The hidden costs of uncontrolled locum hiring

NHS trusts are struggling with a growing dependence on locum doctors to plug the existing staffing gaps.
 
Some hospitals have resorted to using locums for up to 19% of shifts since 2019, which is just a temporary perception of a crisis. As effective as these doctors can be in addressing patient’s need in the short term, the cost of these temporary staffing arrangements especially from agencies is inching hospital finances towards a crisis. Money is not the only problem, locums also throw off team relationships, teamwork, communication, and continuity of care that question whether this quick fix would be creating bigger problems in the end.
 
There are concerns also arising from patient safety issues. An increase in complaints has been noted in regulatory activity in Trusts where locum doctors are widely used. This was likely because of the lack of familiarity of the locums with the hospital’s ways of doing things. Is it true that the NHS switches short-term staffing relief for longer-term risks? This article examines in greater depth the phenomenon of locum hiring and why there is an urgent need for strategic workforce solutions in order to avert deterioration in the provision of care and erosion of financial viability.
 
The UK's healthcare system has since 2019 to 2024 relied on locum doctors to fill staffing gaps, with some trusts seeing up to 19% more shifts covered by temporary staff between 2019 and 2024¹.
 
The UK is facing challenges to keep the staffing levels of the hospitals. In order to find a solution, the NHS has increasingly turned to locum doctors or in other words, temporary physicians who fill short-term positions, and this trend has been particularly notable in the period from 2019 to 2021, during which the utilization of locum doctors saw a substantial increase as a response to the first wave of the pandemic.
 
Some sources have reported a 19% rise in locum contracts over this period, thus showing a substantial growing in the practice of hiring external doctors. The dependency on locum doctors is especially pronounced in smaller NHS trusts and those that have received lower ratings from the Care Quality Commission (CQC), such as "inadequate" or "requiring improvement". These trusts frequently have more broader staffing shortages making them more dependent on locum docs to cover crucial workforce gaps. This growing reliance on temporary healthcare workers highlights deeper structural problems in the NHS. The healthcare system is still under pressure due to ongoing personnel shortages and the ensuing need for temporary fixes, underscoring the critical need for long-term, sustainable workforce initiatives.
 
The increasing trend is indicative of the NHS’s approach of dealing with a long-term reason using a short remedy. Certainly, locum doctors have played their roles in the relief of staff shortages, especially during the peak of the pandemic, however, increasing dependence points out bigger problems. As locums, most smaller trusts have been struggling to recruit staff, as the trend of permanent physicians shifting to hiring locum physicians increases. It shows that this trend is not about how to use more pre-crisis filling-the-gaps policy but how to tackle the very underlying problem which has caused the imbalance in the labor force in the first place.
 
This uncontrolled reliance on locum doctors has driven up expenses, strained team structures, and raised red flags in the realm of patient safety and care, especially where trusts are already under pressure from quality ratings.
 
The issue of hiring locum doctors in the NHS is very multifaceted. The security of the patients and the continuity of the patient journey remain in the forefront. A narrative review showed that locum doctors suffer more complaints and experience more regulatory action than their substantive colleagues. This is sometimes viewed in terms of their mobility in the healthcare settings, which could be new to the environment and team’s practices. The findings showed that increased locum use is associated with an increase in patient abuse, demonstrating the dangers of over-relying on such temporary medical workers.
 
Financial pressure is inscribed into the practice of using locums owing to the fact that most of the NHS trusts depend largely on booking locums through agencies’ Such financial constraints are exorbitantly bias on agency usage where in 2019, about 66.1 percent of locums filling in shifts were sourced from Agencies most of which charge steep charges than the internal locum bank. Efforts to limit agency use because of high costs continued the sourcing of services that has persistently been the case such patterns have become so embedded that they squeeze budgets. Part of the problem also is that most of the trusts acknowledge that a significant proportion of their locum shifts are filled externally indicating underused/insufficient internal resources.
 
