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Locum doctors are a vital component of the NHS workforce, providing essential flexibility and specialist skills. However, their ability to integrate swiftly is often undermined by persistent onboarding issues. As a consultant forensic psychiatrist working exclusively in locum posts, I have repeatedly encountered significant, preventable delays. While this article focuses on the acute challenges faced by locums, the principles of effective onboarding are universal. This article may be of value to locums in other areas of work e.g. nursing, social work, psychology etc. It is not a gripe about any particular organisation. It is an overview of consistent patterns across many healthcare organisations in the last 5 years. The article aims to offer solutions and better value for spending of public money.

These obstacles create professional disadvantages for any new doctor and pose risks to patient care. This article outlines the key areas where Trusts ought to improve their processes for all incoming medical staff.

The Digital Handcuffs

A doctor cannot work effectively without the correct tools. Upon starting at a new Trust, there are consistent delays in the provision of essential hardware. Access to a functioning desktop or laptop is a fundamental requirement. Connection to networked printers is sometimes a protracted process. These initial technical hurdles prevent a locum from completing basic tasks and starting their clinical duties promptly.

The problem is magnified when it comes to Electronic Patient Record (EPR) systems. Locums are confronted with a diverse and fragmented digital array, including platforms like Rio, Paris, Lorenzo, EPMA and EPIC. Each system requires separate, mandatory training before access is granted. This creates an immediate bottleneck. Delays in accessing patient records and, critically, electronic prescribing platforms (EPMA) leave the locum unable prescribe medication efficiently. The result is a doctor who is present in the hospital but digitally locked out from their primary responsibilities.

Physical and Bureaucratic Barriers

The challenges are not confined to the digital realm. Simple physical access to the workplace can be a significant issue. Obtaining an ID badge and having it programmed for electronic door access (or keys) is frequently a low-priority task for administrative departments. This restricts a locum’s movement, making it difficult to attend wards, meetings, or even access their own office space.

Practical matters like parking also contribute to a frustrating start. Some Trusts require vehicle details to be logged in a central system. Failure to complete this administrative step can lead to parking fines or an inability to park on-site, adding unnecessary stress before the clinical day has even begun. These may seem like small details, but they create a cumulative burden and signal a lack of organisational readiness for the locum’s arrival.

The Support Deficit

Effective clinical practice requires a robust support structure. Locum doctors frequently experience difficulties in connecting with managerial supervisors. A lack of assigned and available supervision leaves the locum isolated. They have no clear point of contact for guidance on complex cases or for navigating the Trust’s specific clinical governance pathways. This absence of support is particularly acute in high-stakes specialties like forensic psychiatry.

This is often coupled with inadequate secretarial, or ‘admin’, support. The administrative demands on a consultant are significant. Without reliable admin assistance, the locum is forced to spend a disproportionate amount of time on paperwork and organisational tasks. This diverts their focus from skilled clinical work and directly impacts their productivity. When a locum is bogged down by administrative duties, they cannot get on top of the clinical work that the Trust has hired them to do.

The Value Proposition

Organisations that fail to get onboarding right are not just inconveniencing doctors; they are failing to secure value for money. Trusts invest significant resources in recruiting and hiring both permanent and temporary staff. This expenditure is justified by the need to fill critical gaps in service with experienced practitioners. However, when that new team member is unable to work at full capacity for days, or even weeks, the Trust receives a poor return on its investment.

Every hour a locum spends waiting for a password, chasing an ID badge, or figuring out who to ask for support is an hour of highly paid, unproductive time. This inefficiency directly impacts the budget. A streamlined onboarding process ensures that the specialist skills being paid for are deployed swiftly. It maximises the efficiency of spending and ensures that the investment in temporary staff translates directly into patient care. Ultimately, effective onboarding is not an administrative courtesy; it is a core component of responsible financial management.

A Blueprint for the First Week or before.

To translate these principles into action, Trusts should adopt a structured onboarding schedule. Locums would do well to set out their expectations for onboarding to Trusts (or private sector healthcare organisations).

Healthcare organisations should avoid wasting money and time in the first week. If some of the following can be done in the week before arrival that places the service at a decisive advantage.

The following table provides a template for ensuring a locum (or new substantive doctor) is fully integrated and effective within their first week. It can be copied and modified to match individual needs.

Conclusion

The onboarding process for new medical staff in many NHS Trusts is not uncommonly a systemic failure with direct consequences. That perception is based on evidence across many Trusts over the last 15 years.

Efficient onboarding makes for enables doctors to perform their duties efficiently, avoid delays in accessing essential hardware, patient records, and even the physical hospital wards.

Adopting a structured and proactive onboarding plan is the clear solution. It ensures that any new doctor, whether locum or permanent, can contribute effectively from their very first day. Ultimately, getting onboarding right is a fundamental part of good governance. It demonstrates a commitment to staff wellbeing, ensures value for money, and most importantly, safeguards the quality and continuity of care for every patient.