Background
Methods
Study design
Study settings and sampling
Data collection
Data analysis
Results
Locum work
Job description
JD5: “Long term locums are there for months…they get very good at their job as they become part of the team”
JD2: “at some point you don’t have a shift to do, you are waiting for the next one, and you are in transit… the satisfaction struggles to be the same.”
JD4: “I would prefer to be in a training programme definitely. Working as a locum doesn’t let you progress career wise – I like to be learning new things.”
JD2: “You don’t see that you’ve diagnosed correctly or that the patient received the right treatment and they got better and went home…so you miss out on that as a locum.”
Motivational factors
JD5: “…it’s much more lucrative than working in an NHS-contracted job by two or three times.”
JD3: “…there are more elements other than how much you get paid – how comfortable you are working in certain posts…how easy it is to book the shift…how much you trust the person who gives you the job...”
JD3: “Working as a locum provides you with the flexibility to work in specialties that you may not have had experience in.”
Challenges of locum work
JD2: “If information was made more available then it would improve the process.”
JD5: “Sometimes you don’t even get a login or a card. Then you can’t order any blood test or look at results…”
JD4: “when someone comes in, with little experience of the speciality and gets paid a much higher rate than someone on a training programme… that can make people angry”
Workforce planning
For locum doctors: | For speciality managers: |
Speciality required | Speciality of applying doctor |
Grade requirements | Grade of applying doctor |
Duration of post | Availability of doctors |
Who to report to | Doctor contact details |
Access to hospital buildings/wards | Photo of person booked for shift |
Whereabouts/map of hospital | Pre-employment checks |
Access to patient records | Previous quality issues |
Hourly rates and payment methods | Knowledge of the real market rate |
Inefficiencies
SM2: “We had a spreadsheet with a list of doctors. If we needed one, the first thing we did was to send an email to all of our ‘doc bank’ staff...”
SM2: “We would like to use our ‘doc bank’ because we know the doctors, they’ve been checked, we know they’re not going to be a risk to us. With agencies you can only get a vibe from what the CV says.”
ED1: “We are investing in our own bank doctors to develop them, to become one day consultants or leaders. It’s an investment for everyone.”
JD1: “You would get a panicky email when the shift was due to start…or a speciality manager running around the ward trying to find doctors.”
JD5: “The manager goes home at 5pm having not filled the shift and she doesn’t really care because it’s not part of her job...but because they’re not doctors, they don’t realise that the hospital works 24/7 and that the rest of us just take on the slack.”
SM1: “you call agencies, you call people who call agencies – so there’s middlemen for middlemen, and then you just wait for someone to get back.”
SM2: “If we didn’t get responses [from the internal bank staff] we would then ring around the agencies”
HC1: “agencies are saying ‘Well, we can’t find anyone, unless you put the price up a little bit’ and the hospital has no idea how many people are on the market, so they agree.”
JD2: “The locum agencies themselves will harass you. You will generally get two to three calls day. It is annoying…you end up blocking them!”
Workforce planning technology
User evaluation
Ease of use
SM2: “Everything you do these days is online…you can do the same with booking shifts.”
HC1: “What really impressed me about this application is that it’s very simple to use, it’s very user-friendly”
Administrative efficiency
JD5: “The app tracks how and what you’re paid with all your timesheets in, that’s just such a huge benefit…for managers as well…they don’t have to track loads of bits of paper.”
I2: “The hospital is using its own doctors more. They had a 300% increase in terms of their own doctors filling the vacancies.”
ED1: “the first 4 months we saved around £21 000 as a Trust.”
HC2: “if hospitals shift to this app, there’s a stark possibility that agencies aren’t going to be needed.”
HC1: “pay-centric locum doctor have been using agencies to get higher rates - I think ABG will damage that”
JD2: “managers can give you information through the app about where you’re going, what kind of work you’ll be doing, who to report to…So any problems, you know who to approach.”
Diffusion of innovation
ED1: “If the product is good and it is saving them money, I think it is something that they [HR directors] will ultimately talk about with their colleagues in another hospital.”
ED1: “We made them [managers] see the benefits of it - no time sheets…no pieces of paper going misplaced or missing.”
HC2: “Technically when a Trust buys software they make a huge upfront investment by paying annual support and maintenance. This is ‘pay as you use’ with no upfront investment”
HC2: “There is a lack of consistency…there’s nobody in NHS who’s going to say ‘Every Trust must use this technology’ - it doesn’t work like that. But, the outcome would be far better if that happened”
Information exchange system (IES) model
IES Dimensions | Traditional Staff Banks | External Locum Agencies | ABG |
---|---|---|---|
Convenience (1 = low, 2 = high) | 1 | 1 | 2 |
Time Requirements (1 = high, 2 = low) | 1 | 1 | 2 |
Transparency (1 = low, 2 = high) | 2 | 1 | 2 |
Within budget (1 = no, 2 = yes) | 2 | 1 | 2 |
Recruitment method: Locum Agencies | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
IES dimensions | Convenience | Time Requirement | Transparency | Cost within budget | |||||||||||||
Score(delete as appropriate) | Low | High | Low | High | Low | High | No | Yes | |||||||||
1 |
2
|
2
| 1 | 1 |
2
| 1 |
2
| ||||||||||
Relative importance for Trust/Department 1 = low, 4 = high |
1
| 2 |
3
|
4
| 1 |
2
|
3
|
4
|
1
|
2
|
3
| 4 |
1
|
2
| 3 |
4
| Total score |
Score x Weight | 2 | 1 | 4 | 3 | 10 |
Recruitment method: Traditional Staff Banks | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
IES dimensions | Convenience | Time Requirement | Transparency | Cost within budget | |||||||||||||
Score (delete as appropriate) | Low | High | Low | High | Low | High | No | Yes | |||||||||
1 | 1 | 2 | 2 | ||||||||||||||
Relative importance for Trust/Department 1 = low, 4 = high |
1
| 2 |
3
|
4
| 1 |
2
|
3
|
4
|
1
|
2
|
3
| 4 |
1
|
2
| 3 |
4
| Total score |
Score x Weight | 2 | 1 | 8 | 6 | 17 |
Recruitment method: ABG | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
IES dimensions | Convenience | Time Requirement | Transparency | Cost within budget | |||||||||||||
Score (delete as appropriate) | Low | High | Low | High | Low | High | No | Yes | |||||||||
2 | 2 | 2 | 2 | ||||||||||||||
Relative importance for Trust/Department 1 = low, 4 = high |
1
| 2 |
3
|
4
| 1 |
2
|
3
|
4
|
1
|
2
|
3
| 4 |
1
|
2
| 3 |
4
| Total score |
Score x Weight | 4 | 2 | 8 | 6 | 20 |