Archive for July 11th, 2010

Crawling with idiots

Following on from this in the BMJ

People like me are crippling the NHS, sucking money from it like leech. Honestly.

I have abandoned my secure pension and holiday priviledges and study leave to become a mercenary.

For those who don’t know what a locum doctor is, it’s kind of similar to a substitute teacher.

Someone on the regular staff is sick or on a course or not present for any number of reasons so we need someone to cover.

Sometimes this gap in the staffing can be filled by other people in the department. frequently the gap is left unfilled and everyone just has to work harder. (or simply the patients wait longer, it’s not like people were sitting twiddling their fingers…)

If the hole in staffing is big enough then we try to get a locum doctor in.

Lots of different types of doctors make up locums.

1) people already in the same department who are looking some overtime – these folk are probably the best to get as they know how the department runs inside out and they have a certain loyalty or commitment to the job already so they often really make the effort

2) people from different specialties/departments who want to keep their experience broad and earn a bit of extra cash – this can range from GPs wanting a bit of hospital experience to guys who are now into specialty training but who did a bit of emergency medicine at some point and are able to work at a lower level in emergency medicine

3) people on time out in a research or academic job who are looking to keep up their skills and supplement their income – these guys tend to be enthusiastic and motivated (motivated enough to do research for a bit!) – this is the category I currently fall into. I’m also working in my old ED (emergency department) so i feel extra wonderful…

4) locum agency staff – often we know very little about who these guys are. Often the locum agencies don’t know. This can range from highly qualified and motivated individuals to guys who have a medical qualification form somewhere but have never managed to obtain an NHS job. Language skills are highly variable and knowledge of both how the NHS works and how the department works is sometimes sorely lacking.

[GP locums and consultant and long-term locums are a slightly different kettle of fish, I mainly refer to middle-grade and junior-grade doctors]

We are also using an ever increasing number of locum doctors. There are lots of reasons for that. I agree part of the blame falls at the feet of EWTD and MMC but there are simply greater demands and expectations on the services we provide. The change in the visa rules leading to a greater restriction in how non-EU doctors work in the UK has also left us short staffed (roughly half of doctors in the UK trained overseas).

The EU regulations that allow free movement and recognition of medical registration means that regulation of EU doctors is to a certain degree out of the hands of the GMC. The best example being this doctor who has been struck off the UK medical registrar but is allowed to freely practice in Germany.

In our department there are two big gaps in staffing. The looming (come change-over in August) gap is that of juniors. No one, it seems, wants to do emergency medicine in Northern Ireland. The training jobs were massively undersubscribed leading the NI deanery to take a trip to India on a recruitment drive.

The junior staff see a large number of our 78000 patients. Will be interesting to see how many juniors we get.

The other main staffing issue is the middle-grade rota. This consists of people who are further on in their training (registrars) but not yet consultants and staff grade doctors (or speciality doctors as we’re called these days). Staff grades are doctors with experience in their specialty, able to work without supervision but haven’t (for any number of reasons) done consultant training.

I’m pretty convinced that middle-grades in our department see the majority of patients (though I’d love solid numbers to back that up). The business of seeing the patients and getting the waiting room emptied and supervising the juniors largely falls to us. Naturally I think we’re the most important part of the department…

[NB the consultants are hardly ornaments in the department but a lot of their day to day job isn’t seeing patient after patient, nor do i think it should be]

We have funding for 8 middle-grade doctors. We had 5 up until I quit in June and now they have 4. To my knowledge the gap is being made up by locums (a group that I now form a part of!).

If we had a fully and consistently staffed rota I think the place would run pretty well but the problem is we can’t fill the posts. No one wants to do non-training middle-grade jobs. Quite frankly it’s too much work for not enough reward (either career or financial) for most people. ED jobs are really tough. Without doubt the toughest of all the jobs I’ve ever worked.

So we will become increasingly dependent on locums and will pay these staff often up to 4 times what the permanent staff are getting. Despite the fact that some of the locums we are paying for this are of dubious value for money to say the least.

I will get (in my opinion) extremely well paid for the few locum shifts I do this summer, in a place I love to work in. But the more the NHS employs locums like me the less likely it will be able to afford the contented and permanent staff it needs.


July 2010