Junior Locum Doctors – Plans For the Future

 

It has proven to be truly turbulent times for employees of the NHS. Now, I cannot speak for every position but I can definitely see from the perspective of junior / locum doctors because these are the people I deal with on an everyday basis. Without a doubt, the NHS has been a fundamental part of the UK and what it stands for – but what is happening to it and what is the stance of the crop of junior doctors who will be leading the clinical front in the near future?

I have been interviewing doctors for nearly five years. Doctors of all ages, specialties and grades – Clinical Attachment candidates to Consultants. Needless to say, I’m in contact with doctors on a regular basis and I always like to chat about what their thoughts are on the current market and revelations.

Times have changed!

Since the start of the year the opinions that I hear are completely different to those that were expressed 5 years ago; and even a year ago. Junior doctors in particular feel that there is little to no stability in the NHS anymore. They do not know what is coming or going; and to be honest the way that the NHS is going isn’t inspiring them with a lot of confidence – the recent protests are a clear example of this.

There was a time when junior doctors were so sure about what they wanted to do. They knew what they wanted to specialise in and where their career was going to go. It is customary nowadays for junior doctors to complete their two years of Foundation Training and then take a year out (much deserved) before committing another portion of their lives to Core Training.

Who could blame them? You study all through school, through college, go through 5 or 6 years of intense studies at university, then get thrown straight into your 2 year rotation – I think it’s fair to take a break.

However, even through all that – junior doctors still had a decent idea of what they wanted to do. They would use this welcome gap year to blow of some steam, go travelling and supplement their lifestyle with locum work so they can keep in touch with their clinical skills whilst earning.

Let’s fast-forward to today. We are half way through 2017 and I have interviewed in excess of 100 doctors this year. 95% of these doctors are junior doctors who are looking to complete their second year of Foundation Training and take a year out; as per the norm. As the year has gone by and as the changes in the NHS are becoming more frequent, the general opinion of junior doctors has changed.

I used to hear:

“I’m taking a year out… I’ll do some travelling for a month or two… I’ll do a bit of locum work and I’ll be applying for a Training Post and cracking on with my career!”

Now I hear:

“I’ll be taking two years out because I’m not sure what is happening with the NHS… I may not even locum here in the UK, I was thinking of doing a year in Australia/New Zealand/South Africa… Actually I don’t even know if I want to do clinical anymore, I may just go for a research post!”

It’s a stark contrast but unfortunately it’s the cold truth – the way the NHS is going, it is pushing our junior doctors away and in the long run that leads to fewer practicing doctors. Even when taking a year out, doctors would still do locum shifts so we would have a good pool of doctors available on an ad-hoc basis to fill vacancies. However now doctors are choosing to go abroad it drastically dilutes the pool of available doctors. This means further understaffed departments, which leads to existing staff overworking -> this leads directly on to tiredness and exhaustion of doctors -> this of course leads to existing working doctors requesting time off  -> which in turn leads to an already understaffed department being more understaffed – see the vicious cycle that’s unfolding?

This is the position we are in and it is the harsh reality that we are facing. Are we going to see a change? Will the “new” government be able to change the way things are being dealt with? Your guess is as good as mine; but I would definitely like to know your thoughts and opinions.

Until next time folks – have a good day

The Importance of Compliance in the Locum Market

I have been working in the medical recruitment sector for near enough 5 years; granted it’s not as long a tenure as a lot of people out there – but it has certainly proved long enough to witness and experience the change in compliance standards; especially in the locum market.

 

Since the inception and implementation of Frameworks (such as PASA, Buying Solutions, GPS, LPP, CPP… the list goes on) the concept of compliance has evolved into something that is detested by locum doctors. Gone are the days where all the documents you would need to book a locum doctor could be counted using the fingers on one hand – now you will need several hands!

 

• “There are so many documents involved!”
• “Why do you need 3 variations of the same document?”
• “How many more forms do I need to fill out?”
• “References? I just gave you three referee details two weeks ago and now you want more??”
• “Why are you stricter than the NHS in terms of documents?”

 

I’m sure that these comments are heard on a regular (if not daily) basis by compliance staff nationwide; and I certainly feel your pain when you have to repeat the same answer to each locum and hope that they don’t get sick and tired of the registration process and decide to withdraw their interest altogether. Believe me, locum agencies are not too thrilled about requesting every document under the sun dating back to when you started nursery either! We are in the same boat.

 

However… with all that being said. There is a necessity for the strict level of compliance. Working as a locum will automatically bring agencies to the spotlight if there is a complaint, issue, malpractice, etc. Unfortunately as a locum, you probably will be under more scrutiny while you work and the sad story is, if something was to go wrong – your investigation will most likely go deeper when compared to a substantive member of staff. Hardly fair, but as they say… “That’s how the cookie crumbles”.

