Alliance Manchester Business School, Institute for Health Policy and Organisation, University of Manchester, Manchester, UK.
Health Services Management Centre, University of Birmingham, Birmingham, UK.
Br J Gen Pract. 2023 Aug 31;73(734):e667-e676. doi: 10.3399/BJGP.2023.0039. Print 2023 Sep.
Locum doctors give practices flexibility to deliver patient services but there are concerns about the impact of locum working on continuity of care, patient safety, team function, and cost.
To explore locum working in English general practices, and understand why and where locum doctors were needed and how they were engaged, supported, perceived, and managed.
An online survey was sent to 3745 practices.
Quantitative responses were analysed using frequency tables, -tests, and correlations. Free-text responses were analysed using thematic analysis.
In total, 605 (16.2%) responses were returned between June and December 2021. Practices made frequent use of locums, preferring regular locums familiar with processes and patients. Disadvantages of agency locums included cost, lack of patient familiarity, and impact on continuity of care. Care provided by locums was generally viewed as the same but sometimes worse compared with permanent GPs. Some practices reported that locums did not always perform the full range of duties, resulting in increased workload for other staff. Practices were largely unfamiliar with national guidance for organisations engaging locums, and, although processes such as verifying documentation were conducted, far fewer responders reported providing feedback, support for revalidation, or professional development.
Locum working is an essential part of English general practice, but this research raises some concerns about the robustness of arrangements for locum working and the impact on quality and safety of care. Further research is needed about the clinical practice and performance of locums, and to explore how locum working can be organised in ways that assure safe and high-quality care.
驻场医生为提供患者服务赋予了实践灵活性，但人们对驻场工作对护理连续性、患者安全、团队功能和成本的影响存在担忧。
探索英国全科医生中的驻场工作，并了解为什么以及在哪里需要驻场医生，以及他们是如何被聘用、支持、感知和管理的。
向 3745 家诊所发送了在线调查。
使用频率表、t 检验和相关性对定量应答进行分析。使用主题分析对自由文本应答进行分析。
在 2021 年 6 月至 12 月期间，共收到 605 份（16.2%）回复。诊所经常使用驻场医生，更喜欢熟悉流程和患者的常驻驻场医生。代理驻场医生的缺点包括成本、缺乏患者熟悉度以及对护理连续性的影响。驻场医生提供的护理通常被认为与永久全科医生相同，但有时更差。一些诊所报告称，驻场医生并非总是履行全部职责，导致其他员工的工作量增加。诊所对聘用驻场医生的国家指南大多不熟悉，尽管进行了验证文件等流程，但很少有回应者报告提供反馈、支持再认证或专业发展。
驻场工作是英国全科医疗的重要组成部分，但这项研究对驻场工作安排的稳健性以及对护理质量和安全的影响提出了一些担忧。需要进一步研究驻场医生的临床实践和表现，并探索如何以确保安全和高质量护理的方式组织驻场工作。
