It is widely reported today (14 January 2014) that NHS spending on locum doctors to provide cover in A&E departments has soared by 60% over the last few years.  A Freedom of Information request by the Labour Party generated responses from 75% of hospitals providing A&E services and revealed that spending on locum A&E doctors at all levels of seniority topped £83 million last year, up from £52 million in 2009/10.

The political debate over the reasons for the increase has begun with arguments over staffing levels, recruitment and retention;  the impact of European legislation on working hours and practices;  when the problems first started;  and who is to blame.  In the meantime, reliance on locum doctors is increasing.

The problem of A&E staffing is not new and successive recent governments have struggled to solve it.  Hospitals are clearly finding it difficult to recruit doctors to A&E vacant posts because of  the pressure and long hours associated with this specialty.  This difficulty creates a vicious circle in that the fewer doctors who choose to work in A&E, the greater the demands upon them and the less likely others will embark on that career path. 

The risks, however, are clear.  Andrew Clayton, associate in the Penningtons Manches' clinical negligence team, explains: "We receive many enquiries and handle numerous claims for patients who have experienced poor care in A&E.  The pressures on our A&E departments are well known but continue to affect patient safety.  Waiting list targets and staff shortages are compounded by hospitals relying on locum doctors whose unfamiliarity with local arrangements reduces their ability to deal with patients as efficiently as permanent staff, further increasing the pressure and the risk of errors. 

“The steeply rising cost of locum cover is a worrying indicator that staffing shortages are worsening.  This latest evidence highlights that reliance on locum doctors affects all levels of A&E care.  It suggests that this is a long-standing problem, with fewer doctors choosing A&E as a career and progressing through the grades to consultant level.  The risk is that training and levels of experience are undermined and lead to greater risks to patients' safety.  Urgent attention needs to be given to attract doctors into A&E at all levels, particularly junior doctors, to avoid this problem spiralling and exacerbating the A&E crisis in years to come."