Revealed: the trusts with the highest locum usage

The research, shared exclusively with HSJ, by Manchester University academics examined NHS trusts’ use of locum doctors between 2019 and 2021.

It 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).

Specialist trusts including Royal Papworth Hospital (0.02 per cent) and Alder Hey Children’s Hospital (0.2 per cent) were among those with the lowest locum usage.

The remainder of the top 10 were acute trusts, while the average across providers was 4.4 per cent.

Psychiatry ‘bearing the brunt’

Mental health providers with the highest locum usage acknowledged their reliance on locums to fill staffing gaps or vacancies.

The researchers warned of safety concerns, including lack of clinical continuity/oversight, short-term locums’ unfamiliarity with clinical policies/procedures, and lack of induction/integration with clinical teams leading to professional isolation and deskilling. 

Rotherham, Doncaster, and South Humber Foundation Trust’s medical director Graeme Tosh said it was introducing flexible working to make medical jobs more attractive: “We acknowledge our reliance on locums and many actions are under way to address this. These actions include international recruitment… and use of recruitment and retention premia to attract substantive doctors.”

Meanwhile NELFT said it was “working hard to ensure the trust is not over-reliant on temporary measures”, through revamped workforce plans to cut agency spend.

Oxford Health said it needs to use agency medics to keep services safe, adding: “This is driven by our inability to recruit adequate numbers of senior doctors, particularly in hard-to-fill specialties such as child and adolescent mental health services.”

Researchers said qualitative work identified some “particularly problematic specialities”, such as psychiatry, where workforce shortages were acute.

A recent Royal College of Psychiatrists’ analysis of NHS workforce targets suggested a current shortfall of 690 consultant psychiatrists across England – a 15 per cent staffing gap. 

RCPsych president Adrian James said almost one in seven medical posts in mental health trusts is currently vacant: “As this report notes, psychiatry is bearing the brunt of these workforce shortages…

“No mental health service should be relying on locum doctors to deliver specialist care. Sadly, the lack of proper workforce planning by successive governments means some trusts have no choice but to rely on locum psychiatrists.”

A Department of Health and Social Care spokeswoman added: “We’re working to attract, train and retain the workforce of the future, and while this takes time, we’re already seeing results. The number of full-time staff in the mental health workforce increased by over 8,900 people in the year up to December 2022.

“Continued focus on training of new and existing staff will be crucial as we deliver our ambitions – including the NHS long-term plan aim to expand the mental health workforce by an additional 27,000 staff by March 2024.”