31. All references and appraisals/assessments must be disclosed to the doctor concerned and their feedback sought. The process must be open, transparent and accountable.
32. Locums will need to have an identified body to turn to for assessment/appraisal and study leave.
33. Each doctor in the UK must have an allocated study leave budget. Atypical doctors must receive this from employers. Doctors in pure private practice should fund their own study leave with a tax rebate.
34. Employers should be given a tax rebate to motivate them to provide study leave, especially locum agencies.
35. If the government is unable to make locum agencies provide study leave to locums, then either locum salaries must be raised to cover such costs, or the deaneries or Trusts must provide this facility in the interests of high quality patient care and patient safety.
36. Locums must not be denied audit and training opportunities. Consultants and medical directors of hospitals deliberately denying a locum such opportunities should be penalised for failure of duty to protect patients through adequate training of junior locum staff

The effort made by the doctor rather than thickness of the portfolio should count depending on the degree of work the doctor does. If a doctor does whatever he does well, he should not be denied revalidation.

38. "Local profiling" for locums will have a different meaning to that of substantive doctors. An unemployed doctor may read journals at home or in a library. Local should be where the working or learning activity is based. For locums this will be scattered nationwide.
39. Long-term locums i.e. those in post for six months or more should be treated on par with substantive doctors unless there are reports of discrimination.
40. These should include records of learning, teaching, attendance and participation at medical meetings, grand rounds, lectures, courses, audit and logbooks of hands-on work.
41. References and assessments.
42. Appraisal of locums will be difficult as most "appraisers"' in the profession have little direct knowledge of locums or the particular doctor. Discussions will be needed between us for this.
43. Safeguards such as signing a declaration of interest or conflict of interest in the doctor must be included in the process. A standard form should be used. This is a must to protect locums from further abuse and blackmail.
44. Reports and surveys from nurses, other health professionals and the patients should be included.
45. Structured assessment forms should be used, which state the duration of direct contact with the locum.
46. Locums should provide a feedback assessment about their colleague in each post. This will give a balanced view about those doctors in turn.
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