Agency usage in general medicine removed
45% increase in bank hours delivered
£1.9m annual reduction in agency expenditure
£1.2m annual savings achieved through Direct Engagement
70% reduction in the number of agency locums
The Situation
In June 2023, South Tyneside and Sunderland NHS Foundation Trust (STSFT), like all NHS Trusts, was facing a challenge when it came to recruiting and retaining Trust doctors within a very competitive market. This had resulted in a sharp increase in the use of bank and agency doctors to ensure safe staffing levels were maintained.
In the summer of 2023, NHS Professionals (NHSP) and Doctors Direct put forward a proposal to reduce the reliance on commercial agencies, to enable a decrease in cost, whilst maintaining sustainable and equitable rates of pay.
The Solution
NHSP undertook a 'deep-dive' into the Trust’s agency and accounts payable data and produced a paper with recommended actions to reduce the agency medical locum bill by over 15%.
Areas of focus included a review of long-standing agency locums, typical agency commissions, agency terms and conditions and 'reasons for hire'. This allowed us to determine the minimum, average and maximum pay and charge rates applied per directorate.
Following our analysis, an agency reduction proposal was produced detailing a suggested approach and potential savings. We recommended a phased plan, which included:
Phase one
- Capping agency commission charges (especially for long-term bookings)
- The introduction of a structured, specialty and sub-specialty specific agency cascade, with appropriate tiers based on cost and ability to fill
- Increase Direct Engagement uptake from 85% to over 90%
Phase two
- Migration of long-standing agency workers
- Capping rates by specialty and grade
"It has been amazing to work the Client Services Team from NHS Professionals, who took the time to understand our Trust doctor requirements in Medicine. They worked quickly and collaboratively to ensure a strong pipeline of Bank doctors to replace all our Medicine agency bookings. The engagement of these doctors at an early stage was critical to this success. Communications between all parties allowed us to achieve 100% Bank by 1st November 2023. They delivered the plan enthusiastically and with drive and passion to ensure all stages of the process were in place. It really was a team effort. We look forward to the next phase of our local plan."
Angela Wilkinson, Medical & Dental Rostering Manager, South Tyneside and Sunderland NHS Foundation Trust
The Results
The initiative to reduce agency doctors and replace them with doctors from the Bank has improved continuity of care and led to STSFT having enough Bank resource to completely eradicate agency doctors’ bookings in some areas.
Thanks to the success of this initiative, we have also experienced a substantial rise in applications from agency workers seeking to migrate to the Bank. We introduced capped commissions, saving of over £4000 per month immediately and re-structured the agency cascade, so agencies had far less visibility of shifts, resulting in 28 long-standing locums migrating to the Bank.
Other key achievements included:
- 0% agency usage in General Medicine in October 2023
- £1.2m annual savings have been achieved through Direct Engagement
- 45% increase in bank hours delivered in 12 months
- 70% reduction in the number of agency locums between FY 22/23 and 23/24
- £1.9m annual reduction in agency expenditure in FY 23/24