Working arrangements for temporary doctors in NHS ‘can pose safety risk’
THE way many temporary doctors are expected to work in the NHS can pose a risk to patient safety, a new study suggests.
Temporary doctors, also known as locums, are used in the health service to fill staffing gaps.
Researchers, led by academics from the University of Birmingham, wanted to examine whether locum working arrangements impact on patient safety or quality of care.
They conducted in-depth interviews with 88 people including locum doctors, locum agencies, permanently employed doctors, nurses and patients.
Locums described “often working in unfamiliar environments, sometimes with minimal induction and varying levels of support”, the authors said.
But the researchers said the lack of familiarity “could at times be beneficial” as locums can come in with a “fresh perspectives” on patient treatment, management or organisational cultures.
Locum working sometimes created extra work for permanent staff, they found.
They also pointed out how some locum doctors were “stigmatised, marginalised and excluded” by permanent staff.
And some locums felt they were more likely to be “scapegoated” if things went wrong, with some describing “defensive practice” in order to avoid such situations – including avoiding making high risk decisions or ordering extra tests or referrals. The authors said that temporary doctors recognised that having “an NHS run by locums was detrimental” and that many avoided working for organisations that were “locum dependant”.
“Our findings show that the way in which doctors who worked on a temporary basis were integrated into organisations posed some significant challenges and opportunities for patient safety and quality of care,” the authors wrote in the journal BMJ Quality and Safety.
“Our findings are a call to action for organisations to take stock of how they engage, support and work with locums, and asks both locums and organisations to reflect on whether their practices support a collective approach to patient safety and quality of care.”