{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T23:16:06Z","timestamp":1782947766225,"version":"3.54.5"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T00:00:00Z","timestamp":1711497600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T00:00:00Z","timestamp":1711497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health Services and Delivery Research Programme","doi-asserted-by":"publisher","award":["NIHR128349"],"award-info":[{"award-number":["NIHR128349"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We accessed electronic health care records (EHRs) for 3.5 million patients from the CPRD GOLD database with linkage to Hospital Episode Statistics from 1st April 2010 to 31st March 2022. We used multi-level mixed effects logistic regression to compare consultations with locum and permanent GPs for several patient outcomes including general practice revisits; prescribing of antibiotics; strong opioids; hypnotics; A&amp;E visits; emergency hospital admissions; admissions for ambulatory care sensitive conditions; test ordering; referrals; and prescribing safety indicators while controlling for patient and practice characteristics.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Consultations with locum GPs were 22% more likely to involve a prescription for an antibiotic (OR\u2009=\u20091.22 (1.21 to 1.22)), 8% more likely to involve a prescription for a strong opioid (OR\u2009=\u20091.08 (1.06 to 1.09)), 4% more likely to be followed by an A&amp;E visit on the same day (OR\u2009=\u20091.04 (1.01 to 1.08)) and 5% more likely to be followed by an A&amp;E visit within 1 to 7\u00a0days (OR\u2009=\u20091.05 (1.02 to 1.08)). Consultations with a locum were 12% less likely to lead to a practice revisit within 7\u00a0days (OR\u2009=\u20090.88 (0.87 to 0.88)), 4% less likely to involve a prescription for a hypnotic (OR\u2009=\u20090.96 (0.94 to 0.98)), 15% less likely to involve a referral (OR\u2009=\u20090.85 (0.84 to 0.86)) and 19% less likely to involve a test (OR\u2009=\u20090.81 (0.80 to 0.82)). We found no evidence that emergency admissions, ACSC admissions and eight out of the eleven prescribing safety indicators were different if patients were seen by a locum or a permanent GP.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Despite existing concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs. The practice and performance of both locum and permanent GPs is likely shaped by the organisational setting and systems within which they work.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12916-024-03332-z","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T01:24:59Z","timestamp":1711502699000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Comparing the clinical practice and prescribing safety of locum and permanent doctors: observational study of primary care consultations in England"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-8648","authenticated-orcid":false,"given":"Christos","family":"Grigoroglou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Walshe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Kontopantelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Stringer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren M.","family":"Ashcroft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Allen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,27]]},"reference":[{"issue":"1","key":"3332_CR1","doi-asserted-by":"publisher","first-page":"23611","DOI":"10.3402\/gha.v7.23611","volume":"7","author":"C Aluttis","year":"2014","unstructured":"Aluttis C, Bishaw T, Frank MW. The workforce for health in a globalized context\u2013global shortages and international migration. Glob Health Action. 2014;7(1):23611.","journal-title":"Glob Health Action"},{"issue":"10288","key":"3332_CR2","doi-asserted-by":"publisher","first-page":"1992","DOI":"10.1016\/S0140-6736(21)00231-2","volume":"397","author":"M Anderson","year":"2021","unstructured":"Anderson M, O\u2019Neill C, Macleod Clark J, Street A, Woods M, Johnston-Webber C, et al. Securing a sustainable and fit-for-purpose UK health and care workforce. Lancet. 2021;397(10288):1992\u20132011.","journal-title":"Lancet"},{"key":"3332_CR3","unstructured":"Sizmur S, Raleigh V. The risks to care quality and staff wellbeing of an NHS system under pressure. Oxford: The King's Fund; 2018. 24."},{"issue":"1","key":"3332_CR4","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1186\/s12913-018-3118-6","volume":"18","author":"S Salloch","year":"2018","unstructured":"Salloch S, Apitzsch B, Wilkesmann M, Ruiner C. Locum physicians\u2019 professional ethos: a qualitative interview study from Germany. BMC Health Serv Res. 2018;18(1):333.","journal-title":"BMC Health Serv Res"},{"key":"3332_CR5","volume-title":"What our data tells us about locum doctors","author":"General Medical Council","year":"2018","unstructured":"General Medical Council. What our data tells us about locum doctors. 