Early in 2004 District Health Board Mental Health Managers and Clinical Directors raised concerns at the cost and time involved in the recruitment and use of locum psychiatrists within mental health services nationally. The Mental Health Commission has undertaken this stock take of locum psychiatrist usage in order to gauge the extent and depth of the problems.
Methodology
The stock take has consisted of two parts, the first being a questionnaire (attached as Appendix 1) sent to all 21 District Health Boards, of which twelve were returned, a completion rate of 57%. The second part consisted of a follow up phone call where required, for clarification and amplification of the questionnaire response.
The stock take specifically addressed the use of locum psychiatrists in the financial year 2002/03. It has concentrated on three primary areas of interest, being recruitment, cost of locum psychiatrists, and impact (both positive and negative) on service provision. This report covers each of those three areas in turn, and then concludes with some general observations on the issues identified in the stock take.
Key Results
Locum psychiatrists are widely used throughout the New Zealand mental health sector, and fulfil a valued role. DHBs are concerned at the level of their use, and the impact such use has on the quality and particularly continuity of service for service users.
The use of relationships through existing staff or recruitment agencies is seen as key by DHBs to their effective recruitment of locums and other psychiatrists.
Indirect costs of using locum psychiatrists are quite high. Given that, it is interesting that no Australian psychiatrists were used by the DHBs responding to the stock take, in that the presumed indirect cost of Australians would be less, due to common College membership.
Few locum psychiatrists desire permanent appointments, and few take them up.
The general sense obtained from the stock take is that locums are valued for the support and experience that they bring, but that DHBs would much prefer to make permanent appointments. In one respondent‟s view, locum psychiatrists are expensive, potentially disruptive (positively and negatively), and unfortunately necessary.
If we accept that necessity, then there are many ways of making improvements. DHBs have more in common regarding their requirements than they have differences. Standardised recruitment and induction and reducing the costs of the internal market both have merit. A coordinated national approach to these issues, as set out above is one option that is definitely worth considering.