High impact action 2: Manage the process and take control

Nurses talking

09 / 9 / 2011 1.30pm

As a first step you should review your internal processes relating to agency booking to identify what systems and controls are in place.

As well as examining any policies and procedures that may govern the use of temporary staff, it is important to identify how these are controlled and implemented and, where they are not followed, the reasons why.

As can be seen from the case studies and from the specific actions below, there are a number of options available in order to assist you in tightening internal governance such as increasing the level of authority required for booking external agency or ensuring that all bank and agency shifts are booked through a central point.

Measures such as these can allow you to identify whether or not there is a more cost effective (and potentially higher quality) option to using external agency staff, such as moving staff between departments to cover or using the internal bank rather than an agency.

There are however, occasions when recruiting external agency staff is necessary. It is therefore essential to implement robust booking procedures and ensure that trusts follow the NHS Improvement agency rules when engaging recruitment agencies. There are a number of ways in which you can effectively manage the process and take control.

Establish rules within the organisation that mean a certain level of sign off is required for the booking of bank or agency staff

By requiring a certain level of authorisation for the requisition of bank and agency staff, NHS trusts can both improve the amount of control they have over the booking of temporary staff, as well as increasing the level of accountability within the organisation. 

In organisations where effective e-booking systems are in place, this process can be streamlined by using electronic authorisation, meaning that the requests can be submitted to someone with the required level of authority for them to approve. One of the benefits of requiring sign off from a relatively senior level, is the level of oversight that can be given to requests and whether cover arrangements can be agreed from within existing substantive staffing pools or staff banks.

Where appropriate, try and centralise the responsibility for booking temporary staff

By centralising booking responsibility for agency staff, NHS organisations can increase the amount of control they have over the billing procedure (as a central requisitioning point should lead to a more effective invoicing system) and it can also lead to a more cost effective method of requisitioning agency staff.

By shifting responsibility for all bookings to a single point, trusts may be able to achieve significant economies of scale, and also ensure that temporary staff are being booked from the most cost effective agency.

Ensure that billing mechanisms are effective and give you full visibility of what you are paying for

There are a number of options available to organisations to ensure that their billing and invoicing procedures for agency staffing are as robust as possible.

These include:

  • ensuring that all invoices received are validated
  • exploring the possibility of agency self billing
  • reporting non compliant agencies when using a framework agency
  • cross checking invoices received with temporary staff used (this can be much more effective when the booking of temporary staff is centralised).

Further details from NHS trusts who have put the five high impact actions into practice can be found in our five high impact case studies.

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