What our data tells us about locum doctors

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2 What our data tells us about locum doctors Executive Summary Our data shows that a growing proportion of doctors are choosing to undertake work as locums. From 2013 to 2017, there was an increase of almost 12,000 licensed doctors working as locums. This equates to nearly 1 in 5 of all licensed doctors. This paper presents a segmentation of those locum doctors into mutually exclusive groups, defined by our data on contract arrangements. The groups are then used to examine what types of doctor are choosing to do different kinds of locum work and to test for differences in the proportion that are complained about and investigated. We have found that: There are differences in the proportion of doctors working as locums between register groups. GPs are more likely to work as locums than specialists Our data on NHS and locum agency contracts identifies three mutually exclusive categories of locums with different working arrangements: o Locum-only doctors who work only as locums, either full time or part time in the NHS or through locum agencies o 1 NHS contract and 1 locum contract doctors who also work either part time or full time with a non-locum contract within the NHS o 3 or more different contracts those with many contracts of different types and work patterns. Different registers, such as GPs and specialists, have different proportions falling into each segment Certain demographic groups of doctors, such as male doctors aged 70 or over, have a greater proportion of doctors working as locums Locum doctors are more likely to have complaints that reach the threshold for a full investigation Among specialists, agency locums are investigated more than any other group

3 Contents What our data tells us about locum doctors... 1 Executive Summary... 1 Introduction... 2 The changing make-up of the locum workforce... 5 Types of locum identified within our data Locum work arrangements and register type GPs Specialists Neither register and not in training Neither register and in training Prevalence in FtP of locum doctors Limitations Conclusions Introduction Our strategic aim is to support doctors in maintaining good practice. We want to focus our efforts in working with and supporting doctors to prevent harm and drive improvement rather than simply taking action once harm has occurred. To do that, we have to understand the experiences and challenges facing different groups of doctors practising in UK. This analysis is the first in a series of work that aim to better understand such distinct groups of doctors and the unique challenges they face. In this paper we share what our data tells us about the types of locum work and whether some types have a greater risk of being complained about to the GMC or investigated by us. The identification of groups with a greater risk is a key step. Early intervention would seek to reduce the risk of more serious problems and regulatory action later on. This initial analysis is intended to start a discussion about the nature of locum work and the challenges they face in the workplace. This will inform the GMCs future research programme. We welcome all feedback on this analysis to insightandresearch@gmc-uk.org. 2

4 What are locum doctors and why are we producing this analysis In today s healthcare system, doctors can work in various roles simultaneously. Doctors on any of the GMC registers can choose to work as a locum and most that choose to do so usually take up temporary short term positions. A doctor may be in this role for more than one organisation at the same time and may move relatively frequently from one employer to another. NHS guidance on locum doctors employment (Guidance on the appointment and employment of NHS locum doctors, NHS, 2013) states: A doctor in locum tenens is one who is standing in for an absent doctor, or temporarily covering a vacancy, in an established post or position. The principles in this guidance also apply to other short term or fixed term medical contracts. Some locums practice on the fringes of governance systems. We know that many move between employers on a frequent basis due to the nature of their work. This leads to challenges that are unique to working as a locum. A locum doctor has to integrate into a team whose working practices and environments may be substantially different to the locum doctor s past experiences.* Inductions for locum doctors may not always be as comprehensive as for other doctors because of the short time they can spend in the post. This is despite the NHS guidance on the appointment and employment of a locum doctor clearly stating that all locum doctors should have the same induction as other doctors. Locum doctors may frequently move to new teams and this can leave them feeling isolated or without a professional support. For example, each institution has its own schedule and routine for appraisals so locum doctors can find themselves without regular appraisals. How we identified if a doctor is a locum Previous reports based on the type of designated bodies doctors connect to (in order to revalidate) failed to identify all doctors working as locums. For that reason, we decided to look at all the data available to us from reliable sources. In this analysis doctors were considered a locum in any year if at the time of the snapshot for that year (30 June each year): the doctor had any kind of locum work (full or part time) recorded in their NHS practice history record, or were connected to a locum agency for revalidation. * Secondary_care_locums_report.pdf_ pdf 3

