Locum Work Research Articles

Orthopedic surgeons' transition into full-time practice over the last 20 years: an analysis using Ministry of Health billing data.

Underemployment is a reality for many new graduates, who accept locum or part-time work as an alternative to unemployment because of lack of opportunities. We sought to analyze orthopedic surgeons' Ontario Health Insurance Program (OHIP) billing data over a 20-year period as a proxy of practice patterns and hypothesized that billing in the first 6 years of practice would be affected by underemployment and locum. We analyzed the annual average billing totals of orthopedic surgeons, broken down by year of graduation, year of billings, and number of surgeons billing in that year. We analyzed public census data of the Ontario population size as a proxy of orthopedic demand. A 2019 cross-sectional analysis showed that around 15 surgeons per graduating year were billing in Ontario from the 1995 to 2016 cohorts, while 2017 and 2018 saw an increase to 30 and 36 actively billing surgeons, respectively. The number returned to more historical numbers in 2019, with 20 actively billing surgeons. For those surgeons billing in Ontario, billing trends have been roughly stable, with average billings increasing each year for the first 6 years in practice (p < 0.001). Year of graduation did not have an effect on the first 6 years of billings (p > 0.5). Billings were stable after 6 years in practice (p > 0.09). The Ontario health care system has not expanded to support more orthopedic surgeons despite the aging and growing population; despite our growing population, the number of surgeons being trained and retained has not matched this growth. Further research needs to be done to guide optimal health human resource decision-making.

The use of locum doctors in the NHS – results of a national survey of NHS Trusts in England

BackgroundLocum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used.MethodsAn online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis.ResultsMost NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal.ConclusionsLocum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.

Role of locum GPs in antibiotic prescribing and stewardship: a mixed-methods study.

BackgroundMost antibiotics are prescribed in primary care. Locum or sessional GPs (locums) are perceived as contributing to higher prescribing and may face barriers to engaging with antimicrobial stewardship (AMS).AimTo identify how locums’ antibiotic prescribing compares with other general practice prescribers, and how they perceive their role in antibiotic prescribing and AMS.Design and settingMixed-methods study in primary care.MethodData on antibiotic prescribing, diagnoses, and patient and prescriber characteristics were extracted from The Health Improvement Network database. A mixed-effects logistic model was used to compare locums’ and other prescribers’ antibiotic prescribing for conditions that do not usually benefit from antibiotics. Nineteen semi-structured telephone interviews were conducted with locums in England and analysed thematically.ResultsLocums accounted for 11% of consultations analysed. They prescribed antibiotics more often than other GPs and nurse prescribers for acute cough, sore throat, asthma and chronic obstructive pulmonary disease exacerbations, and acute bronchitis. The number of patients receiving antibiotics for these conditions was 4% higher (on absolute scale) when consulting with locums compared with when they consulted with other GPs. Four themes capture the perceived influences on prescribing antibiotics and AMS: antibiotic prescribing as a complex but individual issue, nature and patterns of locum work, relationships between practices and locums, and professional isolation.ConclusionLocums contribute to higher antibiotic prescribing compared with their peers. They experience challenges but also opportunities for contributing to AMS, which should be better addressed. With an increasing proportion of locums in general practice, they have an important role in antibiotic optimisation and AMS.

Changes to IR35 and what this will mean for the vet profession

Changes to IR35 tax legislation will come into force from April this year, affecting all locums who currently work via a limited company and those practices who engage locum services. This article explains the implications of the changes for the veterinary profession and outlines the alternatives available for those wishing to continue carrying out locum work.

Rural general practice staff experiences of patient safety incidents and low quality of care in Norway: an interview study.

Background and objectivesGeneral practitioners (GPs), nurses and medical secretaries (practice staff) are responsible for the continuous provision of safe care in rural general practice. Little is known about their role in situations where patients were or could have been harmed in a rural setting. Therefore, we sought to investigate rural general practice staff experiences of patient safety incidents and low quality of care.MethodsDescriptive qualitative interviews using the critical incident technique. Systematic text condensation analysis involving GPs and practice staff in eight rural municipalities in Norway.ResultsSixteen participants (eight GPs, one nurse and seven medical secretaries) with mean work experience of 11.8 years were interviewed for a total of 11.5 hours. We identified three main factors that make rural GP clinics vulnerable to patient safety incidents and low quality of care: use of locums, work overload and rough weather and distance to hospital. There was a wide range of patient safety incidents. The healthcare personnel explained how they used local knowledge about people and context and greater awareness of risk of error in order to prevent these incidents from happening.ConclusionRural GP clinics that suffer from frequent use of GP locums and work overload are vulnerable to patient safety incidents. Practice staff use various forms of continuity of care to prevent safety incidents from happening; this highlights the strengths but also some major safety concerns in these GP clinics. Staff at these clinics proved to be a resource for patient safety research.PodcastAn accompanying podcast on patient safety is available as Supplementary Data, in which Martin Bruusgaardf Harbitz and Per Stensland provide insights into the context of this study.

A questionnaire study of the negative outcomes for UK health professional volunteers in low and middle income countries

IntroductionPast research has reported considerable benefits of international health professional volunteering for British healthcare professionals; however, there are also some negative outcomes reported. Negative outcomes reportedly happen on a personal,...

How to step into new shoes

Eloise Meldrum looks at the pros and cons of locum work

A focused mapping review and synthesis of a priori risk factors associated with medical misconduct

BackgroundMedical misconduct is an international problem. It is judged according to whether a doctor has endangered the health of the public. Little is known about the risk factors associated with...

