Intended for healthcare professionals

Editor's Choice Editor's choice

Why this unholy trinity?

BMJ 2007; 335 doi: (Published 16 August 2007) Cite this as: BMJ 2007;335:0

Sticking together - or sticking to standards?

Tony Delamothe talks about "tears of helpless laughter" when he
considers the future of the medical profession - but we dont think the
poor performance of large numbers of locum doctors is funny at all. Our
evidence is observational and from just one general practice but
unfortunately - and despite the undisputed examples of excellence out
there(1) - we think it is widely generalisable.

We have been using locum doctors as part of the salvage process for a
high health need, inner city practice over the last six months. Many of
these doctors miss potential 'red flags', have poor or very poor record
keeping, poor prescribing, very poor referral practices and out-of-date
management of long term conditions. Many of those from elsewhere in Europe
dont know how the UK NHS works, or how to work in the NHS. Perhaps not
surprisingly - since locums are generally unsupervised and unsupported -
most dont seem to reflect systematically on their clinical practice.

So far, in this one practice over the last few months, we have
referred one doctor to NCAS (National Clinical Assessment Service) and
another for formal investigation (potentially pending NCAS review). Dozens
of others are being referred to their host PCTs.

We realise that we are unusual in having an assertive quality
process, routinely reviewing the day-to-day work of all our clinicians. We
also realise that this level of review and referral takes up time and
resources which we would, to be honest, rather spend on our patients.

Maybe this is why no-one else has picked up these issues and these
individuals. But this isnt really a good enough excuse. We think that
there is widespread collusion between employers (often GPs, sometimes
PCTs) who want holidays and other staff gaps filled; locum agencies who
are apparently oblivious; and - perhaps most importantly - with other
doctors who seem to be in denial about poor performance even when they
actually notice it.

If the profession continues to turn a blind eye, we cant be surprised
if the government takes action. Roger Jones calls for professional unity.
Surely this must mean sticking to our standards, rather than sticking



Competing interests:
None declared

Competing interests: No competing interests

21 August 2007
Caroline Mawer
General Practitioner
Douglas Russell
Tower Hamlets, London