Locums in Wales are poorly managed, says Audit CommissionBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7290.816/c (Published 07 April 2001) Cite this as: BMJ 2001;322:816
NHS trusts in Wales and the National Assembly have been told that they need to improve controls over locum doctors, including an accreditation scheme. An Audit Commission review has found that management monitoring of the use of locums was poor and that data on the costs and reasons for the use of individual locums were generally missing.
Lack of formal contact with locum agencies also meant that it was not clear whose job it was to carry out each appointment check, resulting in omissions and duplications.
Performance review forms for locums were also a problem. “Medical staff resistance towards assessing the performance of fellow doctors meant that performance review forms are rarely completed,” said the report.
It added, “Trusts in Wales will need to take action … if they are to minimise the financial and clinical risk associated with the use of locum doctors.”
The report said that the National Assembly for Wales needed to develop an accreditation system to assure the quality of the pool of locum doctors and ensure that performance reviews are carried out for all locums. The report, A Picture of Health, also urged closer working between orthopaedic surgeons and physicians in the care of elderly people with hip fractures: “Only one trust in Wales reported that they had such arrangements in place, suggesting that there is scope for closer joint working between orthopaedic surgeons and physicians in Welsh trusts.”
There was room for improvement too in the management of district nursing—compared with district nurses England, those in Wales see fewer patients and visit less frequently.
In a separate report the auditor general for Wales, Sir John Bourn, warned of serious concerns about the NHS in the principality.
Last year NHS trusts reported deficits of in excess of £10m (£0.7m), compared with a surplus of £5m for the five health authorities. Three trusts—North East Wales, Carmarthenshire, and University Hospital of Wales—had deficits of more than £1m.
“I remain seriously concerned about the financial health of the NHS in Wales. The NHS Directorate of the National Assembly and NHS bodies need to monitor the recovery plans carefully to ensure that they are effective,” wrote Sir John in his report.
His report also showed the maximum potential future costs of clinical negligence claims in Wales. Where settlement is certain or probable the total is £111m, and claims where settlement is a possibility, but not provided for, total a further £197m.
A Picture of Health is available from the Audit Commission, PO Box 99, Wetherby LS23 7JA, price £20. NHS Wales Summarised Accounts by the auditor general for Wales is available from the National Assembly, Cardiff Bar CF99 1NA.