NHS hospitals heavily reliant on local doctors charging up to £850 per service ‘undoubtedly’ putting patient safety at risk, study warns

Hospitals that rely heavily on local doctors are ‘undoubtedly’ putting patient safety at risk, a study into NHS practice has found.

While temporary staff are a ‘critical resource’ to fill workforce gaps, issues such as unfamiliarity with protocols and procedures mean they ‘pose significant patient safety challenges’ for the NHS, experts say.

The report warned that many felt isolated and stigmatized by local staff, creating a ‘hostile environment’.

This has led to a ‘defensive’ culture towards errors, which researchers say is hindering improvements in care.

NHS leaders are calling for greater scrutiny by inspectors and must rethink how these professionals are supported and used, the authors said.

Researchers from the University of Birmingham wanted to investigate whether locums’ working arrangements affect patient safety or the quality of care.

They interviewed local doctors, authorities, permanent doctors, nurses and patients in primary and secondary care between March 2021 and April 2022, in what is described as the most comprehensive study of its kind.

Temporary doctors described how they often worked in an unfamiliar environment, sometimes with minimal induction and varying levels of support.

They admitted that unfamiliarity with, lack of access to, or other limitations on computer systems, policies, procedures, and facilities meant they were not always able to do their jobs safely, productively, or effectively.

Respondents said high locum numbers were detrimental to the quality of care and safety.

The focus groups and surveys found showed that their clinical competence was questioned more often and that they were no longer able to make decisions.

Meanwhile, other staff felt that some locums were simply avoiding work and evading responsibility for patients by passing work onto others or into the future.

Departments that were disproportionately dependent on it were often seen as lacking clinical leadership and direction, meaning quality improvement would occur more slowly or less likely.

“Our findings provide profound and worrying insights into patient safety and quality of care,” the authors wrote in the British Medical Journal.

‘The way in which locums were recruited, introduced, deployed and integrated, and supported by organisations, undoubtedly had an impact on quality and safety.’

They added: ‘Our findings indicate that, regardless of their level of experience, observers were unlikely to function optimally in unfamiliar environments; and organizations that had poor support infrastructure and governance mechanisms for locums were less likely to deliver safe, high-quality services.”

The NHS’s floundering workforce and the growing trend of doctors choosing to become locums rather than a more traditional career path have seen the number of locums more than double since 2009.

Professor Richard Lilford of the University of Birmingham’s Institute of Applied Health Research wrote in a linked editorial that the findings suggested that ‘the observer’s life is difficult and lonely and opens many avenues to unsafe practices.’

Comparing it to airline pilots, he suggested that staff would benefit from standardized practices – such as how the medicine cabinet is stocked – to minimize errors.

Agencies that provide staff should get routine feedback from employers and local staff to increase patient safety, he said.

He added: ‘Inspection processes could monitor the use of medical locums and encourage hospital managers to model their staffing needs to find the optimal balance between substantive and temporary posts.

‘Because locums find it difficult to adapt to different procedures and protocols, organizations could be encouraged to standardize.’

Meanwhile, a separate study published in the journal BMJ Open examined the retention of NHS staff.

Efforts to retain staff varied by age and profession, rather than applying a ‘one-size-fits-all’ approach, according to the survey of more than 70,000 senior doctors and almost 450,000 nurses working at the NHS work.

An NHS England spokesperson said: ‘All temporary NHS doctors undergo strict employment checks and are supported with induction programs so they can get started straight away when they start a shift.

‘As part of the NHS Long Term Workforce Plan, the NHS will reduce its reliance on agency staff by almost doubling its medical and nursing training places, and providing better support to staff, so that up to 130,000 people can continue to work for the NHS. longer.’