5 This research uses only locum doctor practice history data that could be sourced from the Electronic Staff Record (ESR), Primary Care Information Service (PCIS), Scottish Workforce Information Standard System (SWISS) and GPREF databases. There was no practice history data available for analysis for doctors in Northern Ireland or for GPs working in Wales. The GMC are pursuing equivalent data for all doctors working in Northern Ireland and GPs working in Wales and will produce supplementary analyses for these groups once the data has been sourced. Other data used in this analysis includes the UK medical register and the type of body that a doctor connects to for revalidation (their designated body). * Doctors were only counted if licensed, involved in fitness to practice, or had a contract record in a given year. As a result figures may vary from other publications. * Practice history data extracted on August 4 th 2017, register and designated body data used as at June 30 th

6 The changing make-up of the locum workforce The number of locums has been increasing The number of licensed doctors has been relatively constant from 2013 to 2017 at about 232, ,000 (Figure 1). The proportion of licensed doctors working as locums increased from 13% to 18% The rate of increase in doctors working as locums has slowed since Overall, the number of locums has risen by over a third (38%) in just five years from just under 31,500 to nearly 43,500. Figure 1: Number of licensed doctors showing locums and non-locums. Locum working is common in younger and older doctors but not as prevalent for the middle age groups In 2017, the highest proportion of licensed doctors working as locums were aged 70 and over with 25% choosing to do so (figure 2). Doctors in the age group were the next largest proportion at 23% in Over the 2013 to 2017 study period used in this research, changes were broadly linear unless otherwise stated. 5

7 Figure 2: Number and proportion of licensed locums and non-locums by age group or more % of age group Doctors % change in number of doctors % of age group Doctors Total 29,808 2% 30,443 Locum 11% 3,148 25% 13% 3,921 Not locum 89% 26,660-1% 87% 26,522 Total 73,993 2% 75,319 Locum 18% 13,676 26% 23% 17,274 Not locum 82% 60,317-4% 77% 58,045 Total 62,388 3% 63,989 Locum 13% 8,105 47% 19% 11,913 Not locum 87% 54,283-4% 81% 52,076 Total 44,900 3% 46,254 Locum 9% 4,148 55% 14% 6,450 Not locum 91% 40,752-2% 86% 39,804 Total 19,059-9% 17,410 Locum 10% 1,830 62% 17% 2,969 Not locum 90% 17,229-16% 83% 14,441 Total 4,527-27% 3,317 Locum 11% % 25% 819 Not locum 89% 4,031-38% 75% 2,498 A higher proportion of female doctors choose to work as locums The difference between male and female locums is relatively low. A fifth of females and a sixth of males work as locums. The difference observed is relatively low, and not consistent with a view that female doctors are far more likely to work as locums (Figure 3). Figure 3: Number and proportion of licensed doctors and locums by gender Female Male % of gender Number of % of doctors % change gender Number of doctors Total 100% 102,589 8% 100% 110,984 Locum 16% 16,083 38% 20% 22,140 Not locum 84% 86,506 3% 80% 88,844 Total 100% 132,086-5% 100% 125,748 Locum 12% 15,320 38% 17% 21,206 Not locum 88% 116,766-10% 83% 104,542 6

8 Females aged are more likely to work as locums than males of the same age Proportionally more females work as locums across all age groups. This difference is most pronounced, but still fairly small, in the age group where 25% of females work as locums compared to 20% of males (Figure 4). This is identified as the peak age group for having young children. Figure 4: Proportion of locum doctors by gender and age Male doctors aged 70 or more are most likely to work as locums Male doctors reach their greatest proportion of locums in the 70 or more age group. 25% of males 70 or over are locums compared to the 17% figure for males overall. Doctors with an IMG primary medical qualification are most likely to be working as a locum A slightly higher proportion of international medical graduates (IMGs) work as locums than UK and EEA graduates (21%, 17% and 17% respectively in 2017). The fastest growth in working as a locum from 2013 to 2017 is in EEA doctors (Figure 5). But despite their numbers increasing by two-thirds over five years, they still only account for one in every 12 locums (8.4%) 7

