Reliance on locums must end, says report

Public hospitals have been urged to turn away from their "unsustainable" and "potentially dangerous" heavy reliance on casual employees to fill doctor vacancies.

A top-level inquiry panel has told district health boards they should change training and employment arrangements for new-graduate doctors and trainee specialists to make permanent jobs more attractive and reduce the need for and appeal of locum work.

In its report released yesterday, the Health Ministry-appointed Commission on the Resident Medical Officer (RMO) Workforce controversially recommends a new national agency be created to replace the health boards as the employer of most of the country's 2500 house officers and registrars - a return to what existed until 1987. The Government will consult further on this.

The report presents RMOs as a demoralised workforce which feels unvalued by the health system. It says RMOs feel hospitals treat them as "units of labour" rather than "professionals in training" and this culture needs to change.

The commission, headed by former state services commissioner Don Hunn, says the diversion of medical graduates into the locum market poses a serious threat to the medical workforce's long-term sustainability.

"In a time of workforce shortage, locum work, which offers better remuneration and flexibility, appeals to an increasing number of RMOs, diverting them away from vocational training programmes, and thereby reducing the number of specialists ... in the longer term."

"We believe that while locums will always be needed, the current widespread costly use of locums is unsustainable, and that having no limit on or monitoring of [locum] working hours is unacceptable and potentially dangerous."

The commission was told some RMOs worked 80 hours a week from doing locum shifts on top of permanent jobs.

It says high locum use is driven by RMO shortages in the face of rising demand for health care and the imposition of a shorter working week for patient-safety reasons.

Health Minister Tony Ryall accepted the commission's recommendation to beef up national leadership of medical training and is creating a Clinical Training Agency Board to advise him on training of all health workers.

But he is seeking advice from health boards on the suggestion of creating a new agency to employ RMOs, which he said would require either legislation or new industrial arrangements.