Repeated warnings on locums ignored in NHS's own inimitable fashion

Exhortation alone will not budge the supertanker one inch. If ever the NHS provided a clear example of the truth of this, it surely lies in its failure to do anything about how it employs locum doctors.

For a service at the mercy of a government which loves to be seen to be doing something - anything - about problems with a propensity to hit the headlines, the NHS's stubborn resistance to tackle its insouciant way with locums is truly remarkable. Report after report, scandal after scandal with locums at their heart periodically outrage public and politicians alike. Yet the NHS snoozes on through another wake-up call.

This time, the Commission for Health Improvement is quite rightly indignant about how Swindon and Marlborough trust employed locum consultant pathologist Dr James Elwood 22 times in four years despite concerns about his work at another hospital and a law case pending against him. More to the point, CHI is convinced that most other trusts would have performed no better. This despite the Department of Health issuing a code for employing locums in 1997 specifically designed to get a grip on the problem.

In a report the following year, the Audit Commission found only 38 per cent of trusts checked locums' references and less than 10 per cent examined their certificates of qualification. Yet it calculated that 3,500 locums were at work in the NHS on any one day, and a third of trusts had reported adverse events involving them in the previous year. It also found that 70 per cent of locums had trained overseas, and many were insufficiently qualified for full status or a permanent job. Anyone could have predicted that it would be only a matter of time before one such would cause a major tragedy.

That duly happened at the hands of the incompetent locum anaesthetist Dr John Evans-Appiah, who was eventually banned from practising last year.

GP practices as well as trusts monitor locums ineffectively. The Consumers' Association found only 13 per cent in general practice had been asked for references last time they were employed, and fewer than a third had been asked to supply even a CV.

As CHI identifies, it is 'continuing failure' to follow 'basic procedures' which is putting patients at risk, and which must now be addressed 'with urgency and determination'. The NHS is far too reliant on locums, but it is hard to see that changing overnight: years of poor workforce planning leading to a doctor shortage and demands to sharply increase capacity will squeeze the service from two sides. All the more important then that procedures are tightened once and for all, and that trusts become far more familiar with how to investigate allegations of incompetence. Crucially, the system needs someone to own and be responsible for the 'tribe of wandering locums'. A role for the new National Clinical Assessment Authority, perhaps?