9 Figure 5: Number and proportion of licensed doctors and locums by PMQ UK EEA IMG Number of % Number of % PMQ doctors change % PMQ doctors Total 100% 150,047 5% 100% 158,121 Locum 13% 20,123 37% 17% 27,657 Not locum 87% 129,924 0% 83% 130,464 Total 100% 23,717-9% 100% 21,609 Locum 9% 2,219 65% 17% 3,656 Not locum 91% 21,498-16% 83% 17,953 Total 100% 60,911-6% 100% 57,002 Locum 15% 9,061 33% 21% 12,033 Not locum 85% 51,850-13% 79% 44,969 GPs are much more likely to be locums than specialists Figure 6 shows that only 7% of specialists worked as locums in 2017 in comparison to 36% of GPs. This is broadly similar to findings by the National Association of Sessional GPs who calculated that 40% of the GP workforce was sessional. * Figure 6: Number and proportion of licensed locums by register type GP % register type Number % of % register doctors change type Number of doctors Total 100% 58,211 2% 100% 59,598 Locum 28% 16,284 31% 36% 21,309 Not locum 72% 41,927-9% 64% 38,289 Specialist Total 100% 70,188 6% 100% 74,055 Locum 4% 2,697 79% 7% 4,824 Not locum 96% 67,491 3% 93% 69,231 GP and specialist Total 100% 1,297-3% 100% 1,254 Locum 19% % 23% 283 Not locum 81% 1,055-8% 77% 971 Neither register Total 100% 104,979-3% 100% 101,825 Locum 12% 12,180 39% 17% 16,930 Not locum 88% 92,799-9% 83% 84,895 * National Association of Sessional GPs How many locums are there in the UK available at: (accessed 14 July 2017) 8

10 More IMG doctors work as locum GPs and neither register locums The proportions of doctors working as locums vary with primary medical qualification region (PMQ). Whereas similar proportions of the 47,000 UK GPs and 3,000 EEA GPs work as locums (about 35%), a higher proportion of the 10,000 IMG GPs (43%) work as locums (Figure 7). IMG doctors who are on both registers and those on neither register featured a higher proportion of locums than their UK or EEA counterparts. EEA and IMG specialists are more likely to work as locums Specialists locum work is notably more common for EEA (12%) and IMG (11%) doctors than for UK doctors (only 3%) (Figure 7). Those doctors with a non-uk PMQ account for nearly 70% of specialist locums. Figure 7: Number and proportion of licensed locums by register type and PMQ. Register PMQ % of PMQ group % change in % of Doctors number PMQ of group doctors Doctors GP UK 26% 11,832 36% 34% 16,064 EEA 26% % 35% 1,068 IMG 37% 3,561 17% 43% 4,177 Specialist UK 3% 1,105 34% 3% 1,485 EEA 6% % 12% 1,307 IMG 6% % 11% 2,032 Neither and in training UK 13% 6,108 16% 14% 7,105 EEA 12% % 13% 292 IMG 18% 1,696-25% 20% 1,274 Neither and not in training UK 7% % 20% 2,817 EEA 6% % 17% 935 IMG 11% 2,778 62% 20% 4,507 The proportion of each specialty group that work as locums varied between 4% and 8% in Of the 13 specialty groups, * only the very small Public Health specialty did not see an increase in both number and proportion working as locums between 2013 and * Medicine, Emergency Medicine, Anaesthetics and Intensive Care Medicine, Obstetrics and Gynaecology, Occupational medicine, Ophthalmology, Paediatrics, Pathology, Psychiatry, Public Health, Radiology, Surgery, and Other specialty or multiple specialty groups 9

