国民保健制度中聘用临时工医生的情况——对英格兰国民保健信托的全国性调查结果。

The use of locum doctors in the NHS - results of a national survey of NHS Trusts in England.

机构信息

Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Booth Street West, Manchester, M15 6PB, UK.

Health Services Management Centre, University of Birmingham, Birmingham, UK.

出版信息

BMC Health Serv Res. 2023 Aug 23;23(1):889. doi: 10.1186/s12913-023-09830-9.

DOI:10.1186/s12913-023-09830-9

PMID:37612669

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10464080/

Abstract

BACKGROUND

Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used.

METHODS

An online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis.

RESULTS

Most NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal.

CONCLUSIONS

Locum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.

摘要

背景

在医疗机构中，临时医生的工作对医生个体和组织都有好处，但人们对临时医生工作对医疗连续性、患者安全、团队功能和成本的影响感到担忧。我们对英格兰的国民保健服务信托基金进行了一项全国性调查，以探讨临时医生的工作情况，更好地了解为什么和在哪里需要临时医生；临时医生是如何被聘用、支持、感知和管理的；以及在使用临时医生方面正在进行哪些改变。

方法

我们向 191 家国民保健服务信托基金发送了在线调查，其中 98 家（51%）做出了回应，包括 66 家（67%）急症医院、26 家（27%）精神卫生机构和 6 家（6%）社区卫生服务提供者。使用频率表、t 检验和相关性对数据进行了分析。对自由文本的回复使用主题分析进行了分析。

结果

大多数国民保健服务信托基金经常使用临时医生，且使用时间长短不一。信托基金更愿意从内部临时医生库中使用临时医生，但经常依赖临时医生机构。使用临时医生的好处包括保持劳动力的能力和灵活性。重要的是，与固定医生提供的护理相比，临时医生提供的护理通常被认为是相同或稍差。使用临时医生机构的主要缺点包括成本、不熟悉和对组织发展的影响。一些受访者认为临时医生可能不可靠，不太可能投资于质量改进。国民保健服务信托基金对英格兰国民保健服务提供的支持临时医生的国家指导大致不熟悉，重点是合规检查和入职等流程，而对提供反馈和支持评估的关注较少。