Locums make up a fifth of doctors in emergency units at weekends

A locum company has warned that the NHS will not be able to continue with what it says is a “chronic” shortage of doctors working in hospital emergency departments.

HCL Workforce Solutions, a commercial provider of healthcare professionals to the NHS, said that acute care hospital trusts in England were facing a dangerous combination of factors that were undermining their ability to maintain sufficient emergency services and called for a long term radical review of emergency medical staffing.

In a report the company said that each month its medical locum division, HCL Doctors, received an average of 3200 requests for a locum doctor from NHS emergency departments–the highest number of requests from any specialty and accounting for more than 40% of all requests.1

The report used data from the HCL Doctors division, data obtained under a freedom of information request made to 54 NHS acute trusts in England, and interviews with specialists in emergency medicine.

It found that locum doctors made up almost a fifth of the total number in emergency departments at weekends, with around 13% supporting the service during the week.

At trusts with the highest reliance on locums, 40% of doctors in emergency departments were temporary. This was the case on weekdays at University Hospitals Coventry and Warwickshire NHS Trust and at weekends at South London Healthcare NHS Trust, the figures showed. Both these trusts have recently faced financial difficulties.23

Some trusts seemed to be unable to get their staffing needs under control, said the company, especially non-foundation trusts, which had an average spend on locum emergency doctors of around £9.19 (€10.7; $14.2) per patient, almost three times the average spend of £3.16 per patient in foundation trusts.

Trusts were also still being exploited over the price of locums, the company claimed. The report said, “Sadly, this situation is further exacerbated by the intense competition for these medics, which encourages some unregulated commercial staffing agencies, who operate ‘off-framework’, to attempt to hold the NHS to ransom by supplying candidates to the highest bidder.”

Responses to the freedom of information questions showed that a fifth of trusts had vacancies for middle grade doctors and that 36% had consultant vacancies.

Various factors were coming together to make the situation particularly difficult, such as the creation of 26 regional trauma centres last year, because these had absorbed available qualified emergency care professionals, leaving the rest of the country unable to source staff.

In addition, there was a “choking off” of further supply channels, given that the UK Border Agency had increased restrictions on doctors from outside the European Union coming to work in the UK in December last year, while at the same time interest among medical students in becoming an emergency specialist was low.

Liz Bickley, managing director of HCL Doctors, said, “For several years workforce planners, medical educators, professional bodies, and the government have identified the challenges of staffing NHS A&E services but have not offered tangible solutions that resonate with those managing the shop floor.

“With over 21 million attendances recorded at A&E centres in England last year—and growing—we see no realistic reduction in demand in the short or even medium term, yet at the same time we are seeing a real crisis in medical staffing.

“While we can provide them with high quality locum candidates via a government procurement service framework to ensure continuity of their A&E service in the short term, a long term radical review of emergency medical staffing is needed.”

In an interim report published last November the Emergency Medicine Taskforce said that more routes into emergency medicine were needed to boost the number of trainees in the specialty.4

The taskforce was set up in September 2011 by the Department of Health and the College of Emergency Medicine amid growing concerns over the rising caseload and the shortage of skilled staff to treat patients safely.