11 For non-specialist doctors aged between 30 and 59, Figure 7 shows that the highest proportion of doctors working as locums is among UK trained GPs years old and IMG GPs in their 40 s. Specialists are not shown in figure 7 as the numbers are too small. In contrast, the lowest proportion of locums is among UK female years old specialists (1.3%). Figure 8: Proportions and numbers of locum doctors grouped by register type, gender and PMQ* *showing only groups that are >0.5% of the total licensed doctors in

12 Types of locum identified within our data Our data on NHS and locum agency contracts can identify three mutually exclusive categories of locums with different working arrangements:! Locum-only doctors who work only as locums, either full time or part time in the NHS or through locum agencies;! 1 NHS contract and 1 locum contract doctors who also work either part time or full time with a non-locum contract within the NHS, and! 3 or more different contracts those with contracts of different types (honorary, retainer, permanent, etc.) and work patterns (full or part time) Working only as a locum is increasingly common Most locums work only as locums, without any extra non-locum NHS contracts. The number of locum doctors has increased in the period from While the number of locum-only and doctors with 3 or more contracts increased each year, in 2015 the number of doctors with both locum and NHS contracts started to decline (Figure 9). Within each of the three main types we have identified subtypes with different contractual arrangements (Figure 10). While exploring this data we found that the sub-types of locums were demographically similar. Figure 9: Primary types of locum identified 11

13 Most locum-only doctors have one locum contract The majority of doctors working as locum-only have just one locum contract and a significant proportion work for locum agencies (Figure 10). In 2017 only 6% of locum-only doctors had 2 or more contracts. Out of 13,034 locum doctors in 2017 with only 1 locum contract, almost 82% had a part time locum GP contract. Figure 10: Subgroups of locum-only doctors Very few doctors have 3 or more contracts Only a small number of locum doctors had many (3 or more) contracts. Most of those doctors (more than 70%) had a part time NHS contract and 2 or more part time locum contracts. Different register types have different contractual arrangements Approximately 45% of locum-only doctors in 2017 were GPs and only 15% were on the Specialist register. This leaves close to 1 in 3 locum-only doctors that were on neither register and not in training. The large majority of doctors with 1 NHS contract and 1 locum contract shown in Figure 9 were on the GP register (58%). Only 6% were on the Specialist register and 31% were in training. 12

14 Although there were few doctors with 3 or more contracts, more than half of those were in training and 1 in 3 were on the GP register. Only 1 in 12 doctors with 3 or more contracts were on the Specialist register. Locum work arrangements and register type Different register types exhibit different contractual work arrangements as Figure 11 shows. Between 2013 and 2017 about 50% of locum GPs worked only as locums. The remaining 45% to 49% had one non-locum contract with the NHS and worked additionally as a locum. Among specialists, most locums work as locumonly (78% - 83%), which is similar to doctors on neither register and not in training (between 82% and 86%). By contrast, locum doctors in training (on neither the specialist nor GP register) mostly worked as locums with one NHS contract and extra locum work. But, the proportion of doctors with one NHS contract and one locum contract declines from 75% to 55% between 2013 and 2017 in favour of locum-only arrangements. Doctors in training (on neither the specialist nor GP register) are the only register type containing a greater proportion of locums with 3 or more contracts (Figure 11). Figure 11: Primary types of locum identified by register type. The numbers above each stacked bar represent the total number of doctors for each column. 13

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16 GPs Only a very small proportion of GPs had 3 or more contracts (only 4% in 2017). About 48% worked only as locums while the remaining 48% had one NHS and one locum contract (Figure 11). Locum-only GPs are most likely to have one locum contract The majority (92%) of locum-only GPs have just one locum contract. The number of locum only agency locums and those who work with 3 or more contracts is negligible. GP locums with one contract mostly work part time Our data shows that the vast majority (99%) of one contract locum GPs work part time. But, we only hold data on NHS contracts so can only speak of full time and part time in terms of the NHS. Some people working part time for the NHS as locums may also work in the private sector and thus be working full-time overall. Unfortunately, our data for the specific hours worked on each contract is unreliable. Our best estimate of working patterns is only to divide by part or full time contracts. 15

