meaning that the trust is particularly vulnerable.
Given this backdrop, this guide will offer a series of tips, suggestions and approaches that trusts can take in order to better control their use of and expenditure on medical locum staff.
Next page: diagnosing your locum use