HR061 - Employment of Medical and Dental Locums and Agency Locums Document Reference No: Version No: 3 PtHB / HR061 Issue Date: July 2015 Review Date: July 2018 Author: Document Owner: Accountable Executive: Approved By: Operational HR Manager & Medical Workforce Manager Director of Workforce & OD Director of Workforce & OD Executive Team Approval Date: 1 st July 2015 Document Type: Policy Clinical / Non-clinical Scope: PtHB Disclaimer Do not print this document. The latest version will be accessible via the intranet. If the review date has passed please contact the Author for advice. Powys teaching Health Board is the operational name of Powys teaching Local Health Board
Version Control Version Summary of Changes/Amendments Issue Date 1 Initial Issue Aug 2005 2 Reviewed WPRG May 2010 3 Clarification of process and flowchart additions June 2015 Issue Date: 2015 Page 2 of 16 Review Date: 2018
Contents Page Introduction 6 Aims 6 Objectives 6 Scope 7 Definitions 7 Use and Duration of Locum Appointments 7 Roles and Responsibilities 8 Application 10 Special Considerations 11 Assessment of Locum doctors 12 Links to Supporting Documents 12 Review and Control 12 Appendices Performance Process and Reporting Mechanism For locum medical and dental staff Procedure for authorising employment of agency medical and dental staff 13 15 Procedure for authorising employment of locum and medical and dental staff 16 Issue Date: 2015 Page 3 of 16 Review Date: 2018
ENGAGEMENT & CONSULTATION Key Individuals/Groups Involved in Developing this Document Role / Designation Medical Workforce Manager Workforce Policy Review Group Circulated to the following for Consultation Date Role / Designation 23/06/2015 WPRG 29/06/2015 PtHB Staff Evidence Base Please list any National Guidelines, Legislation or Standards for Health Services in Wales relating to this subject area? NHS Employers Guidance on the Appointment and Employment of NHS Locum Doctors (August 2013) Issue Date: 2015 Page 4 of 16 Review Date: 2018
IMPACT ASSESSMENTS Equality Impact Assessment Summary Age Disability Gender Race Religion/ Belief Sexual Orientation Welsh Language Human Rights No impact Adverse Differential Positive Statement However, as PtHB does not routinely translate its policies and other written control documents into Welsh, there is an impact on staff for whom, Welsh is the first language. Translation of this policy and procedure will be arranged if requested. Risk Assessment Summary Have you identified any risks arising from the implementation of this policy / procedure / written control document? No risks identified Have you identified any Information Governance issues arising from the implementation of this policy / procedure / written control document? N/A Have you identified any training and / or resource implications as a result of implementing this? No additional resource/ Guidance may be needed for interpretation Issue Date: 2015 Page 5 of 16 Review Date: 2018
Employment of Medical and Dental Locums and the use of Agency Staff 1. Introduction The employment of all staff including locum medical and dental cover requires strict governance arrangements to ensure patient, staff and organisational safety. This policy seeks to ensure that Powys teaching Health Board provides clear, consistent guidance and procedures for the engagement and use of temporary medical and dental staff. Powys teaching Health Board is committed to the delivery of safe, effective and efficient services. To achieve this, employment of locum and agency doctors and dentists must sit within a clinical and financial framework. The Health Board will not approve any payments in excess of nationally agreed rates, without formal approval of the Executive team. 2. Aims This policy provides a framework for the request, authorisation, use and governance of temporary and agency staff. 3. Objectives The purpose of this policy is to: - Ensure all appointments comply with statutory requirements and employment law and eliminate unlawful discrimination. - Ensure that all doctors and dentists recruited by PtHB have been through an appropriate pre-screening and on-boarding process and are suitably qualified. - Promote good practice in selection methods and a positive image of Powys thb as an employer. - Ensure appropriate monitoring of ad hoc locum and agency usage. - Ensure appropriate scrutiny and authorisation. This policy must be complied with in all respects. Issue Date: 2015 Page 6 of 16 Review Date: 2018
