Key messages

• North Bristol NHS Trust recognises that ad-hoc agency usage does not present best value for money and in some cases does not offer the best quality of care for patients. With this in mind, they sought to tackle two interrelated problems:
  - a shortage of nurses on key wards and
  - the use of a high number of agency shifts particularly expensive off framework agency (OFA) with speciality services.
• The team implemented a higher bank shift pay rate to compete with OFA rates, known locally as bank 'break glass' rate. They wanted a solution that would meet their improvement priorities, be attractive to workers, be financially sustainable with the same robust level of control as OFA to maintain efficacy and could be adopted across their system partners.
• Within six months this led to a reduction in off framework shifts from 282 to 47 per month and reduced costs by £3.9m. It also led to improved patient care, staff satisfaction and a reduction in complaints about agency staff.
• The strategy was supported by unions and senior leaders with a collaboration between nursing, finance, and HR teams crucial to the initiative's success.
• Future plans include working within the South West provider collaboration to reduce use of agency, reducing the break glass rate in line with agency caps and expanding the strategy to other specialist areas like intensive care and mental health nursing.
  
  

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