How agency direct employment could save NHS Scotland more than just a pretty penny by also recruiting and retaining temporary staff workers.

5 December 2018

This week, analysis released by BMA Scotland said the shortage of consultants in Scotland’s NHS is twice as bad as official figures indicate because hundreds of vacancies are not recorded.  The body warned that the vacancy rate is higher than official figures and is more likely to be 13.9 per cent, the equivalent of around one in seven posts lying empty. The difference is the equivalent of 375 full-time consultants, enough to staff a large hospital.

Last month, Audit Scotland called for improved strategic workforce planning in a report that cites good strategic planning as key to integrating and improving health and social care services. The report also refers to Integration Authorities (IAs) identifying as not being able to recruit and retain the workforce they need as a risk. This is on top of concerns raised over the potential delay of a health and social care workforce plan in Scotland.

With more than 8 years of workforce experience within the NHS, we’re pleased to see Audit Scotland’s rallying cry for better workforce planning. The concept of agency direct employment for temporary staffing in the NHS is not new but it is new to some of Scotland’s Health Boards.  We’ve been working with one Health Board, NHS Shetland, to introduce our TempRE workforce service not only to realise cost savings, but also to drive efficiencies across the Health Board’s vast geographical spread.

NHS Shetland needed to quickly develop a temporary workforce engagement platform to widen the pool of locums and achieve greater visibility and control. The Health Board also needed support in workforce planning to plug gaps in the rota by attracting and engaging locums to some of its more remote posts. Another requirement mandatory to Scottish Health Boards was ensuring that NHS Shetland complied with all applicable Scottish regulations and compliance requirements, covering National Services Scotland Framework, Employment Law and treatment of VAT.

So, we delivered a large-scale education and training programme around agency direct employment with both the finance and the HR and staffing teams across the Health Board’s dispersed hospitals and patient centres. It was also important that we worked with agencies and developed a simple sign up process for locums to convert to agency direct employment.

During the pilot project the health board received zero complaints from agency direct employed locums with 100 per cent conversion. One medical worker who switched to agency direct employment with NHS Shetland has seen an improvement in pay, shifts booked and tax support since using TempRE – proving the service to be a great retention tool.

The Health Board is now engaging the workforce by using better information and systems to drive down costs and seek further opportunities for savings via efficiencies and streamlining. Given the size and spread of its workforce pool, TempRE is allowing the Health Board much greater self-sufficiency.

NHS Shetland made savings of £175,488 in the first eight months and a rise in substantive banks as locums filled these roles. In Summer 2018 a 100 per cent locum worker conversion to agency direct employment saw NHS Shetland filling all junior doctor posts and fully staffing two health centres – reducing the need for agency worker supplier reliance. Today, AHPs and locums are also agency direct employed.

We estimate that an agency direct employment model, if used across the whole of the NHS Scotland, could produce over £9 million of efficiency savings per year. This sum is equivalent to about 200 nursing posts and is based on savings across temporary staff, including locums, AHPs, and administration and assumes a spend of £108m (£90m plus VAT) on agency staff.

We see agency direct employment as the first step to getting a tighter grip on workforce efficiencies, then a focus on growing a medical bank to assist Health Boards with rota gap planning and staff retention.

But the bigger prize is the drive for potentially growing a collaborative bank across NHS Scotland – sharing locum resources across regions and specialities.  This pioneering approach has seen us deliver a collaborative bank of 840 junior doctors across 41 specialties with eight trusts collaborating (with more about to join) in the North East of England.

As Liaison Workforce’s first TempRE client in Scotland, NHS Shetland’s six-month pilot of the agency direct employment workforce service acted as proof of concept for Scottish Health Boards and one we think Audit Scotland and other Scottish NHS organisations would be interested in.

If you’d like to find out more you can access the case study here or contact me directly on 07900 741295.

Robert Little
Regional Account Director

Liaison Workforce