4. Scope This policy refers only to Medical and Dental Locum and Agency staff within the hospital and community environments, as defined below, and does not extend to locums contracted through Service Level Agreements, which are subject to the scrutiny and formal appointments process (including issuing of appointment letters and contract of employment), which are subject to PtHB s recruitment policy. 5. Definitions Locum under NHS Employers definition a doctor or dentist in locum tenens is one who is standing in for an absent doctor or dentist, or temporarily covering a vacancy, in an established post or position. The principle in this guidance, also apply to other short-term or fixedterm medical contracts. For the purpose of this policy: Short Term covers regular or ongoing commitments for up to six weeks. This is intended to cover short term gaps or emergency cover pending recruitment to substantive posts, prior to a longer term post being subject to the formal recruitment process. Long Term refers to cover of between six weeks and six months, e.g. covering established vacancies. Agency Locum recruited though the approved main provider, Medacs, or alternative suitable agency from the Approved Framework Supplier List. Disclosure and Barring Service (DBS) the DBS was established under the Protection of Freedoms Act 2012 and merges the functions previously carried out by the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA). 6. Use and duration of locum appointments Locum doctors are an important asset to the NHS and make a valuable contribution to healthcare. However, the appointment of a locum doctor should be a temporary measure of limited duration for unforeseen absences such as sick leave. Planned absences, such as maternity leave, can often be covered more effectively by better use if Issue Date: 2015 Page 7 of 16 Review Date: 2018
the substantive workforce and ensuring that work patterns are more effectively aligned to the needs of patients. Careful workforce planning and early recruitment to known vacancies can help avoid the use of locum staff. Employers should consider the relative cost-effectiveness of engaging permanent and locum staff. Ideally, there should be sufficient substantive posts within the unit to meet foreseen service demands, including planned absences. 7. Roles and Responsibilities Medical Director In the case of an agency Consultant locum, checking their CV for suitability for the post against the essential criteria in the Job Description and Person Specification. Locality General Manager with the WOD Business Partner and Medical Workforce Manager Ensure plans are in place to reduce the need for temporary staff i.e. Workforce plans, robust annual leave and absence management systems in place Verify and authorise the requirement for locum cover prior to booking, including signing the booking form as the authorised budget holder Check the doctor is in good standing in terms of appraisal and revalidation Verify and authorise timesheets in line with agency / Health Board protocols and financial controls To ensure ad hoc locums are not used to fill regular or long term vacancy sessions, which could result in employment liabilities. Senior Nurse/Supervisor/Consultant/Medical Workforce Manager Ensure safe local governance for the employment of locums and agency locums, including local procedures to ensure full compliance with this policy. Ensure that visual identity checks against an original form of photo ID on the locum s arrival, and ensure that the appropriateness of employment checks for out of hours locums secured through an agency (if not checked prior to commencement) is reviewed. Ensure any temporary workers receive a local induction. Monitor the performance of temporary workers and deal with any concerns in relation to clinical competence, conduct or performance Issue Date: 2015 Page 8 of 16 Review Date: 2018
appropriately, including alerting the providing agency, employing authority and/or deanery. Provide locums with feedback on their performance for appraisal and revalidation. Medical Workforce Manager and WOD Business Partner Ensure locums proposed to cover have their CV s and supporting employment check documentation reviewed and approved by the Medical Director/Consultant as having experience relevant to the role prior to booking. Support locally known locums and potential new locums with their application and pre-employment checks/renewals. Liaise with the Locality General Manager/WOD Business Partner in relation to any ad hoc locums engaged inappropriately and not according to procedures and provide quarterly reports on noncompliance to the Executive Directors and WG. If a locum confirms locally that they wish to withdraw from providing locum cover, ensure the leaving process is appropriately managed With the Locum Agency. Locum/Agency Locum Adhere to PtHB policy and procedures Submit time sheets within appropriate timescales. Respond promptly to requests for information. 8. Recruitment of Locums Long Term An established post must be vacated before recruitment of a long term locum post. All jobs will be advertised on www.jobs.nhs.uk and will be subject to a short listing, interview process and on successful appointment, pre-employment checks which include DBS, Occupational Health clearance, registration check and satisfactory references. Locum doctors must be offered appropriate induction for their roles and appropriate supervision. Induction must include local clinical protocols and any specialist equipment. Use of existing locums Short Term Issue Date: 2015 Page 9 of 16 Review Date: 2018