17 We re able to observe that the majority of locum GPs with 2 contracts have one part time and one locum GP contract (40% of all locum GPs) (Figure 12). Given the high proportion of GPs working as locums, a significant part of the GP workforce (16%) work only part time in terms of their work with the NHS. Figure 12: Work arrangements in 2017 of doctors who worked as locum GPs. Number of locum doctors in register group % of locum doctors in register group Locum only 1 locum contract only Part time locum GPs 9, % Full time + locum GP 1, % 1 contract 1 locum contract Part time + locum GP 8, % All other groups of 1, 2, or 3 or more All other combinations 1, % contracts Specialists Locum specialists are more likely to work as locum-only The proportion of specialists working as locums is smaller than in any other group. Over time, the number of specialists with one NHS and one locum contract is fairly constant (Figure 11). But the number of locum only-doctors has consistently increased from 1,533 doctors in 2013 to 3,507 in 2017, a 129% increase. Locum-only specialists are mainly agency locums More than half of specialist locum-only doctors were employed through locum agencies. Only about 1 in 20 locum-only specialists work as full time locums compared to 1 in 10 that work as part time locums. It is important to stress again that our understanding of part or full time arrangements are limited to NHS work. Nearly a fifth of specialist locums are doing this as extra hours on top of full-time NHS job More than 17% of all specialist locums in 2017 had one full time NHS contract and one locum contract (Figure 13), meaning locum work was in addition to normal working hours. Figure 13: Work arrangements in 2017 of doctors who worked as specialist locums. Locum only Number of locum doctors in register group % of locum doctors in register group Full time locums % 1 locum contract only Part time locums % Agency locums Agency locums 2, % 1 contract 1 locum contract Full time + locum % All other groups of 1, 2, or 3 or more contracts All other combinations % 16

18 Neither register and not in training Doctors on neither register and not in training show similar working arrangements to specialists The vast majority (90%) of doctors on neither register and not in training worked as locum-only doctors (Figure 11). Of that group, 78% worked for a locum agency. The other notable groups in Figure 14 are the 11% of locum only doctors that worked part time and the 5% of locums that held one locum and one full time NHS contract. With the exception of a small proportion of doctors with 1 NHS contract and 1 locum contract, the distribution across work patterns are similar to those observed for doctors on the specialist register. Figure 14: Work arrangements in 2017 of locum doctors who were on neither register and were not in training. Locum only Number of locum doctors in register group % of locum doctors in register group 1 locum contract only Part time locums % Agency locums Agency locums 5, % 1 contract 1 locum contract Full time + locum % All other groups of 1, 2, or 3 or more contracts All other combinations 1, % Neither register and in training Doctors in training have distinct contract arrangements As part of their training, some doctors in training work as locums but some also do so for financial reasons. This is why, unlike most of the groups, doctors in training are more likely to have one NHS and one locum contract (63%). They are also the only group with a notable proportion of doctors with 3 or more contracts (about 20%) (Figure 11). Locum-only doctors in training work as part time GP locums Around 15% of doctors in training work only under a locum contract but of those the majority (70%) work as part time GP locums. Most 2 contract locum doctors in training also work as locum GPs Most doctors in training that are locums appear to work as locum GPs. This pattern is most likely to result from a mandatory arrangement for doctors in GP training which utilises locum contracts for periods of 12 to 18 months. 17

19 Doctors with three or more contracts that are in training have various combinations of contracts and work arrangements Doctors in training as a group have the greatest proportion of locums with 3 or more contracts. 17% of all locum doctors in training have their work arranged in ways so varied it was impossible to find meaningful patterns or groups (Figure 15). Figure 15: Work arrangements in 2017 of doctors who worked as neither register in training locums. Locum only 1 locum contract only Number of locum doctors in register group % of locum doctors in register group Part time locum GPs 1, % 1 contract 1 locum contract Full time+locum % Full time+locum GP 2, % Part time+locum GP 1, % 3 or more contracts All other groups of 1, 2, or 3 or more contracts All other combinations 1, % All other combinations % 18