2018."},{"key":"3332_CR6","volume-title":"Survey of temporary physician staffing trends 2020","author":"Staff Care","year":"2020","unstructured":"Staff Care. Survey of temporary physician staffing trends 2020. 2020.\u00a0Available from: https:\/\/www.staffcare.com\/uploadedFiles\/staffcare2020surveyPDF.pdf."},{"issue":"21","key":"3332_CR7","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1001\/jama.2017.17925","volume":"318","author":"DM Blumenthal","year":"2017","unstructured":"Blumenthal DM, Olenski AR, Tsugawa Y, Jena AB. Association between treatment by locum tenens internal medicine physicians and 30-day mortality among hospitalized medicare beneficiaries. JAMA. 2017;318(21):2119\u201329.","journal-title":"JAMA"},{"issue":"11","key":"3332_CR8","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1177\/0141076819877539","volume":"112","author":"J Ferguson","year":"2019","unstructured":"Ferguson J, Walshe K. Quality, safety and locum doctors: a narrative review. J R Soc Med. 2019;112(11):462\u201371.","journal-title":"J R Soc Med"},{"key":"3332_CR9","doi-asserted-by":"publisher","first-page":"g4741","DOI":"10.1136\/bmj.g4741","volume":"349","author":"C Dyer","year":"2014","unstructured":"Dyer C. Locum histopathologist is struck off for clinical errors and lying. BMJ. 2014;349:g4741.","journal-title":"BMJ"},{"key":"3332_CR10","doi-asserted-by":"publisher","first-page":"p507","DOI":"10.1136\/bmj.p507","volume":"380","author":"C Dyer","year":"2023","unstructured":"Dyer C. Locum surgeon is struck off for failing to call for help during botched appendectomies. BMJ. 2023;380:p507.","journal-title":"BMJ"},{"key":"3332_CR11","unstructured":"Kirkup B. Reading the signals: maternity and neonatal services in East Kent\u2013the report of the independent investigation. Department of Health and Social Care. London: House of Commons; 2022."},{"issue":"1","key":"3332_CR12","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1111\/1467-9566.13210","volume":"43","author":"J Ferguson","year":"2021","unstructured":"Ferguson J, Tazzyman A, Walshe K, Bryce M, Boyd A, Archer J, et al. \u201cYou\u2019re just a locum\u201d: professional identity and temporary workers in the medical profession. Sociol Health Illn. 2021;43(1):149\u201366.","journal-title":"Sociol Health Illn"},{"key":"3332_CR13","unstructured":"Beech J, Bottery S, Charlesworth A, Evans H, Gershlick B, Hemmings N, et al. Closing the gap. Key Areas for Action on the Health and Care Workforce. The King's Fund. 2019."},{"key":"3332_CR14","doi-asserted-by":"publisher","first-page":"i6207","DOI":"10.1136\/bmj.i6207","volume":"355","author":"T Moberly","year":"2016","unstructured":"Moberly T. Number of locums has doubled since 2009. BMJ. 2016;355:i6207.","journal-title":"BMJ."},{"issue":"3","key":"3332_CR15","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1093\/ije\/dyv098","volume":"44","author":"E Herrett","year":"2015","unstructured":"Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T, et al. Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. 2015;44(3):827\u201336.","journal-title":"Int J Epidemiol"},{"issue":"588","key":"3332_CR16","doi-asserted-by":"publisher","first-page":"438","DOI":"10.3399\/bjgp11X583092","volume":"61","author":"EL Herrett","year":"2011","unstructured":"Herrett EL, Thomas SL, Smeeth L. Validity of diagnoses in the general practice research database. Br J Gen Pract. 2011;61(588):438\u20139.","journal-title":"Br J Gen Pract"},{"issue":"572","key":"3332_CR17","doi-asserted-by":"publisher","first-page":"e128","DOI":"10.3399\/bjgp10X483562","volume":"60","author":"NF Khan","year":"2010","unstructured":"Khan NF, Harrison SE, Rose PW. Validity of diagnostic coding within the General Practice Research Database: a systematic review. Br J Gen Pract. 2010;60(572):e128\u201336.","journal-title":"Br J Gen Pract"},{"issue":"2","key":"3332_CR18","doi-asserted-by":"publisher","first-page":"e020738","DOI":"10.1136\/bmjopen-2017-020738","volume":"8","author":"E Kontopantelis","year":"2018","unstructured":"Kontopantelis E, Stevens RJ, Helms PJ, Edwards D, Doran T, Ashcroft DM. Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study. BMJ Open. 2018;8(2):e020738.","journal-title":"BMJ Open"},{"key":"3332_CR19","volume-title":"Hospital Episode Statistics","author":"NHS Digital","year":"2020","unstructured":"NHS Digital. Hospital Episode Statistics. 2020.\u00a0Available from: https:\/\/digital.nhs.uk\/data-and-information\/data-tools-and-services\/data-services\/hospital-episode-statistics."