In the case of sickness or leave, subject to Working Time Regulations, a locum in existing employment with Powys teaching Health Board may be asked to provide cover. The Medical Workforce Manager and the Locality General Manager will liaise with member of staff to view the practicalities of the cover. Payment of locums will be at national rates or specific speciality variations to this approved by the Executive Team. Use of Agency Locums Care should be taken to ensure that any provision of locum cover is made as economically as possible and that delays in attempting to provide such cover are minimised in the interest of patient safety. It should also be emphasised that requests for locum cover should be made whilst giving as much notice as possible to enable the Medical Workforce Manager/ WOD Business Partner to request suitable replacements from the approved main provider. All appointees must be fully screened before commencement in line with the NHS Employers Employment Check Standards 2008 (amended July 2013), except where procured through an approved agency who accepts this delegated responsibility under the procurement contract. In some circumstances it is necessary for additional pre-employment checks depending on the specialty, e.g. Responsible Clinician in Mental Health. The Health Board will continually seek to ensure the best quality of supply and value for money from agencies by reviewing their usage. The Health Board will use only agencies who operate within the National Framework Agreement for the Supply of Medical Locums and who comply with the NHS Employers Guidance on the Appointment and Employment of NHS Locum Doctors (August 2013). Under the terms of the organisation s agency contract, the main provider, Medacs, should be approached in the first instance, and only if the main provider is unable to meet the requirements within the following contractual timescales should other agencies be approached. 9. Application of this policy Each locality will review the use of locums with the WOD Business Partner in order to ensure this remains the most efficient and effective means of cover. Issues relating to quality assurance, standards and risk management should be considered and the use of locums Issue Date: 2015 Page 10 of 16 Review Date: 2018
continually monitored in line with PtHB s aim to optimise utilisation of its medical workforce and reduce the use of locum doctors/dentists. If, having regard to the above points, a locum is needed at unavoidably short notice (e.g. sickness) and internal cover is unavailable, medical locum agencies may be used via the main provider with the authorisation of the budget holder. It is important that the reason for requesting locum cover is established and that this reason can be fully justified. PtHB will not engage locums who are currently the subject of reservations about standard or competence of previous performance or who are unwilling to provide their most recent reference. 10. Special Considerations Language and Communication skills It is important that localities are aware of distinctions between the GMC language testing requirements for the registration and licensing of doctors who trained and qualified in the EEA and those from outside the EEA. Within the EEA the GMC recognises equivalent medical qualifications and is not expected to test for language competency or communication skills before registering and licensing a doctor for UK practice, which remains an employer responsibility. For further guidance, please refer to NHS Employers Guidance on the Appointment and Employment of Locum Doctors. Pre-employment checks for locums The Medical Workforce Manager will make all appropriate preemployment checks. Induction All locums, including agency locums must receive a local induction which should be performed by either, the Senior Nurse, Ward Manager, Supervisor or Consultant. Payment Payment of locums will be at national rates or specific variations to this must be approved by the Executive Team. Issue Date: 2015 Page 11 of 16 Review Date: 2018
Payment of agency locum shifts must be approved and authorised by the Locality General Manager, a requisition must be raised on the Oracle financial system and follow the normal requisition and authorisation process. Agency locums will be paid on submission of an appropriately authorised timesheet, which must be submitted within four weeks (28 days) of completing a shift to their agency who in turn will raise an invoice. 11. Assessment of Locum Doctors The performance of all locum doctors employed to work within the Health Board will be assessed by completing appendix 1, Assessment Performance Process and \Reporting Mechanism for Locum Medical and Dental Staff. This will ensure that standard of performance are continually monitored and, occasions where required standards are not met identified. The responsible Supervising Consultant/Medical Director is responsible for identifying the unsatisfactory performance of a locum and should provide advice to a doctor/dentist, where appropriate, of any further training they feel the doctor/dentist should have before undertaking any further locum work. Issues of clinical competence, conduct or performance relating to locum activity will be managed in line with organisational policies and procedures, including notification to current employer(s)/agencies. 12. Links to Supporting Information Wales Deanery Guidance acting up in a Consultant post Guidance on the Appointment and Employment of Locum Doctors NHS Employers Language Competency Guidance NHS Employers Check Standards Approved Framework Locum Suppliers 13. Review and Document Control This document will be reviewed ever three years or in the event of Legislative change. Issue Date: 2015 Page 12 of 16 Review Date: 2018
