Reducing agency spend at Croydon Health Services NHS Trust

Key benefits and outcomes

• A 99 per cent qualified nurse fill rate achieved in the emergency department (ED).
• Lowered reliance on agency staff to cover shifts.
• Improved roster efficiency and accuracy.
• Identified another workforce supply route through cost-effective agencies.
• Removed NHSE/I rate cap breaches within department.

What the organisation faced

An existing agency gave Croydon Health Services NHS Trust seven days’ notice of an increase in day rates for emergency nursing staff.  Accepting the rate increase would have meant breaching the NHSE/I rate cap (although this was inevitable during the agency notice period) but removing the agency altogether could have left the department urgently seeking staff with critical skills.

Meetings were held where the supply of agency staff was discussed and analysed, and the trust developed contingency plans to maintain safe staffing levels and high quality care for its patients.

What the organisation did

The human resources (HR) department embarked upon significant engagement with clinical colleagues, most notably the head of nursing for the emergency department, and worked in partnership with them to reset the department’s approach to rostering.

First, they pulled together a contingency plan which included financial modelling, a feasibility study and an assumptive model of converted agency staff to bank staff. The plan was presented to senior staff including the director of human resources and the chief operating officer to show mitigated risk and to gain board support for the proposal to give notice to the agency, while maintaining a safe and consistent supply of emergency nursing staff.

The trust then looked at rostering with the emergency department in forensic detail. It reviewed demand management, looked at patterns of rostering and where auto rostering would deliver the most efficient roster, and worked with managers to go through the policies and principles of rostering to ensure that flexible working commitments were balanced with providing patient care in the most efficient way possible.

After relooking at the basics of rostering, coupled with an assessment of the true demand for staff in the department, the trust discovered that demand had been inflated as more staff were typically requested than were needed. By accurately assessing demand the trust was able to paint a better picture of how many staff were needed to cover shifts.

The trust also assessed bank and agency fill rates to better understand which shifts were most typically filled by agency staff.

To prioritise bank staff and therefore reduce the reliance on agency staff, the trust used the NHS Professionals bank agency ‘bumping’ model – an automated system capability set up by NHS Professionals where bank staff are able to book shifts provisionally allocated to agency staff to ensure a more cost-effective staffing model. This resulted in savings of over £28,000 between 1 February and 31 March 2021. Twice weekly text alerts were issued to all bank staff detailing available shifts to further increase awareness of available shifts.

The trust aims to provide all temporary staff, as with substantive staff, a positive experience of working for the organisation. Agency staff are invited to training events in ED and the head of nursing hosts breakfast meetings to address the combined workforce, helping to foster a team spirit among substantive and agency staff, and to show agency staff they are valued.

The trust regularly profiles the benefits of working for the organisation and is clear that the best way to guarantee shifts is by joining the substantive workforce, to encourage agency staff to move into bank or substantive roles. It also hosts regular open days with NHS Professionals to promote the opportunities of working via the bank.

To build on this work, the trust is now planning to survey agency staff to understand what motivates them to work at Croydon over other trusts, to identify key motivators.

Results and benefits

Since delivering the project, the trust has achieved a 99 per cent fill rate within the emergency department, reduced its demand for temporary staff and has worked to prioritise opportunities for bank and substantive nursing colleagues.

The trust has also identified a further workforce supply route and has successfully recruited a small number of agency staff into bank and substantive roles.

Overcoming obstacles

The development of a contingency plan and engagement with clinical colleagues was key to ensuring board support for the plan. The role of senior colleagues was key in an education piece that successfully outlined the importance of the work and how it was better for patient safety. Removing any source of supply carries a risk as there are no guarantees it can be replaced, the trust accounted for this risk through multiple contingencies and the assurances given by the head of nursing.

Agency supply pre and post the removal of the agency in question:

After notice was given to the trust in January 2021 by the agency, the trust gave notice to the agency and it stopped supplying staff in March 2021.

Top tips

• A comprehensive contingency plan that addressed risk was key in gaining senior approval and board support for the plan.
• By working closely with managers in the department, the trust ensured the basics of rostering were implemented effectively and flexible working commitments were balanced with providing patient care in the most efficient way possible.
• Reassessing demand management was key to understanding the true number of staff needed to fill shifts.
• Ensuring agency staff have a positive experience of work can act as an incentive for them to join the organisation in a bank or substantive role.

Further information

For more information about the work in this case study, contact Jo Boxall, head of workforce transformation, Croydon Health Services NHS Trust: jboxall1@nhs.net