},{"key":"3332_CR20","volume-title":"The English Indices of Deprivation","author":"Ministry of Housing, Communities and Local Government","year":"2019","unstructured":"Ministry of Housing, Communities and Local Government. The English Indices of Deprivation. 2019."},{"key":"3332_CR21","unstructured":"Clinical Practice Research Datalink. Hospital Episode Statistics (HES) Admitted Patient Care and CPRD primary care data Documentation (set 22\/January 2022). CPRD. 2021(Version 2.8)."},{"issue":"7","key":"3332_CR22","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1136\/emj.2010.108548","volume":"28","author":"M Bankart","year":"2011","unstructured":"Bankart M, Baker R, Rashid A, Habiba M, Banerjee J, Hsu R, et al. Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional study. Emerg Med J. 2011;28(7):558\u201363.","journal-title":"Emerg Med J"},{"issue":"624","key":"3332_CR23","doi-asserted-by":"publisher","first-page":"e434","DOI":"10.3399\/bjgp14X680533","volume":"64","author":"TE Cowling","year":"2014","unstructured":"Cowling TE, Harris MJ, Watt HC, Gibbons DC, Majeed AJ. Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey. Br J Gen Pract. 2014;64(624):e434\u20139.","journal-title":"Br J Gen Pract"},{"key":"3332_CR24","unstructured":"Steventon A, Friebel R, Deeny S, Gardner T, Thorlby R. Briefing: emergency hospital admissions in England: which may be avoidable and how? Health Foundation. 2018."},{"issue":"10","key":"3332_CR25","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1136\/emermed-2020-209527","volume":"38","author":"D Lasserson","year":"2021","unstructured":"Lasserson D, Smith H, Garland S, Hunt H, Hayward G. Variation in referral rates to emergency departments and inpatient services from a GP out of hours service and the potential impact of alternative staffing models. Emerg Med J. 2021;38(10):784\u20138.","journal-title":"Emerg Med J"},{"key":"3332_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12916-018-1217-1","volume":"16","author":"JW O\u2019Sullivan","year":"2018","unstructured":"O\u2019Sullivan JW, Stevens S, Oke J, Hobbs FR, Salisbury C, Little P, et al. Practice variation in the use of tests in UK primary care: a retrospective analysis of 16 million tests performed over 3.3 million patient years in 2015\/16. BMC Med. 2018;16:1\u20139.","journal-title":"BMC Med."},{"key":"3332_CR27","volume-title":"The NHS Long Term Plan","author":"NHS England","year":"2019","unstructured":"NHS England. The NHS Long Term Plan. 2019."},{"key":"3332_CR28","volume-title":"Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults","author":"National Institure of Health Excellence","year":"2022","unstructured":"National Institure of Health Excellence. Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults. 2022."},{"issue":"11","key":"3332_CR29","doi-asserted-by":"publisher","first-page":"e1004133","DOI":"10.1371\/journal.pmed.1004133","volume":"19","author":"S Rodgers","year":"2022","unstructured":"Rodgers S, Taylor AC, Roberts SA, Allen T, Ashcroft DM, Barrett J, et al. Scaling-up a pharmacist-led information technology intervention (PINCER) to reduce hazardous prescribing in general practices: Multiple interrupted time series study. PLoS Med. 2022;19(11):e1004133.","journal-title":"PLoS Med"},{"issue":"9","key":"3332_CR30","doi-asserted-by":"publisher","first-page":"e036046","DOI":"10.1136\/bmjopen-2019-036046","volume":"10","author":"C Grigoroglou","year":"2020","unstructured":"Grigoroglou C, Munford L, Webb R, Kapur N, Doran T, Ashcroft D, et al. Impact of a national primary care pay-for-performance scheme on ambulatory care sensitive hospital admissions: a small-area analysis in England. BMJ Open. 2020;10(9):e036046.","journal-title":"BMJ Open"},{"issue":"9823","key":"3332_CR31","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1016\/S0140-6736(11)61817-5","volume":"379","author":"AJ Avery","year":"2012","unstructured":"Avery AJ, Rodgers S, Cantrill JA, Armstrong S, Cresswell K, Eden M, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012;379(9823):1310\u20139.","journal-title":"Lancet"},{"issue":"621","key":"3332_CR32","doi-asserted-by":"publisher","first-page":"e181","DOI":"10.3399\/bjgp14X677806","volume":"64","author":"R Spencer","year":"2014","unstructured":"Spencer R, Bell B, Avery A, Gookey G, Campbell S. Identification of an updated set of prescribing\u2014safety indicators for GPs. Br J Gen Pract. 