09 / 11 / 2012 11.14am
In seeking to understand the issue, it is first of all important for trusts to fully appreciate the reasons that they are using locums in the first place. As doctors are both an expensive and valuable resource, it is vital to ensure that they are used as effectively as possible. To do this trusts need to understand when they are using their substantive medical workforce and which clinical activities, they are performing. Trusts should only then consider how the temporary medical workforce is used around them.
Lack of accurate management information can mean that undertaking an effective review of the link between substantive and temporary staffing can be difficult however, there are a number of systems available that can help.
There are a number of approaches that trusts can use to diagnose spend on medical locums, however key principals to consider are outlined on this webpage.
Map service activity
Developing a robust rota that is effectively aligned with clinical activity is vital when dealing with valuable resources such as doctors. To assess whether or not a trust is utilising this valuable resource as effectively as possible, it is important to be able to map activity. Once the department or organisation has a clear picture of when the peaks and troughs fall, they can plan the workforce based on evidenced need. This may seem incredibly basic but it is essential that trusts take this clinical activity management based approach to help reduce demand for locums. Most NHS trusts have access to this data through their performance and informatics departments.
Develop and monitor a rota
E-Rostering can help trusts to make the best possible use of the substantive workforce and this is extremely important when dealing with a valuable resource such as medical staff. NHS Employers e-Rostering guidance shows however, that benefits to workforce utilisation are reliant on action taken using management information provided by e-Rostering systems. Simple things like having visibility of when doctors are requesting leave and ensuring that locum doctors are not used to cover for any kind of planned leave can help, as can ensuring doctors planned activities are mapped in a way that effectively aligns them with activity.
The quality of information available to trusts when looking at the medical workforce has historically been quite poor and therefore identifying ways to make better use of the workforce can be difficult. When developing rotas it is important to remember the importance of rostering for a service and not for individual professions, taking account of the full range of knowledge and skills working on any given shift.
As well as specialised 'time and attendance' systems that can be implemented for doctors, there are cost effective options available to trusts to help roster and monitor medical staff including the Electronic Staff Record.
Implement a robust invoicing procedure and report regularly
Often trusts find it difficult to assess what they have spent on agency staff across different staff groups and specialities due to the way that expenditure is recorded and the devolved authorisation processes that exist. This information is vital to assess whether invoices received are an accurate representation of the work a locum doctor has done and to illustrate where high cost areas may exist.
There are a number of ways that this management information can be gathered, but the most common (and often most effective) is through using e-Billing (or e-Invoicing) programmes. These can be linked to e-Rostering software to offer complete visibility over exactly how much is being paid for shifts and can be used as a diagnostic tool to identify areas of high expenditure.
Manual systems can be used but this can prove problematic due to the devolved way that medical locums are often procured (with individual consultants often responsible for ordering locums in their departments). To draw out meaningful information (and to ensure consistency) it is advisable to have a central point for booking where possible.
Establish a minimum data set
To undertake an effective 'diagnosis' of agency spend, it is important to identify what needs to be measured and what data will be used. The list of data sets below is far from comprehensive, but serves as a good starting point in terms of what organisations should measure (and assess).
- Number and grade of locums engaged
- Reasons for the need to appoint a locum
- Locum recruitment source (internal, external or agency)
- Cost incurred
- Completion of performance review forms
- Unauthorised locum expenditure incurred
As well as providing a valuable source of data when diagnosing agency use, a scorecard based around these factors can also be used as a performance management tool for the booking of all temporary staff, not just medical locums.
In addition to this data, it can also be helpful to ask the finance department to run a report, detailing spend and average cost per shift across all the agencies the trust has used. This can identify the poorest performing agencies in terms of value and allow steps to be taken to avoid using them in future unless they reduce prices.
Consider the outsourcing of diagnostics
The 'diagnosing' of medical locum usage and expenditure is a potentially complex area, primarily due to the poor quantity and quality of data available to NHS organisations. There are a number of organisations (usually involved in either the provision of medical locums or the provision of e-Rostering solutions) that are able to undertake this work on behalf of NHS trusts.
Next webpage: Reducing demand for medical locums