Locums are afraid to speak out about problems at work or raise concerns about patient safety for fear of losing bookings, industry insiders have told C+D.

The competitive jobs market had forced locums to "just get on with it" over fears that one incident of negative feedback could result in a loss of employment, locum groups and agencies reported. And locums had been left feeling "let down" and "demoralised" because of employers who were able to "pick and choose" more than ever before, they said.

There was a "widespread" problem of locums being forced to compromise their professionalism, said Lindsey Gilpin, founder of forum Locum Voice. "People are worried about their jobs and if you query or say anything is wrong, you're not invited back," she told C+D. "You've got to be one of those people who just gets on with it."

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	"Sometimes it's a matter of safety and it's seen as being awkward, not, ‘I'm glad you brought that to our attention'," Ms Gilpin added. "Jobs are getting harder to get, so it makes people less inclined to raise the sort of issues they should raise."

The competitive environment had seen the growth of a "negative feedback culture" in community pharmacy, causing locums to feel "very isolated", said a practising locum who wished to remain anonymous. "The [feedback] is heavy handed – they talk about things like presentation and don't focus on all the hard work you've done," he told C+D.

"Occasionally you get managers who don't speak to you properly nor treat you like a respected healthcare professional, but more like a commodity," he said, arguing some pharmacies were only concerned with meeting targets.

The fear of losing bookings had seen a rise in locums looking for permanent employment, said income protection insurer PG Mutual. The company reported a 96 per cent increase in enquiries about income protection this year, as locums felt increasingly insecure over their job prospects.

"The feedback would indicate a lot of locums are... not feeling as confident with regard to work on a regular basis, and they're being enticed into working as an employee," PG Mutual chief executive Mike Perry told C+D.

Locum recruitment agency PL-UK said the market had moved away from being "locum-led" to employers being able to "pick and choose". "If we [PL-UK] do receive negative feedback we try to find out what's happened... but quite often clients will say we don't want that locum, and that's potentially after one experience," managing director Shaun Hockey said.

"I would hope there aren't companies out there who get negative feedback and write them off completely as, if that's a large company, then you're in trouble."

Last month, a locum was suspended for making "vindictive" calls to a pharmacy supervisor after a negative feedback form saw him taken off the pharmacy's list.