20 Prevalence in FtP of locum doctors Greater proportions of locum doctors are complained about when compared to nonlocum doctors but there are more insights when dividing the data by register type (Figure 16). The main register groups responsible for locums as a whole having a greater proportion of complaints are the two groups for locums on neither register. GPs have the highest rates of being complained about but, unlike locum doctors of other register types, locum GPs have lower rates than non-locum GPs. Figure 16: Numbers and proportions of locum and non-locum doctors being complained about and their complaints being investigated GP Locum Number of doctors 16,284 17,895 19,461 19,356 Number of doctors complained about % doctors complained about 3.8% 3.8% 3.6% 3.7% Number of doctors investigated % complaints investigated 36% 34% 30% 20% Not locum Number of doctors 41,927 40,257 38,691 39,206 Number of doctors complained about 2,191 2,050 2,013 1,935 % doctors complained about 5.2% 5.1% 5.2% 4.9% Number of doctors investigated % complaints investigated 33% 34% 26% 17% Specialist Locum Number of doctors 2,697 3,580 4,220 4,711 Number of doctors complained about % doctors complained about 3.0% 3.3% 3.0% 3.1% Number of doctors investigated % complaints investigated 57% 44% 45% 34% Not locum Number of doctors 67,491 67,531 67,275 67,459 Number of doctors complained about 2,244 2,148 2,166 2,082 % doctors complained about 3.3% 3.2% 3.2% 3.1% Number of doctors investigated % complaints investigated 37% 35% 29% 17% Neither and in training Locum Number of doctors 8,061 9,393 9,600 8,967 Number of doctors complained about % doctors complained about 1.5% 1.4% 1.1% 1.1% Number of doctors investigated % complaints investigated 47% 46% 43% 22% Not locum Number of doctors 50,868 48,516 48,804 49,706 Number of doctors complained about % doctors complained about 1.0% 1.0% 0.8% 0.7% Number of doctors investigated % complaints investigated 55% 42% 46% 28% 19

21 Neither and not in training Locum Number of doctors 4,119 5,407 7,285 8,333 Number of doctors complained about % doctors complained about 2.9% 2.4% 2.7% 2.3% Number of doctors investigated % complaints investigated 77% 62% 58% 54% Not locum Number of doctors 41,931 39,642 35,743 33,213 Number of doctors complained about % doctors complained about 1.6% 1.6% 1.4% 1.4% Number of doctors investigated % complaints investigated 56% 55% 47% 35% ALL REGISTER TYPES* Locum Number of doctors 31,403 36,537 40,834 41,638 Number of doctors complained about 957 1,069 1,134 1,172 % doctors complained about 3.0% 2.9% 2.8% 2.8% Number of doctors investigated % complaints investigated 45% 40% 37% 27% Not locum Number of doctors 203, , , ,554 Number of doctors complained about 5,630 5,389 5,108 4,861 % doctors complained about 2.8% 2.7% 2.7% 2.6% Number of doctors investigated 2,205 2,019 1, % complaints investigated 39% 37% 31% 20% *The very small numbers of doctors who are on both the GP and the Specialist Register are excluded from individual register type counts but are included in the counts for all register types. Locum doctors are more likely to have complaints which reach the threshold for a full investigation The proportion of locums and non-locums complained about were similar. But there was a slightly higher rate observed among locums for the 2013 to 2016 period (Figure 16). There was a greater difference between locum and non-locum doctors in the proportion of complaints to pass the threshold for investigation. Despite having the highest rates of being complained about, GPs had the lowest rates of complaints which reached the threshold for investigation. The difference between locums and non-locums for GPs was small. For other register types, locums had notably higher rates of complaints that reached the threshold for investigation (Figure 16). Risk of fitness to practice varies by type and subtype of locum When the risk of complaint and the proportion of complaints investigated is examined by type of locum we can clearly see that some types of locum are at a greater risk of complaint, and some are more likely to have those complaints investigated. Figure 17 shows that all doctors who are locums only are more likely 20