Powys teaching Health Board Appendix 1 PERFORMANCE PROCESS AND REPORTING MECHANISM FOR LOCUM MEDICAL AND DENTAL STAFF It is important that all Locum Doctors and Dentists working for the NHS meet the desired standards (Code of Practice, as set down by the NHS Executive, in August 1997). This form should be completed with locum staff periodically for long term placements, and/or on the final shift, to provide summary feedback on their strengths and areas for development, for appraisal and revalidation evidence. Where the Responsible/Supervising Consultant has concerns about conduct, competence or capability, they must escalate in the same way as a substantive member of staff by reporting directly to the Medical Director. If the locum doctor has been engaged through an agency, the employer must always send a copy of this report to the agency, following escalation to the Medical Director where escalation has been required. Where feedback is sent to a third party, it is good practice to ensure that a copy is also provided to the locum/bank employee. Locum s Name: GMC No: From: Specialty: Grade: Covering For: To: Base: SHORT TERM - ad hoc, or regular/ongoing commitments for up to 6 weeks Assessment Criteria Acceptable Unacceptable Above Average LONG TERM (over 6 weeks) Acceptable Below Average Unacceptable Clinical Care 1. History taking 2. Technical ability 3. Investigation and Diagnosis 4. Judgement & Patient Management Maintaining Good Medical Practice 5. Knowledge 6. Audit 7. Risk Management 8. Continuing Medical Education 9. Leadership and Initiative 10. Administration Working Relationships 11. Patients 12. Seniors 13. Peers 14. Nursing and Therapies 15. Secretarial and Admin 16. Sharing Knowledge and Skills Probity 17. Reliability 18. Time Keeping 19. Appearance 20. Integrity Health 21. Sickness Absence Issue Date: 2015 Page 13 of 16 Review Date: 2018
Summary Was this locum Satisfactory Unsatisfactory Would you employ this locum again? Yes No Are you recommending suspension of approved locum status (where applicable) pending investigation? Yes for this Specialty Yes for ALL Specialties In making this recommendation, you are confirming that the issues identified have been escalated in line with the procedure for substantive staff. Please add any relevant notes/attach copies of relevant correspondence. Signed: (Responsible/Supervising Consultant) Please print name: Tel: Specialty: Base: Issue Date: 2015 Page 14 of 16 Review Date: 2018
Appendix 2 PROCEDURE FOR AUTHORISING EMPLOYMENT OF AGENCY MEDICAL AND DENTAL STAFF Potential Locum Vacancy Alternative staffing resources investigated e.g. bank staff, temporary increase in hours. Suitable alternative resource identified Alternative resource not identified Alternative Resource utilised No further Action Need for locum agency doctor is raised with LGM, WOD BP and Medical Workforce Manager (MWM) and the need for Locum is verified. MWM and WOD BP to assess need. MWM to make contact with the approved agency. Suitable Agency Locum Available doctor CV sent from agency to MWM No Suitable Agency Locum Available LGM and MD to approve CVs for Consultants and the Consultant to approve SAS CVs LGM and WOD BP to be informed for escalation Medical Director also informed MWM to confirm that all pre-employment checks are in date and arrange local induction Agency Locum usage to be reviewed regularly by MWM and WOD BP Local Contingency Plan to be enacted On completion of an assignment, the supervising consultant or Medical Director will complete Appendix 1. This is to be returned to the MWM who will forward to the agency. Any untoward issues will need to be identified to Medical Director and addressed with the agency. Issue Date: 2015 Page 15 of 16 Review Date: 2018
Appendix 3 PROCEDURE FOR AUTHORISING EMPLOYMENT OF LOCUM MEDICAL AND DENTAL STAFF SHORT TERM (Sickness or Leave) LONG-TERM (Vacant post) LGM, WOD BP and MWM will verify the use of existing Locum An established post must be vacated before recruitment of a long term locum post can take place Existing Locum asked to cover LGM, WOD BP and MWM will verify the need for a Long Term Locum MWM will liaise with Locum to view the practicalities of the cover and dates required All Long Term vacancies will be subject to the Vacancy Approval Process LGM approves shortterm cover Post to be advertised and appointed to according to normal recruitment practice MWM manages the engagement process Medical Director to view and approve CVs/applications Locum usage to be reviewed regularly by MWM and WOD BP MWM to carry out all necessary pre-employment checks MWM to arrange appropriate induction and supervision throughout placement Locum usage to be reviewed regularly by MWM and WOD BP Issue Date: 2015 Page 16 of 16 Review Date: 2018