Daily Insight: Sector tops locum league

Mental health trusts are relying more heavily on locum doctors to plug staffing gaps than acute or specialist providers, according to new research shared with HSJ, with experts identifying psychiatry as a specialty with “problematic” staff shortages.

Academics from the University of Manchester used internal trust data to compare the number of locum shifts per week with the total full-time equivalent medical staff and presented this as the percentage of shifts carried out by locums, with the highest proportion of locums being at North East London Foundation Trust (around 16 per cent).

Of the five trusts with the highest usage, four were mental health providers, many of which admitted their reliance on locums and said they needed to use agency medics to make services safe. Psychiatry was pinpointed as a specialty with a “problematic” staff shortage, particularly in medical posts. Royal College of Psychiatrists president Adrian James said the profession was “bearing the brunt” of medical workforce shortages in mental health.

At the other end of the scale, specialist trusts for children and cardiac surgery were among those with the lowest locum usage.

Researchers also investigated the safety implications of using locums, including lack of clinical continuity and oversight.

Resistance is futile  

Earlier this month, HSJ reported that 15 integrated care systems had refused to set breakeven plans for the 2023-24 financial year.

Now, one of those ICSs – seemingly of its own accord – has been placed into what used to be known as “special measures”.

Hampshire and Isle of Wight integrated care board, and all seven of its provider trusts, have been moved into segment 4 of the NHS Oversight Framework, which is reserved for “very serious, complex issues” which typically include “critical quality and/or finance concerns”.

The organisations will now be placed into “recovery support programmes”, which means they will require NHS England sign-off and detailed oversight for a swathe of decisions in the system, especially on spending.

The ICS finished the 2022-23 financial year with a deficit of £83.2m despite planning to breakeven, recording one of the largest deficits in cash terms.

This year, H&IOW has submitted a final £24m deficit forecast – equivalent to less than 1 per cent of its total allocation – having reduced it from earlier submissions. The ICB and all six local trusts are planning deficits.

Many systems and trusts have reported being under pressure to declare breakeven, despite not believing they can deliver it, with one ICB stating this publicly.

Hampshire and Isle of Wight ICB said in a statement that it had “requested entry into the national recovery support programme” and would be working with NHSE to access the “necessary support”.