How workforce technology is enabling 'Waiting List Initiative' for North Middlesex University Hospital NHS Trust

Dr Ahmed Shahrabani,
Co-Founder

The number of people on a hospital waiting list in England has hit six million for the first time. About one in twenty of those has been waiting - for routine care such as knee and hip surgery - for more than a year. Naturally, such figures have heightened the need for health and care organisations to address their care backlog even more efficiently, safely, and rapidly than ever before. The elective recovery plan, set out stretching targets to bear down on backlog. One way of doing this is through Waiting Lists Initiatives (WLIs) which are used by NHS Trusts to tackle waiting lists and to meet government targets. They are extra clinics in hospitals at nights and at weekends and NHS patients can also be referred to private providers.

NHS England announced a £160 million funding plan to tackle waiting lists at accelerator sites in May 2021. Although the project was focused on a dozen areas and five specialist children’s hospitals, this agile response has delivered a significant number of planned operations and procedures.

Amanda Pritchard, NHS England and NHS Improvement chief executive, said:

“Treating around 400,000 COVID patients over the past year has inevitably had a knock-on effect on non-urgent care, but our incredible staff still managed to perform more than two million operations and other treatments in the first two months of this year when the hospitals were at their busiest with COVID patients. With COVID cases in hospitals now significantly reducing thanks to the extraordinary success of the NHS vaccination programme, our focus is now on rapidly recovering routine services.”

The North Central London Integrated Care System (NCL ICS) has been chosen by NHS England to become one of 13 ICSs to become an ‘elective accelerator system’. As part of the NCL ICS, North Middlesex University Hospital NHS Trust took up the challenge and drew up plans to work collaboratively, making optimal use of resources in order to: reduce waiting lists, improve patient experience and use the funding to create additional capacity, including extended service hours, WLIs and using the independent sector.

North Middlesex University Hospital NHS Trust has been using Locum’s Nest workforce solutions since June 2018 to advertise their vacant bank shifts, grow their staff bank and reduce their agency spend. By using an innovative and intuitive digital platform, the Trust has benefited from drastically increased shift fill rates (number of vacant shifts covered by clinicians), consistently over 80% and a large engaged temporary medical workforce who are keen to fill gaps where required.

Even though WLIs are not bank shifts per se, we realised that the same principle could be applied to create one electronic gateway for all additional sessions done by substantive staff. As Locum’s Nest was already used Trust-wide and supported the organisation to transition from paper-based process to e-timesheets - ensuring Executive oversight, clinical accountability, and robust approval process, we identified that the most important benefits would be the ability for the Trust to process weekly payments to doctors and minimise the administration burden.

In less than 6 months, our cloud-based solution enabled nearly 4,200 hours of patient care to be delivered, which represents over 700 consultant shifts – half of which were done by surgical specialties.

It is worth noting that a portion of the doctors who applied and worked WLIs shifts for North Middlesex University Hospital Trust were also covering bank shifts in neighbouring Trusts such as Epsom & St Helier University Hospital NHS Trust, Barnet Enfield & Haringey Mental Health NHS Trust and Mid and South Essex NHS Foundation Trust. This is a real testimony to the willingness of NHS clinicians to work flexibly and collaboratively with other Trusts. Indeed, one important contributing factor to the success we’ve seen at North Middlesex University Hospital NHS Trust is the trust’s membership in The Digital Collaborative Bank (DCB) – the largest workforce coalition of NHS trusts in the country spanning across four ICSs since August 2019.

As a member of the DCB, the Trust can directly plug its workforce gaps from nine large acute NHS trusts across all grades and specialties. The DCB now has over 6,000 HR-compliant clinicians ready to cover thousands of shifts each month, positively contributing to continuity of patient care and saving millions on agency costs. For North Middlesex, joining the DCB meant:

• A sharp increase in the trust staff bank, which has more than doubled

• A significant impact on shift fill rate, which jumped from 48% to 78% in the first month they joined.

Each NHS trust which is part of the DCB has saved £3-4m in agency costs. By working openly and collaboratively, the group's fill rate was consistently 5-10% higher than the average trust working independently, reaching a record-breaking 91% shift fill rate across all trusts at the height of the pandemic.

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To find out how your organisation can benefit from Locum’s Nest workforce solutions, get in touch with Dr Ahmed Shahrabani at ahmed@locumsnest.co.uk.

*this blog post was first published on NHS Providers Winter Watch 2021/22