Yes, the impacts of locum doctors are not only patient care and the financial implications, but also, through care quality improvement programs within health organizations over time.  Concern regarding lack of engagement of locum doctors into quality improvement activities and professional development was cited by more than half of the surveyed NHS trusts as a recent Pause and And pagination report describes. The team has an active focus on improvement which helps mitigate the effects of this normal outward looking for years practiced in such facilities and the investment in organizational development and team foe dynamics is lacking broad based impact on health improvement and best practices in such facility.
 
All these factors combined have led to compromised aspects of care delivery, unmanageable bills and lowered aspiration to constantly improve quality – definitely a very pathological scenario for the NHS trusts. Although locum physicians do help to provide important cover and flexibility, the addon of locums to existing systems globerlly only seems to come with much more costs than benefits. Several healthcare personnel being hired under such work teams can undermine the benefits of what would otherwise be full team work by.Communication breakdown is inevitable. Avoiding these pitfalls will hold the secret to effective delivery of health care while maximizing the quality of patient care as well as their safety.
 
All these issues, aggravate the need for careful decisions that would address the needs of flexible, safe and cost effective ways of making sure that the workforce consists of required number and caliber of staff to deliver for levels of in quality improvement. This has led to NHS Trusts seeking to meet this challenge as a ‘need’ in the” of finding creativity that ensures locum use is maximized at the least possible perplexing risks that, inherently come with locum use. It might also require rethinking recruitment procedures, improving induction of temporary employees, and creating stronger internal locum banks to cut down on pricey outside agencies.
 
To constantly ensure care quality even in terms of vacancy, particularly those caused by caregivers' dress-down, tackling staff shortages through the usage of a locum despite a low strategic emphasis enhancement mechanism, faster integration of temp staff, and internal locum banks strategies is important.
 
To meet the difficulties related to the use of locum doctors in the NHS, a combination of strategies is required. To start with, improving the integration of the accommodation health service staff is necessary. NHS trusts need to introduce proper working regimes and facilitation techniques that are specially crafted towards the locum doctors. This is:
 
1. Designing customized orientation packages that expose non-permanent residents to the surrounding environment, processes, and even the team composition in the shortest time possible.
2. Setting up internal evaluations that assess and correct the integration problems as they arise.
3. Implementing locum staffing employment, where new locums will be attached to older permanent staff members. I believe these measures can actually reduce the dangers of the unknown and enhance patient safety.
 
In addition, there is a clear need to rethink the external commercial recruitment strategies with regards to its costs and the continuity of care. This approach entails developing and increasing the number of internal locum pools. Utilization of internal locum resources is made more effective by the application of appropriate internal scheduling systems.
 
There are some organizations where internal locum engagement among permanent staff is encouraged by offering them incentives. It appears that those organizations which completely moved towards the internal bank structure of locums report more than just lower costs.
 
Finally, it is necessary to emphasize long-term workforce planning that can tackle the root causes for the shortage of staff.
 
Graphic and textual depictions capture:
 
1. Improving recruitment
2. Providing retention strategies concerning career development.
3. Modifying and extending the orientation training facilities to make sure there is a constant inflow of competent healthcare personnel.
4. Working with institutions to ensure the healthcare training programs respond to the changing demands.
 
These actions would make it possible for NHS trusts to begin to bring down their dependence on locum doctors and healthcare provision would become more stable, integrated, and cost-effective.
 
About the Research
 
The findings of this research are based on different publications published in different academic databases. Bellow are the references:
 
1. Grigoroglou, C., Walshe, K., Kontopantelis, E., et al. "Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019-2021." BMJ Open 2023;13

2. Ferguson, J., Walshe, K. "The quality and safety of locum doctors: a narrative review." Journal of the Royal Society of Medicine, 2019;112(11):462-471. doi:10.1177/0141076819877539.

3. Stringer, G., Ferguson, J., Walshe, K., et al. "The use of locum doctors in the NHS - results of a national survey of NHS Trusts in England." BMC Health Services Research, 2023;23:889. doi:10.1186/s12913-023-09830-9