09 / 11 / 2012 2.32pm
The information collected through the mechanisms outlined in stage one of the process can be used to help reduce demand for locums and reduce the cost of locums that are used. There are a number of steps that organisations can take to reduce demand for locums, which can often result in an improvement in the quality of services offered to patients.
Most of these initiatives are based around ensuring that the substantive medical staff employed by the trust are utilised as efficiently and effectively as possible through co-ordinated, detailed and service-focussed approach to workforce planning.
Implement robust workforce planning mechanisms
Many of the principles surrounding medical workforce planning are consistent with those for other staff groups (for example ensuring that rotas are based on service need and making sure you have the best shift systems in place).
Key considerations for NHS trusts in medical workforce planning should include:
- succession planning
- ensuring doctors time is used most effectively (and whether the skill mix within the department is correct)
- considering other ways of working
- reducing the length of the recruitment procedure.
Implement robust policies, procedures and controls on the booking of locums
By having a robust set of policies and procedures around both use of substantive staff and the booking of locums, organisations are often able to both reduce demand and unit cost. Key principles organisations should consider the following:
- ensure each department has controls over how many medical staff (of each grade) can be absent from work on planned leave at any given time. This should be linked to how busy the department is (for example, a ward facing chronic winter pressures should not allow medical staff to take significant chunks of annual leave during periods of high demand) and include all types of planned leave, not simply annual leave. Read more.
- before booking a doctor for a temporary shift (be this a locum or a trust employed/ junior doctor working extra hours), a rationale for the booking must be identified rather than simply booking a locum by default each time a doctor is absent. This should include conducting a risk assessment of the implications of not covering a vacant shift and reasons why it was not possible to cover the shift using existing resources.
- all bookings of temporary medical staff must go through a single point (such as a team of rota co-ordinators or medical staffing department). The benefits of doing this are numerous and include the following.
- the process allows detailed management information to be compiled, aiding workforce planning in the future
- by centralising the booking process consistency of policy application is ensured
- complete visibility of the workforce allows alternatives to booking a locum to be explored
- by using specialist members of staff the most cost effective options can be utilised
- one point of booking helps to ensure that invoicing procedures are followed and payments made are accurate
- by booking centrally, trusts may be able to work with suppliers to achieve economies of scale and reduce unit cost
- by linking with a trust’s nurse bank, further discounts with agencies supplying both medical and nursing staff may be achieved.
One simple way of ensuring that the use of a medical locum is essential before booking is to apply the same rigorous vacancy control procedures to each locum booking as the trust would if hiring someone in a substantive position. This may include ensuring sign off for all locum bookings from a director or senior manager and as a part of the locum booking form asking those requesting locums to outline the risk of not booking a locum.
From a systems perspective, it is vital to ensure that there are sufficient forums for challenge put in place, and on occasions this may mean taking responsibility for procuring locums away from medical staff (which in itself may create a number of cultural challenges – see below) and offering a greater deal of autonomy to medical staffing departments and rota co-ordinators.
Establish a control point for locum bookings
North Lincolnshire and Goole Hospitals appointed a number of ‘roster administrators’ who take sole responsibility for ensuring doctors rosters are aligned with activity and then when the need for a locum arises ensuring that they secure a doctor that represents the best value for money. This delivered the following benefits.
- valuable management information collected around when locum doctors are used and required – aiding future workforce planning
- doctors’ time freed up to perform clinical duties rather than compiling rotas (further reducing the demand for locum cover)
- by centralising the locum procurement process, economies of scale can be sought from suppliers leading to a reduction in unit price. When taking a collaborative approach and working with other NHS organisations, these 'bulk discounts' can be multiplied further
- by having complete visibility over the workforce and activity of a department, co-ordinators are able to explore alternative options to procuring a locum
- long-term planning can become easier, meaning all planned leave taken by substantive medical staff can be fully co-ordinated, meaning locums should (in theory) only be used in exceptional circumstances.
Next page: Reducing the cost of medical locums