Doctors working in temporary positions (known as locums) are a key component of the medical workforce and provide necessary flexibility and additional capacity for NHS organisations and services. There have been concerns about the quality and safety of locum practice and the way NHS uses locum doctors. The number of doctors working as locums, and the costs of this to the NHS have caused some concerns nationally in recent years. It has also been suggested that locum doctors may not provide as good a quality of care as permanent doctors.

Our research, carried out by a team at the University of Manchester, funded by the National Institute of Health Research and undertaken during 2020-22 provided important new information on these issues. To explore how the use of locum doctors may affect patient safety and the quality of care, and what NHS organisations can do to try to ensure safe, high-quality care for patients we carried out two large surveys of NHS trusts and general practices in England; interviewed staff, patients and locums; and analysed data that had already been collected about the NHS workforce and about clinical care.

We found that locum working and how locums were integrated into organisations could pose significant challenges for patient safety and quality of care. To improve patient safety, organisations should consider how they integrate and engage with their locum workforce.  At a system or national level, increased locum working probably has marginal effects on overall workforce capacity and using locum doctors should be far from the only strategy NHS organisations use to provide medical workforce flexibility and capacity. Locum use is much higher in some areas of England, some organisations, and some specialties. It is higher in smaller organisations/practices, and higher in those with worse Care Quality Commission ratings. The sustained high use of locums – what some interviewees termed a “service running on locums” is problematic and may well be a threat to patient safety and quality. The use of a lot of short-term locums who are unfamiliar with the organisation may also be a particular safety and quality concern.

Find links to the policy report and other outputs from the project here.

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