Upon investigation or audit, a locum’s file is dissected with a fine surgical knife – no document is left unturned and every record is looked over by a trained keen eye. If there is an error or a missing document, it will most definitely be found and bought to light. If there are issues with documentation then both agency and locum doctor will be at the centre of questioning. Needless to say, this is a scenario that is definitely best avoided rather than experienced.

 

In a nutshell; compliance is necessary and agencies do have to follow the stringent guidelines set out by Frameworks. Ultimately, the compliance of a locum is not just about paperwork or a red-tape, tick-box exercise – it is also about protection. Protection for the locum, the agency, the NHS and of course… the patients.

 

Considering the status quo with the NHS and the government aiming to reduce agency spend and cut down on locums, it would not surprise me in the least if the level of compliance does get more intense as the months and years go on. The only thing we can ask for from an agency perspective is that locums have the patience and understand that we are equally sharing the pain with you – a problem shared is a problem halved, right?

 

If anyone would like to chuck in their two cents, please comment and we can have a healthy discussion.

Agency Caps – Cure or Chaos

With the imminent ratchet down it is timely to reflect on the impact of the Price Caps introduced last November.  What have we learnt? It is difficult to tell because reaction from both agency workers and Hospital Trust has been mixed. Certainly there has not been complete compliance by the Trusts and workers have a wide variety of personal needs to consider when deciding to make themselves available or not.

There is scant evidence of the motive for Agency Caps being achieved with no evident migration to substantive jobs although this may change with future Cap reductions. Surprisingly there is news of some salaried workers moving over to agency status.

There has been a few issues in filling requirements with some Locums unwilling to provide their services but this does not appear to have had dire consequences, with Trusts either being eventually flexible on pay rates or improving staff management.

Add to the mix the ongoing Junior Doctor contract negotiations and the imperative of patient safety there is much  for  hospital  management  to contend with at the moment. They seem to be coping but are they just papering  over  the  cracks  which may open even further with February’s Cap reduction.

Only time will tell

Accident and Emergency waits – the highest for a decade.

It’s interesting to read peoples’ comments on the breaking story about the number of people waiting more than 4 hours in A&E which has risen by 21% compared with the same period one year ago.

Politicians say that more efficiency is needed while doctors say more money. Yet the people say more definition around what constitutes an emergency. Does an ear infection; cold or even a whitlow on a finger constitute an emergency (real examples used on readers’ responses BBCNews)?

It might be that a visit to A&E is more preferable to booking an appointment with the GP which carries the risk of not being able to get an appointment at a convenient time – after all not everyone gets paid for time off or for sick days. If this is happening on a regular basis then no wonder A&E departments are swamped.

Have your say – do you think more money is needed? Is the problem with GP surgery hours? Or does the general population have a complete disregard for “free” services?

Running a hospital is like running a business. True or False?

Running a hospital is a highly complex job and we’ve seen corporate types on telly try to do this and fail, so are there any similarities or not? Like a business a hospital needs to keep its costs under control. So cost management is necessary. An hospital’s income comes from the State- well tax payers -so no similarities here. Operationally an hospital needs to manage staff, buildings, and of course the provision of patients and what patients are in hospital for in the first place – the similarities now start to drift further apart. Businesses have customers to look after but these pay for their services and if they get more customers, then a business can flex up its operations accordingly – which means businesses are a lot more flexible to adjust to their circumstances.

Polly Toynbe sums up the job of running a hospital that is worthwhile repeating:

“Balancing agonisingly tight finance with good quality will be phenomenally difficult, requiring honesty about hard choices ahead. The danger is that NHS enemies will seize on the current crunch to declare the service broken. But they should remember how Danny Boyle’s Olympic spirit revealed a strength of public passion they defy at their peril.”

http://www.guardian.co.uk/commentisfree/2013/feb/07/enemies-declare-nhs-broken-but-not?intcmp=239

Have your say. Is running a hospital like running a business?

Clearly something went wrong at The Mid Staffordshire NHS Trust.

Among the reasoning has been blame on the NHS culture, which focused “on doing the system’s business – not that of the patients”. This is understandable, but let’s not forget that culture comes from the very top of an organisation and has the ability to change behaviour and functions. Governments for a long period of time have inflicted upon hospital trusts, performance statistics to measure their productivity – a term which seems wildly at odds with patient care. If these were not achieved then penalties would be paid. Productivity sits neatly with “manufacturing” and “economic output” but is not so consistent with concepts like care, compassion, concern and charity. How do you measure these? So did successive governments get it wrong? There is no doubt that the pressures on running a country are very different to those pressures of running a hospital. They are almost diametrically opposite. To retain some kind of order though, reporting does need to take place, otherwise the NHS would be a shambles, but a meeting of the ways clearly needs to take place so that The NHS can put back patient care to where it used to be and what it should be.

Lets us hear your opinion.