Leaked memo reveals national locum shortage

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Leaked Department of Health documents have revealed a national shortage of locum hospital doctors, with some trusts reporting they are "lucky if applicants attend for interview". HSJ first highlighted the issue last year and as recently as 14 February the DH was insisting there is no evidence of a widespread shortage.

But the documents, seen by HSJ, show trusts across the country are struggling to find locums to cover vacancies, particularly in emergency units.

The problems have arisen since Modernising Medical Careers created a fixed start and end date for junior doctors' specialist training posts last August, which reduced the pool of staff able to replace doctors who move on or become consultants during the year.

The documents include an email sent by the DH's MMC project lead for recruitment and selection, Steve Buggle, on 7 February, asking strategic health authorities "what the real causal factors are" behind any locum shortages.

It says: "Anecdotally we are aware that... service in some trusts may be experiencing problems in finding locums... and that trusts may also be having problems in appointing to posts which fall vacant throughout the year because the new appointment process has provided trainees to a national timetable."

The documents seen by HSJ include responses from individual SHAs, trusts and deaneries. The reply from Vicky Osgood, director of postgraduate medical and dental education at Wessex deanery, described the problem as "extensive".

She said: "We are having increasing difficulty filling any and all vacancies and locum requests."

Growing concerns

East Sussex Hospitals medical personnel manager John Holland replied: "We are lucky if the applicants attend for interview, and on a number of occasions there have been no applicants to interview on the day."

NHS North East reported more than 42 doctors' vacancies for which they are unable to find any cover, the email showed.

Queen Victoria Hospital foundation trust medical staffing manager Sue Plummer said locums "have proved difficult if not impossible to find" in some specialisms, including plastic surgery.

Jan McClean, from Worthing and Southlands Hospitals medical staffing, warned of a "national shortage of locums".

Jennie Lau from London deanery said there were "growing concerns". She said this was due to "the impact of MMC" and "issues with recruiting to posts in certain organisations due to the reputation of the organisation as a good working environment".

In addition, doctors were reporting sickness and absences too late to find staff to provide cover.

The problem "appears to be concentrated in A&E", she said. This was also the case in several other regions.

Ashford and St Peter's Hospital trust said it was advertising in the Polish Medical Journal for accident and emergency doctors due to problems getting locums from agencies.

Potential solutions

Dr Richard Marks of junior doctors' campaign group Remedy UK, which acquired the documents, said it showed the locum shortage was widespread.

"This shortage was predictable by simple arithmetic modelling before MMC was introduced," he said. He was concerned that there appeared to be no plans to address the situation for before next year's recruitment round.

A DH spokesman said: "This problem has been circulating anecdotally for some time. We do take it seriously, which is why we asked SHAs to help us understand its extent and nature at the beginning of February. It is worth bearing in mind that the NHS employs around 120,000 doctors in England and, while some trusts have reported issues, many haven't.

"There have always been some problems staffing some rotas in shortage specialties. The issue for us has been whether the problem is different this year in terms of its nature and scale. The survey has given us a clearer idea of what is going on. We understand the theory that the single timetable for specialty training recruitment in 2007 might be a contributor and that is partly why we are moving to a three-phase timetable in 2008, but there may be other factors. We are talking to the NHS, to the medical profession and others about potential solutions."