Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019–2021
ObjectivesTemporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019–20...
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| Published in: | BMJ open Vol. 13; no. 6; p. e065803 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
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England
British Medical Journal Publishing Group
25.05.2023
BMJ Publishing Group LTD BMJ Publishing Group |
| Series: | Original research |
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| ISSN: | 2044-6055, 2044-6055 |
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| Abstract | ObjectivesTemporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019–2021.SettingDescriptive analyses of data on locum shifts from all NHS trusts in England in 2019–2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics.ResultsIn 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th–75th centile=2.2%–6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts’ staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019–2021, the mean number of weekly shifts per trust increased by 19% (175.2–208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts.ConclusionsThere were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts. |
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| AbstractList | Objectives Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019–2021.Setting Descriptive analyses of data on locum shifts from all NHS trusts in England in 2019–2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics.Results In 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th–75th centile=2.2%–6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts’ staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019–2021, the mean number of weekly shifts per trust increased by 19% (175.2–208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts.Conclusions There were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts. ObjectivesTemporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019–2021.SettingDescriptive analyses of data on locum shifts from all NHS trusts in England in 2019–2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics.ResultsIn 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th–75th centile=2.2%–6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts’ staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019–2021, the mean number of weekly shifts per trust increased by 19% (175.2–208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts.ConclusionsThere were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts. Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019-2021. Descriptive analyses of data on locum shifts from all NHS trusts in England in 2019-2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics. In 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th-75th centile=2.2%-6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts' staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019-2021, the mean number of weekly shifts per trust increased by 19% (175.2-208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts. There were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts. Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019-2021.OBJECTIVESTemporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019-2021.Descriptive analyses of data on locum shifts from all NHS trusts in England in 2019-2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics.SETTINGDescriptive analyses of data on locum shifts from all NHS trusts in England in 2019-2021. Weekly data were available for the number of shifts filled by agency and bank staff and the number of shifts requested by each trust. Negative binomial models were used to investigate the association between the proportion of medical staffing provided by locums and NHS trust characteristics.In 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th-75th centile=2.2%-6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts' staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019-2021, the mean number of weekly shifts per trust increased by 19% (175.2-208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts.RESULTSIn 2019, on average 4.4% of total medical staffing was provided by locums, but this varied substantially across trusts (25th-75th centile=2.2%-6.2%). Over time, on average two-thirds of locum shifts were filled by locum agencies and a third by trusts' staff banks. On average, 11.3% of shifts requested were left unfilled. In 2019-2021, the mean number of weekly shifts per trust increased by 19% (175.2-208.6) and the mean number of weekly unfilled shifts per trust increased by 54% (32.7 to 50.4). Trusts rated by the Care Quality Commission (CQC) as inadequate or requiring improvement (incidence rate ratio=1.495; 95% CI 1.191 to 1.877), and smaller trusts had a higher use of locums. Large variability was observed across regions for use of locums, proportion of shifts filled by locum agencies and unfilled shifts.There were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts.CONCLUSIONSThere were large variations in the demand for and use of locum doctors in NHS trusts. Trusts with poor CQC ratings and smaller trusts appear to use locum doctors more intensively compared with other trust types. Unfilled shifts were at a 3-year high at the end of 2021 suggesting increased demand which may result from growing workforce shortages in NHS trusts. |
| Author | Kontopantelis, Evangelos Allen, Thomas Ferguson, Jane Stringer, Gemma Grigoroglou, Christos Ashcroft, Darren Walshe, Kieran |
| AuthorAffiliation | 2 Alliance Manchester Business School, Institute for Health Policy and Organisation , The University of Manchester , Manchester , UK 5 NIHR Greater Manchester Patient Safety Translational Research Centre , The University of Manchester , Manchester , UK 4 Division of Informatics, Imaging and Data Sciences , The University of Manchester , Manchester , UK 3 NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research , The University of Manchester , Manchester , UK 1 Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care , The University of Manchester , Manchester , UK 6 Danish Centre for Health Economics , University of Southern Denmark , Odense , Denmark |
