Intended for healthcare professionals

Rapid response to:


Scotland needs tighter controls on locum doctors, audit shows

BMJ 2010; 340 doi: (Published 18 June 2010) Cite this as: BMJ 2010;340:c3308

Rapid Response:

Don't Use a Hammer to Smash a Walnut

As an academic GP who over the past 3 years has taken up
locum work in the Out of Hours Services, to supplement my
part time academic work, I shudder to hear of more
regulation on locums.

There is already so much bureaucracy being introduced to
address the quality and performance of locums in the UK, yet
I fear that it is creating as many hurdles for good quality
as for poorer quality performers, such that those who have
better reputations will get jobs elsewhere and not work as
locums. It appears that funders want a pool of known local
doctors who will cover their locums, however requirements
such as being on one performers list and having appraisals
that have very little relevance to the locum’s work is a
barrier to doctors from other areas and countries who may
have high quality standards. Being a local GP is no
guarantee for quality, as we locums see quite variable
performances by local GPs who have been regulated and
appraised, in the patients we see in the Out of Hours.

Regulations, QOF, appraisals etc are blunt instruments which
do not discriminate for real quality and are barriers which
in some cases deter the good doctors as much or more than
the poorer performers. It is suggested that the 'medical
managers' actually spend some time in the field, look at
case notes and talk to patients and staff to get a sense of
how doctors are performing. This is accordance with the old
style of the hospital chief or the hospital matron actually
looking and listening, rather than using arms length
bureaucratic activities to judge, once common sense basic
checks on competence, reference and ethical standards are
carried out.

Competing interests:
None declared

Competing interests: No competing interests

21 June 2010
Carmel M Martin
Senior Research Fellow,
Dept of Public Health and Primary Care Trinity College DublinDublin 15