22 to be complained about. Within that group, complaints made about doctors who are agency locums only are particularly likely to need investigation. This leads to further research questions about the environments that such locum doctors operate in. For example, whether certain locum doctors work within a less supportive governance system. Interestingly, locums with 3 or more contracts are less likely to be complained about. Only the small group of doctors who have 1 full time NHS contract and one locum contract are less likely to be complained about. Figure 17: Percentage of locums complained about and investigated between 2013 and 2016, shown by type and subtype*. Dashed lines represent the average percentage of all locum doctors being complained about and investigated. *Subtypes excludes those which had fewer than 30 complaints made 21

23 Figure 18: Percentage of locum doctors investigated by type and subtype Bar width shows the number of doctors Locums of different register types have different rates of being complained about and investigated When compared to the average for all locums, figure 17 shows that GP locums are complained about above the average and investigated mostly below the average. The only exception is a small group of GP locums with 3 or more contracts their rate of being complained about is below average and their rate of being investigated is above average. Agency locum specialists are investigated more than any other group of specialist locums Most specialist locums have rates of being complained about and investigated below the average for locum doctors. But, agency locum specialists, although having close to average rates of being complained about, have rates of being investigated notably higher than any of the other specialist locum types and subtypes. 22

24 Doctors on neither register are complained about less than the average All types and subtypes of locum doctors on neither register have smaller rates of being complained about. But most of them have higher rates of investigation. That is especially true for doctors who are not in training. The largest group of locums, agency locums, has the highest rate of investigations. Doctors in training exhibit a similar trend, with the lowest rates of being complained about among all other register types. Two of the largest locum subtypes of doctors in training, involving locum GP work, part time contract and GP locums have about average rates of investigations. Full time contract and GP locums have well above average rates of investigations. This possibly indicates that increased risk is associated with higher workload and more than full-time working hours. Limitations There is less data publicly available about non-nhs bodies. Understanding the variation in work environments of locums is challenging. In this analysis there were limitations that stem from the data that was available. It was not possible to identify the types of work doctors do in the private sector. To better understand the relative risks of complaint and investigation faced by locum doctors with non-nhs contracts, more data about their scope of practice is required. Without this data, which is not currently available for analysis, we re unable to understand whether locums working in the private sector experience extra or different risks, or are complained about more or less frequently. Conclusions The proportion of doctors with any type of a locum contract is a large part of the workforce. This has increased steadily since Within this growing number there are clear differences in the prevalence of locum working when analysed by age, gender and PMQ. A simple framework for segmenting locum doctors into mutually exclusive groups is presented, based on contract information. This framework is used to better understand the nature of locum work across the different register groups and to then explore the likelihood of complaint and investigation. Doctors who act solely as locums or work for locum agencies have a greater risk of being complained about, and complaints about them are more likely to reach the threshold for a full investigation. A wider discussion is essential to understand the root causes of this and to explore whether further professional and workplace support for locums can reduce the risk to patients. 23

25 Website: Telephone: General Medical Council, 3 Hardman Street, Manchester M3 3AW Textphone: please dial the prefix then to use the Text Relay service Join the facebook.com/gmcuk linkd.in/gmcuk youtube.com/gmcuktv This information can be made available in alternative formats or languages. To request an alternative format, please call us on or us at publications@gmc-uk.org. Published April General Medical Council The text of this document may be reproduced free of charge in any format or medium providing it is reproduced accurately and not in a misleading context. The material must be acknowledged as GMC copyright and the document title specified. The GMC is a charity registered in England and Wales ( ) and Scotland (SC037750) Code: GMC/WODTLD/0418