A curious yet seemingly essential phenomenon in filling medical staffing rotas nationally is the existence of the locum doctor. ‘Locums’ are generally short term, (reasonably!) highly paid contracts, similar to supply work for teachers, or subcontracting for builders. A doctor is parachuted into a new team, often in a hospital where they have no previous experience, and potentially into a role where they have had minimal post-graduate experience. The roles filled by locums are often key to the functioning of a given team within a hospital (such as general medical, general surgical, and orthopaedic teams). Often a fairly hair-raising and exhausting experience, veteran locums become hardened to unfamiliar work environments, clapped out NHS on-site accommodation and loneliness (if working in new pastures for short times).
These contracts are highly costly to NHS trusts, but I suppose are justified by the logic that ‘anyone is better than no-one’. Trusts cannot leave themselves open to criticism by leaving these key roles unfilled lest a patient come to harm from understaffing. However from the inside it often appears as though many of these holes in rotas are predictable – there must be a better way!
One solution might be to adopt a similar system to the antipodes, where junior doctors are required to complete a ‘relief run’, a period of 3-4 months where they plug holes in rotas in a similar way to locums but are paid a salaried wage. I duck as I write this however, for this suggestion may bring slander and outrage from my colleagues who would consider this period to be of poor educational value.
An arguably unnecessary waste of NHS money perhaps, but until a better system is devised, locum shifts will continue to plug the gaps in essential medical rotas throughout the UK. They are great for the three of us however, as back to back locum shifts are what we are depending upon to finance our expedition!