Background United Lincolnshire Hospitals is a large, rural, multi-site Trust which has been reliant on medical locums. Despite very high-performing doctors, the practice of some fell below the standard. We found that recruitment practices contributed to quality issues.

Objectives/Methods To investigate whether there was an association between quality and the practice of:

1. Appointing locums without specialist registration to Consultant posts.

2. Employing doctors with pre–existing GMC conditions.

The prevalence of doctors with GMC conditions by specialty was established. Incidents by specialty was sourced allowing for comparison.

Information was sourced on doctors who had encountered difficulties that required escalation to the Medical Director.

Results Specialist Registration (SR)

18% of Consultant posts were filled by locums without SR. 42% of locum Consultants did not hold SR. A correlation was demonstrated between the lack of SR and risk. A moderate positive correlation (0.57) was identified with serious incidents. A weak positive relationship (0.36) was identified with incidents.

GMC Conditions

Seven doctors with pre-existing GMC conditions were aligned to the Trust. From 2011, four (57%) had concerns escalated to the Medical Director. From 2011–18, approximately 1,030 doctors were aligned to the Trust. Only 285 (28%) doctors had concerns escalated, indicating those with conditions were twice as likely to encounter difficulties.

Conclusions There is evidence that recruitment practices impair quality and so it was necessary for the leadership team to act. Employing doctors with GMC conditions was suspended. Services could not operate if SR was immediately made mandatory so a programme of staff development has been instigated to reduce the need for this practice. This involves working with the clinicians, Health Education England, GMC and professional bodies to:

• Re–open the Associate Specialist grade.

• Overhaul the CESR offering.