Case study 6 - DRC Locums

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You can download our case study for DRC Locums (pdf).

Introduction

DRC Locums is a provider of medical staff to both the public and private sector. The organisation, which is based in Milton Keynes and has a sister office in Scotland, employs 100 people who are responsible for identifying and connecting candidates with positions across the UK. The organisation works with between 450 – 500 locum doctors at any one time. It is an approved staffing supplier to the NHS and therefore a designated body like hundreds of NHS and independent sector organisations.

DRC currently holds over 100 service agreements with individual hospital trusts, and is one of only five suppliers to be awarded a place on the NHS Scotland Framework. It has also recently been appointed to the London Procurement Programme (LPP) framework.

Challenges

One of the main challenges facing DRC Locums in their preparations for revalidation was the small number of locum doctors who had previously taken part in appraisals. Locum doctors are currently required to provide the date of their last appraisal, which is expected to have taken place in the last 12 months. However, DRC Locums estimates that more than half of new recruits that have not recently worked in the NHS have not had a recent appraisal and in many cases have never been appraised at all.

This challenge was exacerbated as the team at DRC Locums had no experience of medical appraisal, not being clinical staff themselves, and therefore knew they would have to seek external support to help them develop a system of appraisal for those doctors who will revalidate with the organisation.

DRC Locums is currently responsible for the revalidation of approximately 200 of the doctors in its locum pool. However because of the nature of their work, keeping track of the number of locum doctors who will revalidate with the organisation is a major challenge.

DRC Locums does not employ the locum doctors it works with – it contracts their services – and many will work in other roles and with other agencies across the UK and internationally. As Helena Turpin, Revalidation Project Lead at DRC Locums, explains, some of her counterparts in primary and secondary care have been running medical appraisal systems for over ten years and therefore ‘had a strong base on which to build when preparing for the introduction of revalidation.’

Action

DRC Locums’ first step was to appoint a responsible officer and medical director to work alongside Helena and the team. In August of last year, the organisation appointed Dr Stuart Sanders, who with over seven years’ experience of managing appraisals in the independent sector, was well placed to help steer the development of DRC Locums’ appraisal, revalidation and clinical governance systems.

In August 2011, DRC Locums was told it had been successful in its application to take part in an NHS Revalidation Support Team pilot to test its new Medical Appraisal Guide (MAG). DRC Locums was keen to assess how well the appraisal guide would work for some of their doctors who, because of their location, were likely to find it more difficult to engage in appraisal and revalidation. RST needed around 30 locum doctors for the pilot who qualified outside of the UK and work in England.

DRC Locums chose to run the pilot with locums who live abroad and come to the UK infrequently. The group was made up of doctors with fifteen different nationalities who had qualified in some seventeen different countries - including India, Romania, South Africa and the Sudan.

The pilot began in September 2011, and in the month between finding out they would be taking part and the pilot starting, DRC Locums had to ensure it had an appraisal system in place. As Helena explains: ‘This meant going from zero to a hundred percent in terms of our preparations for medical appraisal and revalidation, and all in the space of a month. We had to write a code of conduct, appoint and train a team of appraisers, and identify a number of doctors who would be willing to travel to the UK to take part in the pilot.’

When identifying their appraisers, DRC Locums decided to approach senior doctors within their locum pool. ‘Because of the nature of their role, many of the locum doctors we work with don’t know from one week to the next where they will be working,’ says Helena. ‘It’s very difficult to appreciate some of the challenges this creates regarding appraisal unless you work in the sector, so we were keen to ensure all of our appraisers were locum doctors themselves. We currently have seven appraisers and are looking to double or triple this number in the next year.’

Another challenge DRC Locums faced was determining how many of the doctors they work with would be revalidating with the organisation. As Helena explains, ‘It can be hard for locum doctors to identify who they will revalidate with, so we decided to run our own telephone survey. We contacted all of the locum doctors currently working with DRC, and all those that have applied to work with us, to discuss where they are planning to revalidate.

This is always going to be a challenge, but the survey really helped and we are looking at resurveying all of our doctors every six months, possibly online, as we find this tends to work well given the geographic spread of the doctors working with us.’

Results and benefits

The feedback from doctors who took part in the pilot was very positive and many found the template RST materials particularly useful in guiding them through the process of appraisal and the information they need to collect. ‘Working with the RST meant we were able to access a lot of support which made it easier to implement our medical appraisal system in such a short space of time,’ explains Helena. ‘The pilot also helped to identify a number of difficulties that we need to overcome ahead of the roll out of revalidation.’

One of the key issues identified is that many of the locum doctors feel excluded from CPD events and as a result unable to collect the supporting information required for medical appraisal and revalidation. In response DRC Locums has adapted the list of information doctors can provide so as to be more flexible.

However colleague and patient feedback is one area that is proving to be more challenging. ‘Some of the doctors we work with, such as pathologists or anaesthetists, won’t come into contact with patients very often, while others may only see them for a short space of time,’ explains Helena. ‘Whereas peer feedback can be collected reasonably easily if you have robust processes in place, patient feedback can be more challenging.’

In response, DRC Locums has launched a roadshow of events to meet with locum doctors and clients across the country. The events are open to all and aim to provide locum doctors with an overview of what is involved in revalidation and the support available to help them prepare.

Events aimed specifically at clients take more of a workshop format, looking at how DRC Locums can work together with them to find joint solutions to challenges such as patient and colleague feedback, for best practice in sharing information or concerns. So far events have been held in London, Manchester, and Birmingham and additional events are due to take place in Glasgow, London and Manchester in the coming months.

DRC Locums has also recently launched a new website that includes a number of useful resources to support those doctors revalidating with the organisation, including a free CPD tracker that locum doctors can use to track their CPD points. The organisation will soon be launching a monthly email reminder to encourage doctors to record evidence of CPD as they go along, rather than leave this until the last minute.

‘The roadshow is proving invaluable in helping us to build stronger relationships with our clients and develop joint solutions to these challenges,’ says Helena. ‘Some of these things can’t be resolved immediately, but our preparations for revalidation are already giving our clients increased confidence.

‘We’ve always been committed to providing a high quality service, and revalidation will help us to demonstrate that we work with some of the most qualified doctors, who are competent and fit to practise. We’ve already developed much more robust channels for dealing with poor performance and procedures for communicating concerns between designated bodies, all of which give our clients increased confidence in the service we provide.’

Key findings

• DRC Locums understands the challenges that locum doctors may face in collecting supporting information and has decided to keep its arrangements as flexible as possible. It is accepting supporting information in different formats to make it simpler for doctors to demonstrate they are keeping up to date with their practice.
• DRC Locums believes the systems it has put in place for revalidation and for dealing with concerns about doctors are giving its clients greater confidence in the services it provides.
• Some doctors, such as locums, may find it more challenging than others to collect supporting information for appraisal. Having appraisers who have experience of these challenges or understand them is hugely important.