Medical agency locum policy

1. Introduction
2. Purpose
3. Scope
4. Responsibilities, accountabilities and duties
5. Procedure or implementation
6. Training implications
7. Monitoring arrangements
8. Equality impact assessment screening
9. Links to any other associated documents
10. References
11. Appendices

1 Introduction

Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) recognises that excessive and unnecessary reliance on locums is ineffective in terms of increased costs, risk and reduced quality of patient care. Medical workforce shortages feature on the risk register across the adult care groups in RDaSH.

The lack of permanent, good quality medical employees has a negative impact upon care quality. This places a strain upon the existing workforce and the staffing levels are also having an impact in terms of morale.

RDaSH medical vacancy rates are consistently above the national and regional average. The use of medical agency and locums will be minimised by adequate workforce planning to ensure the right numbers of appropriate qualified employees are available for the service needs and a re-profiling of the current workforce. Consideration will be given to where alternative professions are able to carry out the approved clinician (AC) role.

Reviews of service provision and individual consultants’ workloads will also be carried out to ensure positions are both attractive to potential recruits and to enable retention of the current medical workforce.

Each locality will also ensure adequate arrangements are in place for effective planning of annual and study leave to minimise reliance on locums.

2 Purpose

The purpose of this policy is to reduce the locum usage, standardise the employment of locums and clarify the procedures for requesting and booking locums.

3 Scope

A locum is defined as a doctor working in a temporary capacity to provide cover for an absent member of the permanent medical or dental staff or to address short term changes within service delivery. Due to the ad hoc nature of this work, the payment will be on an hourly or programmed activity basis and there will be no substantive contract of employment.

The target audience has the responsibility to ensure their compliance with this document by:

• ensuring any training required is attended and kept up to date
• ensuring any competencies required are maintained
• co-operating with the development and implementation of policies as part of their normal duties and responsibilities

3.1 Glossary or definitions

The following terms and acronyms are used within the document:

Definitions

Acronym	Long form
AC	Approved clinician
CGMD	Care group medical director
CGD	Care group director
CL	Clinical lead
COO	Chief operating officer
CV	Curriculum vitae
DBS	Disclosure barring service (formerly called CRB)
DCGD	Deputy care group director
DCOO	Deputy chief operating officer
DMD	Deputy medical director
EMD	Executive medical director
EPMA	Electronic prescribing medicine administration
EWTD	European working time directive
GMC	General medical council
HEE	Health Education England
CHOS	Corporate heads of service
HR	Human resources
ID	Identification
IR1	Incident reporting system
JNR DR	Junior doctor
MS	Medical staffing
NHS	National Health Service
NHSI	NHS improvement
NHSR	NHS resolution (formerly called NCAS)
Occ health	Occupational health
RAP	Establishment control panel
RDaSH	Rotherham, Doncaster and South Humber
RTT	Referral to treatment time
SAS	Specialty doctors, associate specialists and staff grades
SpDr	Specialty doctor
TCS	Terms and conditions of service
WTE	Whole time equivalent
YTD	Year to date

4 Responsibilities, accountabilities and duties

4.1 Service managers and local consultants

Service managers and local consultants or care group medical and nurse directors will, in conjunction and relevant to their role:

• be responsible for identifying vacant shifts and ensuring all steps to cover the shift without the use of a temporary worker
• complete the locum request paperwork as appropriate
• approve the bank worker and agency workers CVs
• carry out local induction, complete induction checklist and identify any gaps in mandatory and statutory training that will needed or necessary for the duration of the placement
• verify the identity of the locum by checking a full signed passport, UK biometric resident permit card or photo card driving licence (non UK licences are only acceptable for a period of 12 months from the first date of entry to the UK), once checked the document should be copied, the copy should be signed and dated and a copy sent to the medical staffing department
• provide relevant information for appraisal purposes for locum doctors working within their service
• be responsible for ensuring that a locum assessment form is completed for each new agency worker

4.2 Budget holder (CGMD or CGD)

Budget holders will be responsible for approval of trust locum request forms and agency time sheets as required; also responsible for completing the request form for consultant and long-term agency workers.

4.3 CEO and EMD

The CEO will be responsible for authorisation and sign off for paying beyond NHSI capped rates (see appendix E).