Balancing traditional activities and cognitive pharmaceutical services by community pharmacists: a work sampling study

Background Community pharmacy is undergoing a transition, shifting focus from traditional roles to the provision of cognitive pharmaceutical services. However, traditional activities performed by community pharmacists reduce the amount of available time for implementing and providing such services. Therefore, hampering the community pharmacist in the transition. Objective The aim of this study was to identify characteristics of community pharmacists that spend a higher proportion of their time on cognitive pharmacy services and to identify activities that compete with time spent on such activities by community pharmacists. Setting Daily community pharmacy practice. Method Self-reporting work sampling using smartphone technology was used to register the activities of community pharmacists. Participating pharmacists recorded their current activity five times per working day for 6 weeks and also completed an online survey about baseline characteristics. Main outcome measure Time utilization. Results Ninety-one Dutch community pharmacists provided work-sampling data. The results showed that Dutch community pharmacists are predominantly spending less time on managerial activities when spending more time on cognitive services (from 25.7% to 14.5%, p = 0.016). Pharmacists who are spending more time on such services, want to spend even more time on direct patient contact compared to pharmacists who spend less time on it (p = 0.030). Conclusion This study shows that community pharmacists that spend more time on cognitive pharmacy services are devoting less time on managerial activities, logistics and other activities. Pharmacists spending more time on cognitive pharmaceutical services are mostly locum pharmacists or work at a pharmacy located in a residential area with largely older inhabitants.

New guide to life as a locum

Have you ever considered working as a locum? Contrary to what some people think, locum work isn't necessarily an easy option but it can be an extremely rewarding one in several respects: personally, professionally and financially.

Lending a paw: locum tips and tricks

Locum work is becoming increasingly popular throughout the UK. Many veterinary surgeons will work as locums at some stage in their careers. Locum work allows plenty of flexibility and can offer travel opportunities, endless variety, and extra money. However, locum veterinary surgeons do not have a stable income, may find it difficult to get certain types of loans, often have long commutes, and are responsible for their own professional expenses and accounting. Many cases will be lost to follow-up, and it can be difficult not being part of a permanent practice team. You may work through a limited company or through an umbrella company, which is often organised through a locum agency. Most locum veterinary surgeons in the UK find work through locum agencies, although freelance work is also possible. The author has found locum work personally and professionally rewarding, and would recommend freelance locum work as an alternative career option.

Locum Life in Spiritual Health Care – Is It for Me? Is It for You?

This article is a brief consideration from an individual perspective about locum spiritual care practice gained from experience working in psychiatric and geriatric units, emergency departments and neurological disease wards. The article addresses questions such as, “What is it like being a locum?” “What are some of the issues for the locum practitioner, the organization, the field of spiritual care?” Locum work in the spiritual care field is not new, but the ongoing professional development of spiritual care as a recognized professional discipline requires it to be carefully examined in the light of best practice spiritual care in the healthcare sector. A version of this personal reflection was originally presented at the Spiritual Care Australia national conference, “Inspiration in Diversity: The Shifting Sands of Spiritual Care” (SCA, Melbourne 2016).

It's all a matter of time!: Managing risk takes time.

There has been much media coverage of shorter UK GP consultation times recently, with the UK having the shortest consultation times in the developed world.1 After 30 years I recently retired from my partnership and decided to take up a portfolio career, which included locum work back at my old practice. In returning to general practice after a gap of several months, there were four areas of concern for me personally — short consultation times, IT, changes to local referral pathways, and managing risk, with consultation times and risk being my primary concerns. The Retained Doctor Scheme2 did not alleviate these concerns and so I negotiated a system …

Driven by a passion for people and their pets (and dancing).

Paula Bailey thought she might enter academia after gaining clinical experience. However, a period of travelling and locum work confirmed her enjoyment of practice life.

Participation of psychiatric nurses in public and private mental healthcare in Kenya.

We studied the rate of participation of psychiatric nurses in mental healthcare in Kenya. A simple questionnaire was delivered to 50 nurses attending a mental health meeting of the National Nursing Alliance of Kenya in April 2012. Of the 40 nurses with psychiatric nursing qualifications, 19 worked specifically as psychiatric nurses; among those employed as general nurses, half their case-loads were mental health patients. Ten per cent of psychiatric nurses had run a private clinic (75% of them general clinics) and 15% were doing private locum work alongside salaried employment. Kenya would need to increase the number of psychiatric nurses 20-fold in order to achieve an internationally recommended ratio (for low-income countries) of 12 psychiatric nurses per 100 000. It appears psychiatric nurses are migrating internally to nursing positions in other areas of healthcare, aggravating the 'brain drain' in mental health.

Janet Anne Robertson

Born in Hamilton, Janet was the second oldest of four children and her family’s social convener from an early age. After house jobs and a rotation that included posts in...

Loretta Dunn: New ways of working

Practice NursingVol. 23, No. 11 ProfileLoretta Dunn: New ways of workingLoretta DunnLoretta DunnSearch for more papers by this authorLoretta DunnPublished Online:29 Sep 2013https://doi.org/10.12968/pnur.2012.23.11.578AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 November 2012Volume 23Issue 11ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 29 September 2013 Published in print 1 November 2012 Information© MA Healthcare LimitedPDF download

Working as a locum

Hugo Richardson was keen to pursue a career in wildlife conservation and enrolled on a Masters in wild animal health. Locum work helped to support him during his studies, and he found that this style of working suited him while he waited for that elusive conservation project

Current Challenges of Ophthalmology in France

Current Challenges of Ophthalmology in France

Creating the conditions for effective work by locum educational psychologists

In this paper the authors provide a description of the organisational and professional context of locum work, identify challenges and opportunities for locum educational psychologists and for services where they are employed, and propose a protocol for use by educational psychologists (EPs) working in a locum capacity and for the services employing them. This is based on a review of the relevant literature in this and other professions and from the experience of the first author as an educational psychologist working independently and providing locum cover in several local authority areas in England.