| AuthorAffiliation_xml | – name: 1 Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care , The University of Manchester , Manchester , UK – name: 2 Alliance Manchester Business School, Institute for Health Policy and Organisation , The University of Manchester , Manchester , UK – name: 5 NIHR Greater Manchester Patient Safety Translational Research Centre , The University of Manchester , Manchester , UK – name: 4 Division of Informatics, Imaging and Data Sciences , The University of Manchester , Manchester , UK – name: 3 NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research , The University of Manchester , Manchester , UK – name: 6 Danish Centre for Health Economics , University of Southern Denmark , Odense , Denmark |
| Author_xml | – sequence: 1 givenname: Christos orcidid: 0000-0003-1621-8648 surname: Grigoroglou fullname: Grigoroglou, Christos email: christos.grigoroglou@manchester.ac.uk organization: Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK – sequence: 2 givenname: Kieran surname: Walshe fullname: Walshe, Kieran organization: Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK – sequence: 3 givenname: Evangelos orcidid: 0000-0001-6450-5815 surname: Kontopantelis fullname: Kontopantelis, Evangelos organization: Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK – sequence: 4 givenname: Jane surname: Ferguson fullname: Ferguson, Jane organization: Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK – sequence: 5 givenname: Gemma surname: Stringer fullname: Stringer, Gemma organization: Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Manchester, UK – sequence: 6 givenname: Darren surname: Ashcroft fullname: Ashcroft, Darren organization: NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK – sequence: 7 givenname: Thomas orcidid: 0000-0002-2972-7911 surname: Allen fullname: Allen, Thomas organization: Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37230514$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1111/1467-9566.13210 10.1136/bmj.m3057 10.1287/isre.2013.0480 10.1177/0141076819877539 10.3399/BJGP.2021.0311 10.1016/S0140-6736(21)00231-2 |
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| References | Rimmer (R1) 2020; 370 Lin, Lucas, Shmueli (R15) 2013; 24 Ferguson, Tazzyman, Walshe (R18) 2021; 43 Anderson, O’Neill, Macleod Clark (R4) 2021; 397 Ferguson, Walshe (R17) 2019; 112 Grigoroglou, Walshe, Kontopantelis (R9) 2022; 72 Ferguson (2023073121200723000_13.6.e065803.17) 2019; 112 2023073121200723000_13.6.e065803.9 2023073121200723000_13.6.e065803.19 2023073121200723000_13.6.e065803.1 2023073121200723000_13.6.e065803.10 2023073121200723000_13.6.e065803.2 2023073121200723000_13.6.e065803.11 2023073121200723000_13.6.e065803.3 2023073121200723000_13.6.e065803.12 2023073121200723000_13.6.e065803.4 2023073121200723000_13.6.e065803.13 2023073121200723000_13.6.e065803.5 2023073121200723000_13.6.e065803.14 2023073121200723000_13.6.e065803.6 2023073121200723000_13.6.e065803.15 2023073121200723000_13.6.e065803.7 2023073121200723000_13.6.e065803.16 2023073121200723000_13.6.e065803.8 Ferguson (2023073121200723000_13.6.e065803.18) 2021; 43 |
| References_xml | – volume: 43 start-page: 149 year: 2021 ident: R18 article-title: You’re just a locum: professional identity and temporary workers in the medical profession publication-title: Sociol Health Illn doi: 10.1111/1467-9566.13210 – volume: 370 year: 2020 ident: R1 article-title: NHS england workforce plan fails to tackle staff shortages, say health leaders publication-title: BMJ doi: 10.1136/bmj.m3057 – volume: 24 start-page: 906 year: 2013 ident: R15 article-title: Research commentary —too big to fail: large samples and the P -value problem publication-title: Inf Syst Res doi: 10.1287/isre.2013.0480 – volume: 112 start-page: 462 year: 2019 ident: R17 article-title: The quality and safety of locum doctors: a narrative review publication-title: J R Soc Med doi: 10.1177/0141076819877539 – volume: 72 start-page: e108 year: 2022 ident: R9 article-title: Locum doctor use in english general practice: analysis of routinely collected workforce data 2017-2020 publication-title: Br J Gen Pract doi: 10.3399/BJGP.2021.0311 – volume: 397 start-page: 1992 year: 2021 ident: R4 article-title: Securing a sustainable and fit-for-purpose UK health and care workforce publication-title: Lancet doi: 10.1016/S0140-6736(21)00231-2 – ident: 2023073121200723000_13.6.e065803.2 – ident: 2023073121200723000_13.6.e065803.5 – ident: 2023073121200723000_13.6.e065803.6 – ident: 2023073121200723000_13.6.e065803.9 doi: 10.3399/BJGP.2021.0311 – ident: 2023073121200723000_13.6.e065803.3 – ident: 2023073121200723000_13.6.e065803.1 doi: 10.1136/bmj.m3057 – ident: 2023073121200723000_13.6.e065803.15 doi: 10.1287/isre.2013.0480 – ident: 2023073121200723000_13.6.e065803.4 doi: 10.1016/S0140-6736(21)00231-2 – volume: 43 start-page: 149 year: 2021 ident: 2023073121200723000_13.6.e065803.18 article-title: You’re just a locum: professional identity and temporary workers in the medical profession publication-title: Sociol Health Illn doi: 10.1111/1467-9566.13210 – ident: 2023073121200723000_13.6.e065803.8 – ident: 2023073121200723000_13.6.e065803.7 – ident: 2023073121200723000_13.6.e065803.11 – ident: 2023073121200723000_13.6.e065803.10 – volume: 112 start-page: 462 year: 2019 ident: 2023073121200723000_13.6.e065803.17 article-title: The quality and safety of locum doctors: a narrative review publication-title: J R Soc Med doi: 10.1177/0141076819877539 – ident: 2023073121200723000_13.6.e065803.12 – ident: 2023073121200723000_13.6.e065803.13 – ident: 2023073121200723000_13.6.e065803.14 – ident: 2023073121200723000_13.6.e065803.19 – ident: 2023073121200723000_13.6.e065803.16 |
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| Snippet | ObjectivesTemporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is... Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about... Objectives Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is... |
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| SubjectTerms | Consultants Employment England Expenditures Health policy Health services Health Services Research Hospitals Human resource management Humans Labor shortages Mental health Organisation of health services Physicians, Family Quality of Health Care Recruitment State Medicine Workforce Workforce planning |
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| Title | Use of locum doctors in NHS trusts in England: analysis of routinely collected workforce data 2019–2021 |
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