4.4 Corporate heads of service or deputy care group directors

Corporate heads of service or deputy care group directors will be responsible for checking and approving time sheets as required and if applicable approve short-term locum bookings where delegated responsibility had been given.

4.5 Medical staffing

Medical staffing will:

• be responsible for receiving CV’s and compliance packs from agencies and passing these to service managers, corporate heads of service, care group medical and nurse directors and deputy care group directors in a timely manner. Checking packs for GMC registration, Identity documentation and AC status if required
• be responsible for the booking of all medical locums
• be responsible for the collection of spend and usage reports from the finance department in order to report this to recruitment, retention and medical staffing group on a monthly basis

4.6 On call or site manager

The on call or site manager will be responsible for the booking of locums out of hours, from 1700 to 0900 the following day, Monday to Thursday, from 1700 Friday to 0900 Monday and on general public holidays.

5 Procedure or implementation

When a vacancy occurs, steps will be taken to make a substantive appointment sufficiently early to avoid unnecessary locum appointments. Long term locums will be avoided where possible.

Where locums are required for doctors that are on sick leave, the care group director, care group medical director and medical staffing (MS) will liaise with the trust’s external occupational health provider to anticipate the likely duration of the leave to enable locum cover to be managed effectively.

The use of locums will not be considered a matter of routine and will always need to be justified in the light of service need with reference to quality assurance, standards and risk management and the provisions of the terms and conditions of service. To ensure this is monitored appendix A, locum request form, will be completed to request a locum. Note this form is not required where the “exceptions rule” is used (see section 5.1)

Medical staffing is responsible for booking all agency locums in hours and on-call managers are responsible out of hours. Services should not liaise directly with locum agencies.

The care group medical director or care group director and corporate head of service or deputy care group directors or service managers for each locality will be responsible for determining how service requirements can be alternatively met and risks mitigated if a locum of sufficient quality cannot be appointed. Where a decision is made to not appoint a locum if based on a financial reason an explanation of how the risks will be mitigated to keep services safe needs to be provided to the EMD and COO with immediate effect by the care group director (budget holder).

1. Service Identify uncovered shifts.
2. Request cover, budget holder (or appropriate delegate) to sign off.
3. CGD and CGMD search for cover (internal first).
4. CGD or CGMD approves CV.
5. If agency MS book locum.
6. Locum covers shift and completes time sheet.
7. Service manager signs off completed time sheet if it is for the exact hours on the request form.
8. If the time sheet is for more time that was originally requested, CGD approval is required..
9. Locum paid via agency or RDaSH as appropriate.

5.1 Exceptions rule

Getting approval for locums can often take a lot of time, sometimes where shift cover is urgent this can cause problems with finding cover. The exceptions rule prevents these issues. The rule is that any out of hours emergency cover shifts that occur due to a long-standing vacancy or sickness do not require formal approval and can be covered immediately, without prior approval.

5.2 Non-resident consultant on call cover

Covering non-resident consultant on calls with agency locums is extremely expensive. Prior to booking an agency locum to cover a non-resident on call shift, executive director approval must be given. Locum Request Form for non-resident on call form in appendix B must be completed and signed by an executive director in advance of the booking, along with appendix C the medical recruitment authorisation panel (RAP) form, see section 5.4.

5.3 Consultant and long-term agency worker approval

A consultant agency worker is the most expensive agency doctor; approval must be obtained for any agency consultant request and for a request for any agency doctor that is going to be for four weeks or more. The approval must be from the medical recruitment authorisation panel (RAP). Membership of this panel is the executive medical director (EMD) and or care group director (CGD), director of finance (DOF), deputy chief operating officer (DCOO) and MS representative. The RAP form is enclosed as appendix C. The outcome of this panel is reported to the medical staffing and retention group (MSRG) on a monthly basis.

5.4 NHS locums

The trust will seek to book NHS locums before an agency worker. Locum doctor appointments will be made following a similar process as a substantive appointment and will be line with the Employment checks policy.

5.5 Agency locums

Where external locums are required, the trust will only use agencies on an approved framework by NHS improvement, crown commercial services or workforce alliance.

Requirements will be outsourced to framework agencies who are required to ensure compliance with national, pre-employment check guidance prior to a placement or booking being made.

All locum CV’s must be approved by the local CGMD or CGD within the locality that the locum will be working in. For the children’s care group this will be the lead consultant or CGD.

