Limit locum appointments to unavoidable or unplanned absences such as sick leave.

Reduce reliance on agencies and, as far as possible, aim to appoint locums whom trusts can vouch for - former members of staff or locums who have been used before.

Set up trust banks or pools of locums to ensure the right skill-mix and cut agency fees.

Collaborative arrangements to allow trusts to put agency work out to tender.

A national scheme to monitor the performance of individual locums and report back to hospitals.