NHS A&Es use locums in quarter of senior posts

Almost a quarter of NHS A&E departments in hospitals in England are filled with agency doctors or locums.

NHS AnEs use locums in quarter of senior postsThe reliance on freelance staff to fill senior posts costs hospital trusts more than £120 million in a year.

Some trusts have far higher rates of vacancies filled by locums, with three trusts running at rates of more than 50% and the highest at 69%.

The information comes from a Freedom of Information request made by the BBC.

Locum or agency doctors are routinely used to plug gaps in rotas, not just in A&E departments but generally across the health service.

But the BBC has found that many hospitals are routinely using locums to fill the two most senior roles in Emergency Departments; consultants who run the teams and senior registrars.

They approached 142 hospital Trusts in England that run large Emergency Departments, known in the NHS as Type 1 A&Es. Of those, nearly 90% responded to our request for information about how many of the senior roles were filled with locums, and how much that was costing.

Given a shortage of consultant and senior registrar grade doctors working in emergency medicine the use of locums is an expensive but unavoidable way of making sure A&E departments are properly staffed.

Locums offer hospitals a flexible way of managing their workforce in response to demand.

When drawn from other specialties or departments they can also help spread best practice and the latest knowledge.

But A&E consultant Prof Suzanne Mason, of the College of Emergency Medicine, the professional body for senior A&E doctors, says there are significant downsides to relying so heavily on locums.

“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.”

But at present hospitals have little choice over their use of locums, according to Bill McMillan from the NHS Employers organisation.

“Tonight at A&E you need to be able to deal with the patients who turn up. You can’t say to them, ‘You’re in the wrong place, we can’t do anything for you.’

“So hospitals are obliged to try and fill those rotas as best they can with the best quality people they can. You can hardly blame the patients for turning up. You always get a certain amount of flexible workforce in any industry and the health service is no different.

“The question is making sure we recruit locums who are also of the best quality, doing the work we are asking of them, paying the right pay for that. Those are things I think hospitals find really difficult at the moment.”

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.”

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