How cleverly structured staff banks can improve staff morale and strengthen the psychological contract between the employee and the employer

Dr Nicholas Andreou profile picture

13 October 2020

Dr Nicholas Andreou
Co-founder, Locum's Nest

This year's World Mental Health Day got us thinking about the unwritten set of expectations within the employment relationship when using staff banks.

There are two predominant schools of thought around the design of medical staff banks. On the one end of the spectrum you have the open bank, where shifts are broadcast to the wider medical community, with established mechanisms to quickly and safely recruit appropriate staff to cover the shift - in other words casting a wide net. On the other hand, is the closed bank - one with a small, distinct and very controlled group of contingent workers who are the sole audience of available shifts.

These ring-fenced, protected staff banks can negatively affect staff mental health as they can make staff feel an obligation to cover shifts they may not want to or agree to additional hours that may be unsafe. This is because they feel a responsibility to their organisation that goes beyond their employment contract.

This is called the psychological contract. This is an unwritten set of expectations within the employment relationship as distinct from the formal, codified employment contract. Taken together, the psychological contract and the employment contract define the employer-employee relationship. As a result of the relationships they have with colleagues and staffing managers, sometimes these relationships can be exploited and pressure placed on the staff member to cover the vacant shift. This can then lead to demotivation, burn-outs and, in time, the staff members may seek employment elsewhere to meet their work life balance requirements.

Perceived breaches of the psychological contract can severely damage the relationship between employer and employee, leading to disengagement and reduced productivity. Fairness is a significant part of the psychological contract, bound up in equity theory. In other words, employees need to perceive that they're being treated fairly to sustain a healthy relationship with their employer.

Often with the open bank approach and by speaking to staff members, many organisations report that there is less pressure on them to fill vacancies which can increase the connection they have with their primary employer.

We noticed this trend on our Locum's Nest app. Organisations who join a collaborative bank see their own staff members increase their booking numbers within their parent organisation. Beyond the advantage of economies of scale, a reduction in perceived pressure placed on staff to fill vacancies places a greater power on the staff member to take ownership of their work-life balance and apply for the shifts they want to cover, not what they feel they have to cover. This has the desirable outcome of skyrocketing fill rates of vacancies across organisations.

Open bank approaches, appear to create a greater level of engagement with existing bank staff. It could be that this is due to less pressure being placed on staff to fill service gaps. Staff may feel more empowered to decide which shifts they want to fill as they know there will likely be other candidates available via a larger resource pool. This also reinforces the psychological contract between employer and employee and will ideally lead to a more content workforce, who have the flexibility to decide their individual work-life balance commitments, continue to add value to their organisation and others, and above all, will seek to increase retention and recruitment leading to a more sustainable workforce for the foreseeable future.


We work with Locum's Nest as part of NHS Providers Connect. Locum's Nest is the staff bank management web and mobile app that connects healthcare professionals to temporary work in NHS organisations, cutting out the need for agencies.

About the author

Dr Nicholas Andreou profile picture

Dr Nicholas Andreou
Co-founder, Locum's Nest

Dr Nicholas Andreou is a qualified doctor previously working at St George's University Hospital in Tooting. He graduated from Imperial College London in 2014 before accepting his first medical post at St. Helier Hospital, London where he met his colleague and now co-founder, Ahmed. Ahmed and Nick stood back from frontline medicine in 2016 to start Locum’s Nest. Carrying across the deeply rooted values of transparency, honesty and a focus on patient care they embarked on a mission to solve the NHS staffing crisis by empowering clinicians and NHS staff alike through collaborative and flexible working.

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