We need a patient-need led approach to doctor deployment

Suzanne Rankin profile picture

29 November 2019

Suzanne Rankin
Chief executive
Ashford and St. Peter's Hospitals NHS Foundation Trust


Ashford and St Peter’s Hospitals NHS Foundation Trust is the largest provider of acute hospital services to Surrey residents with services spanning across three hospitals. Our trust serves a population of 410,000, including Europe’s largest women’s prison. We have a turnover of £335m with an operating surplus in 2018/19. We have over 3,800 staff and a further 400 volunteers.

Deployment of doctors


Our hardworking staff attend to half a million patients a year with nearly 30,000 emergency admissions and 40,000 planned elective cases each year. However our trust - like the rest of the NHS - is facing rising patient demand and complexity. As all trust leaders will know, it is increasingly important to have the right workforce with the right skills in place to help deliver the best quality care to patients. However, there are multiple factors which need to be addressed in order to help recruit and retain NHS staff. One of these aspects is the historical way doctors, especially colleagues in foundation, core and specialist years are deployed, which can feel traditional in approach and not connected to patient need or levels of demand.

In the nursing workforce, acuity and dependency tools are used to describe how many nurses are needed on a ward or clinical area. Whilst this approach isn’t perfect it does have a logical and systematic approach - by comparison, the traditional model of doctor deployment is linked to a standard 9-5 working week, rotas and on-calls. Junior doctors on rotation sometimes seem to be allocated to organisations a bit randomly, or least I don’t understand the methodology and even in my own organisation at times seem distributed to wards and speciality areas in a rather haphazard way which can impact the quality of care for patients, the quality of learning and supervision for the doctors, nor indeed is an efficient use of scarce skilled practitioners and provides me with little assurance on the robustness of cover to the clinical areas.

We must be able to deploy our workforce in a transparent way, and coherent way to operate safely at all times and we want to empower medical colleagues (and indeed all colleagues) by giving them as much flexibility and control over the pattern of their work hours as possible.

Suzanne Rankin    Chief executive

That’s why I firmly believe we need to move towards a multi-factorial approach led by patient need in order to better determine the shape (skill-mix) and size of the medical workforce. We need to employ a much more sophisticated means of deployment based on patient need and skills, a model which in my view doesn’t really exist anywhere in the NHS as of yet. But I’m working with my colleagues and in particular my medical, nursing and HR directors on seeking options to resolve this issue for example, clinical area rotas based on clinical need drawn in near real-time from an electronic patient record and a platform based deployment tool to fill those rota and be able to redeploy as things change – we are on a mission!

We must be able to deploy our workforce in a transparent way, and coherent way to operate safely at all times and we want to empower medical colleagues (and indeed all colleagues) by giving them as much flexibility and control over the pattern of their work hours as possible.

At our trust, we are looking at ways to achieve this, such as through the annualisation of rotas. The medical director leads a medical scrutiny committee, which is supported by senior HR and clinical leaders, in order to better understand medical workforce utilisation, deployment and costs as well as to generate creative thinking about future models and opportunities that could work for us.

The Locum’s Nest app has greatly supported us as we move towards achieving our transparency and digitisation goals and has helped us better empower the medical workforce.

Suzanne Rankin    Chief executive

The Locum’s Nest app has greatly supported us as we move towards achieving our transparency and digitisation goals and has helped us better empower the medical workforce. It makes it easy for doctors to see and book bank shifts which enabled us to reduce our reliance on agencies filling shifts, and has also supported us to create a collaborative bank with other trusts. It’s been a great exemplar of digital enabled transformation.
 

 

The Digital Collaborative Bank


Our trust is a founding partner of the Digital Collaborative Bank which has transformed the way we are able to fill locum medical shifts. It has enabled doctors to work bank shifts across the collaborative without working via an agency.

As a trust chief executive, I’m not concerned that the use of Locum’s Nest will enable my colleagues to work in other NHS trusts. There is a perceived risk of “what if we lose our doctors” but if we are all honest with ourselves that risk already exists as doctors can work through agencies in other organisations. In this situation a lack of transparency could risk the health and wellbeing of the individual doctor through over-work or indeed the wellbeing of patients.

There is a big opportunity here for us working within the collaborative which far outweighs the risks. With its scale, the bigger it gets the better its efficiency and fill rate, and the transparent way of working it has helped us improve harmonisation of rates, switch agency shifts to bank and vastly improve shift fill rate and reduce costs. Doctors operating on the Locums Nest app are empowered to take control of their patterns of working as well as gain experience across a range of clinical settings. This collaboration has enabled my colleagues to meet the needs of patients and the team not only in our hospitals but also in hospitals and GP practices across the region and I’m proud of that and of being part of something that benefits the wider NHS.

If you’re not already using the collaborative bank, you should. Part of my role is to share my experience that collaboration of this kind is the way of the future and the benefits make it a must do. It’s in my interest as a trust leader for the collaborative to grow rapidly. The way I see it is that the bigger the group, the bigger the opportunity.

And the proof is in the numbers. As I have said we saw our bank fill rates increase significantly, from 18% to 83% in our first year of being part of the collaborative.

Suzanne Rankin    Chief executive

And the proof is in the numbers. As I have said we saw our bank fill rates increase significantly, from 18% to 83% in our first year of being part of the collaborative. We haven’t lost doctors to other trusts. In fact, it’s quite the opposite - all of the trusts in the collaborative have seen increases in bank fill.

The results have been promising but we know that a better approach in how the workforce is deployed is only one factor in tackling the workforce challenge. The upcoming NHS people plan will need to lay out proposals to help leaders in my role and others ensure we have the right people with the right skills in the right place to meet patient needs. The NHS can be and will be a great place to work for all and digital solutions will play an important part in making this a reality.

 

Locum’s Nest will be speaking at our chairs and chief executives network on 5 December in London alongside Hampshire Hospitals NHS Foundation Trust chief executive Alex Whitfield. To find out more about how you could join the digital staff bank collaborative or for more information on the app email contact@locumsnest.co.uk or visit locumsnest.co.uk

About the author

Suzanne Rankin profile picture

Suzanne Rankin
Chief executive

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