All agency workers must take a 20 minute unpaid break for every six hours worked.

5.6 NHS improvement (NHSI) rules

Where applicable any NHSI rules will be followed, which include maximum hourly CAP rates. If the rates need to be breached, then a break glass form must be completed with no exception. This form should be saved with the booking confirmations. The form is enclosed as appendix E.

5.7 Appraisal

All doctors must be appraised annually. The general medical council (GMC) requires doctors to have appraisals as part of the revalidation process.

The trust’s medical revalidation appraisal policy outlines the appraisal process in place to support all locum doctors’ professional and career development and to assist revalidation. If an NHS locum doctor is undertaking the majority of their work at the trust, they should have an appraisal from one of the trusts named appraisers, subject to the thresholds in the medical appraisal policy.

5.8 Monitoring performance of locums

A senior clinician will be required to complete an assessment form for each locum. A copy of the form will be held in medical staffing in the locum personal file. The assessment form is enclosed as appendix F. The locum will also be given the opportunity to make further representations if they wish, especially if a referral to NHSR and or GMC is contemplated.

If the locum was employed through an agency, a copy of the Locum assessment form will be forwarded to the agency for their records.

Assessment forms which raise serious concerns about performance will be referred to the care group medical director and executive medical director. If necessary, advice will be sought from NHSR and or GMC where appropriate. For doctors in training, a copy of any reports showing shortcomings should also be sent to the postgraduate dean. Protection of patients will be the first consideration.

5.9 Out of hours arrangements

The on call manager is responsible for booking locums out of hours. They will comply with all the procedures outlined in appendix A. Booked doctor’s CV and all documentation in relation to the booking will be forwarded to MS for filing.

Ward areas should check the identity of locum doctors attending the ward area, when they are covering an ad hoc shift and don’t normally work within the trust.

6 Training implications

Locum doctors should be offered an appropriate induction for their role and appropriate supervision.

All locum doctors will be given a “guide for locums”, when commencing work at the trust. This includes a locum Induction checklist and important trust information, including reference to relevant policies and procedures, locums are required to hand in the signature signed and completed page confirming that they have received and read the information.

All locum doctors should be provided with a laptop and a phone, where deemed appropriate, on arrival to enable them to be able to commence their work fully on arrival. This needs to be organised by the care group director in liaison with MS. This does not apply to locums covering ad hoc on-call shifts.

7 Monitoring arrangements

Information regarding trends and analysis is reported regularly to MSG including names, length of appointment, specialty and cost.

MS will monitor the reasons locum requests are made on a monthly basis.

The arrangements for monitoring compliance are outlined in the table below:

7.1 Minimising locum expenditure

• How: Locum expenditure calculated and monitored.
• Who by: Medical Workforce team.
• Reported to: Medical staffing group (MSG) and trust board
• Frequency: 12 times a year.
• Action: Action plan will be developed, agreed and followed up.

7.2 Appropriate locum usage

• How: Report of locum usage reviewed.
• Who by: Medical Workforce team.
• Reported to: MSG.
• Frequency: 12 times a year.
• Action: Recommendations will be agreed.

7.3 All Locum doctors must complete, sign and return the induction form to the MS team

• How: An audit, a random sample of locum doctors files is reviewed for compliance of induction form, follow up and or logged.
• Who by: Medical Workforce team.
• Reported to: Medical Workforce team.
• Frequency: 2 times a year.
• Action: Where completion of the induction form is less than 100%, medical staffing will chase them up via the doctors agency. The audit results will be reported annually to the medical staffing group. Where themed gaps are identified following the audit results, these will be actioned and followed up by the Medical Staffing team

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please see the overarching equality impact assessment.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

No issues have been identified in relation to this policy.

8.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

9 Links to any other associated documents

• RDaSH medical appraisal policy

10 References

• Pay and Conditions Circular (M and D) 1/2022.
• NHSI Agency Rules 2019.
• NHSI Price Card 2022/2023.

11 Appendices

11.1 Appendix A Locum request form

• Appendix A Locum request form

11.2 Appendix B Locum request form for non-resident on-call

• Appendix B Locum request form for non-resident on-call

11.3 Appendix C RAP form

• Appendix C RAP form

11.4 Appendix E Break glass form

• Appendix E Break glass form

11.5 Appendix F Locum assessment form

• Appendix F Locum assessment form