Dragons Den, What they did next: start at about 56.20.  Entrepreneur James Caan is visiting one of his businesses.

“Let’s get this team going! Let’s get the buzz going!…” (James)

“What I think, James, is that it would be really good if you got on the phone and showed us how it’s done…” (lady with telephone earpiece on)

“Don’t be so ridicuous! What do you want me to do?”  (James)

(earphones on.) “so I’m calling Catherine….I just wanted to call you, to see how we could help you today, with your vacancies….’caus I really want to send you, only the best…in fact, I want to send you, my star candidate!…..on the phone, three bookings, twenty minutes, 20 thousand pounds of business…Yes! still got it!” (James)

Yes, except that the programme explained at the beginning of this section that this was a company providing locum doctors throughout the UK. Is this business model the best one to route locum doctors to NHS posts?

Here’s an article from a few months back in the BMJ. It’s written by a frustrated professor trying to find a locum and getting confusing and unhelpful advice from locum agencies (and I should say that I have nothing to link these to James Caan’s enterprise) : I quote:

“Dr A—Around Christmas 2009 an agency emailed offering “a fantastic doctor with very good UK experience. He is very flexible and can work days and nights.” I booked him immediately. Four days later came another email from the agency: “He is not wanting to work in Scotland (too cold!!)—only wants to work in or around London.” You win some, and you lose some.

Dr B—The email from the agency read: “I have a very good general medicine SHO [senior house officer], who is available. If he is of interest, snap him up as he won’t be around for long as his CV looks brilliant.” Buried within the CV was a reference from a UK consultant which stated that this doctor’s basic skills were equivalent to a foundation year 1 or foundation year 2 doctor. “Due to only a short period of attachment on my ward I am unable to comment about his competence in great detail but I think he should be suitable for a locum SHO post under close supervision.” We decided not to proceed.

Dr C—This doctor’s UK experience amounted to two months as a locum senior house officer for which no references were provided. Undeterred, the agency were determined to make the most of their investment by writing: “I can confirm that this doctor is still available as of this point, but things change really quickly with SHOs as they seem to be in short supply! For example, I had an SHO in medicine available at 1430 and by 1450 he was gone!” I felt this level of enthusiasm was likely to have been misplaced, but sure enough the doctor had been snapped up in the time it took me to say “book him.”

Dr D—This European doctor was working in the UK and had reasonably good references. I decided to go ahead and wrote a nice welcoming email. The agency assured me that the booking had been accepted and that all the paperwork was in order. Two days later I received an email from Dr D that read “Sorry. I received your message but I do not understand about which company you are talking. I do not know anything about your hospital (that should I can go). If you can tell me more details or it is a mistake?” I phoned the agency to ask for an explanation but no one was able to provide me with one. We never heard from the locum again.

Dr E—This doctor was offered to us as a SHO locum. We booked the doctor but our human resources department subsequently discovered that the locum had only a student visa. A student visa means that a doctor can work only at foundation year 1 level and for 20 hours a week. We did not take the doctor. The agency wrote to us later to say that because the doctor had not acted professionally with their staff and not provided them with information requested they would be taking that person off their books. Because agencies do not share information about doctors who behave unprofessionally with other agencies, this doctor will presumably have no difficulty signing up somewhere else.

Dr F—This doctor had trained for many years overseas and now wanted to move to the UK. The agency offered the doctor to us as an SHO, and the CV said that the doctor had worked at this grade in another UK hospital. The reference stated that the doctor showed very good reliability, timekeeping, clinical and communication skills, and good relationships with patients and colleagues. But the doctor looked terrified on arrival—so much so that we felt we had to employ another SHO to cover during the acute medical take. Fortunately, one of our SHOs had a week off and was prepared to do this. It soon became apparent that Dr F’s comfort zone was somewhere between that of a final year medical student and a foundation year 1 doctor. I urged the doctor and the agency to reconsider their strategy and suggested that it would be better to start off life in the NHS with a clinical attachment and then apply for a foundation year 1 post before considering a more demanding role. We ended the contract. The agency had already offered the doctor another SHO locum.

Dr G—One of our core medical trainees had decided to relinquish her post for personal reasons and did so just as she was due to start a three week receiving block. We advertised for a locum to cover her first weekend but no one materialised. Then unexpectedly, with three or four days to go, we received word that a doctor working as a consultant overseas would be prepared to cover the three 12 hour shifts provided we paid over the odds. We held our noses and duly did so. There were no complaints during the first two nights on call, but during the third night the doctor was discovered asleep on a chair in the doctors’ mess. The doctor with whom the locum was on call asked for help with a difficult patient during the night but was told that the locum was “too tired” to assist. One of the staff nurses filed a critical incident report over the locum’s handling of another case, which she thought was not up to standard. I forwarded both complaints to the locum agency, which in turn forwarded them to the locum for comment, though we have heard nothing since.”

etc, etc. The rapid responses from other doctors in other areas confirm the problems with using agencies.

Locums are invaluable. We need locums to help us cover times of illness and often at holiday times. In general practice, it is far easier to get to know local locums – we need far fewer, for a start. Hospital medicine is different – more doctors, more slots which need covered. The European Working Time Directive hasn’t helped, either. Clearly some private enterprises are doing nicely out of the need for locums, but I am unconvinced that a business model is the best one for the NHS – especially when one considers that locum cover is far more expensive than regular salaried doctors. One has to remember, too, the disaster of MMC, modernising medical careers, which sent hundreds of UK doctors abroad when they couldn’t get any work in the UK. A far better idea would be for the NHS to take on extra doctors who could take turns at being redeployed locally where needed. Not only would this be overall cheaper, but it would also be better for the NHS who would have locally trained doctors able to quickly slot in where needed.

But that’s far too straightforward for the NHS. . . .