2014;64(621):e181\u201390.","journal-title":"Br J Gen Pract"},{"issue":"3","key":"3332_CR33","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1046\/j.1365-2532.1994.1130177.x","volume":"11","author":"N Booth","year":"1994","unstructured":"Booth N. What are the read codes? Health Libr Rev. 1994;11(3):177\u201382.","journal-title":"Health Libr Rev"},{"issue":"5","key":"3332_CR34","doi-asserted-by":"publisher","first-page":"E107","DOI":"10.1503\/cmaj.190757","volume":"192","author":"RA Payne","year":"2020","unstructured":"Payne RA, Mendonca SC, Elliott MN, Saunders CL, Edwards DA, Marshall M, et al. Development and validation of the Cambridge Multimorbidity Score. CMAJ. 2020;192(5):E107\u201314.","journal-title":"CMAJ"},{"issue":"4","key":"3332_CR35","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1287\/isre.2013.0480","volume":"24","author":"M Lin","year":"2013","unstructured":"Lin M, Lucas H, Shmueli G. Too big to fail: large samples and the p-value problem. Inf Syst Res. 2013;24(4):906\u201317.","journal-title":"Inf Syst Res"},{"key":"3332_CR36","unstructured":"Walshe K, Ferguson J, Allen T, Grigoroglou C, Stringer G, Kontopantelis E, et al. Locum doctors in the NHS: Understanding and improving the quality and safety of healthcare. Policy Report. The University of Manchester. 2023. Available from: https:\/\/documents.manchester.ac.uk\/display.aspx?DocID=67075."},{"issue":"715","key":"3332_CR37","doi-asserted-by":"publisher","first-page":"e118","DOI":"10.3399\/BJGP.2021.0354","volume":"72","author":"AJ Borek","year":"2022","unstructured":"Borek AJ, Pouwels KB, van Hecke O, Robotham JV, Butler CC, Tonkin-Crine S. Role of locum GPs in antibiotic prescribing and stewardship: a mixed-methods study. Br J Gen Pract. 2022;72(715):e118\u201327.","journal-title":"Br J Gen Pract"},{"issue":"10","key":"3332_CR38","doi-asserted-by":"publisher","first-page":"3040","DOI":"10.1007\/s11606-020-06578-4","volume":"36","author":"MK Mustafa Ali","year":"2021","unstructured":"Mustafa Ali MK, Sabha MM, Mustafa SK, Banifadel M, Ghazaleh S, Aburayyan KM, et al. Hospitalization and post-hospitalization outcomes among teaching internal medicine, employed hospitalist, and locum tenens hospitalist services in a tertiary center: a prospective cohort study. J Gen Intern Med. 2021;36(10):3040\u201351.","journal-title":"J Gen Intern Med"},{"key":"3332_CR39","doi-asserted-by":"publisher","unstructured":"Stringer G, Ferguson J, Walshe K, Grigoroglou C, Allen T, Kontopantelis E, et al. Locum doctors in English general practices: evidence from a national survey. Br J Gen Pract. https:\/\/doi.org\/10.3399\/BJGP.2023.0039.","DOI":"10.3399\/BJGP.2023.0039"},{"issue":"715","key":"3332_CR40","doi-asserted-by":"publisher","first-page":"e108","DOI":"10.3399\/BJGP.2021.0311","volume":"72","author":"C Grigoroglou","year":"2022","unstructured":"Grigoroglou C, Walshe K, Kontopantelis E, Ferguson J, Stringer G, Ashcroft DM, et al. Locum doctor use in English general practice: analysis of routinely collected workforce data 2017\u20132020. Br J Gen Pract. 2022;72(715):e108\u201317.","journal-title":"Br J Gen Pract"}],"container-title":["BMC Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-024-03332-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12916-024-03332-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-024-03332-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T01:25:27Z","timestamp":1711502727000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedicine.biomedcentral.com\/articles\/10.1186\/s12916-024-03332-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,27]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3332"],"URL":"https:\/\/doi.org\/10.1186\/s12916-024-03332-z","relation":{},"ISSN":["1741-7015"],"issn-type":[{"value":"1741-7015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,27]]},"assertion":[{"value":"22 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study is based on data from the Clinical Practice Research Datalink (CPRD) GOLD database obtained under license from the Medicines and Healthcare products Regulatory Agency (MHRA). The data are provided by patients and collected by the NHS as part of their care and support. Hospital Episode Statistics (HES) data are subject to Crown copyright (2023) protection, re-used with the permission of The Health and Social Care Information Centre, all rights reserved. The interpretation and conclusions contained in this study are those of the authors alone, and not necessarily those of the MHRA, the National Institute for Health and Care Research (NIHR), NHS, or the Department of Health. Approval to conduct this study using the CPRD was granted by the Independent Scientific Advisory Committee (ISAC) of the MHRA (protocol 20_000246). The authors thank the contributing patients and practices to the CPRD GOLD database who have allowed their data to be used for research purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"126"}}