Is the NHS getting the most out of its staff banks?

Using bank staff has helped many NHS staff reduce agency costs and ensure shifts are filled. Over the last few years many trusts have set up their own staff banks and had some success in using their own staff to cover gaps in rotas rather than paying high agency rates.

But relying on an organisation’s own staff to cover all of the available shifts may not give the best outcome.

An HSJ webinar, in association with Locum’s Nest, looked at the best way to organise staff banks to ensure the maximum number of shifts are covered by the most appropriate staff. In many areas, banks which draw on staff from across a wider footprint than just one trust are developed.

Natalie Nightingale, head of temporary staffing at University College Hospitals Foundation Trust, has been involved in setting up an integrated care system-wide bank in North Central London. “The first thing was to get the right people in the room,” she said. “It was identifying those people and getting them in the room to discuss the challenges.”

Support had been built within the organisations to enable the roll out of collaborative banks – and she said these were now the default position. Part of implementing a staff bank was working through the barriers together and finding common ground. “It’s a long and painful process but absolutely worth doing,” continued Ms Nightingale.

But it had been important to stress that there was no intention to disrupt existing relationships with suppliers, she added. It had taken two years but the ICS had now identified two staff groups – doctors and pharmacists - where collaborative banks were now being implemented.

Nuffield Trust researcher Lucina Rolewicz said that national data was limited but there was some evidence that the proportion of vacant shifts delivered by agency staff had declined over the last four years. While bank staff may be filling more of them, about 40 per cent still went unfilled.

“The predominant issue at the moment is whether the use of temporary staff at the current level is sustainable,” she said, adding there was an opportunity to move from agency staff to bank staff.

Dr Ahmed Shahrabani, co-founder of Locum’s Nest, said: “The biggest driver for vacant shifts out there is not due to poor rostering, it is due to simply a shortage of staff. We can’t create doctors and nurses overnight,” he said. One solution was international recruitment, but this has been affected by the pandemic.

Locum’s Nest had data from around 50 trusts which had set up these collaborative staff banks, he added. “When trusts collaborate, their staff not only help each other within the group of trusts within the collaboration, but the data shows that for one extra shift a doctor works collaboratively, they work an additional three at their own trust. We have seen bank fill rates go up to as much as 15 per cent as soon as trusts join a collaborative bank.”

There was still not enough staff in the NHS but working collaboratively could help, continued Dr Shahrabani. ICSs had helped with this and “super collaboratives” across more than one ICS could emerge - there was already one across Surrey, Hampshire and Gloucestershire.

But how can the NHS make the most of both substantive staff who signed up for banks and also those who decided they wanted to work flexibly, asked webinar chair Claire Read?

Ms Nightingale said that clinicians were in a vocation where they wanted to help people and banks offered them the chance to do this across multiple trusts. “By working together we are able to replicate what agencies offer,” she said.

“Both types of workers want the same thing,” said Dr Shahrabani. “They enjoy their work, they value flexibility and to us that does not just mean working less it means having a decent level of autonomy over how you work. Our job as NHS trusts and people working with the NHS is to make it as easy as possible for both those groups to do what they want to do. If we start to be overly controlling, it probably does not work very well.

“We do see a world in the future where everything is transparent, really putting the national back in the equation and all trusts working together. Once that happens the case for working with locum agencies is much more difficult. You have absolute workforce mobility at that point.”

But is there anything centrally which could be done to help? Ms Rolewicz suggested gathering data about the motivations of staff in doing bank work would be helpful – it could allow trusts to cater for their needs. Ms Nightingale said sharing of information – such as employment checks – would be very helpful and also more data in areas like pay rates.

Dr Shahrabani agreed with this but said there was no magic bullet. He said that the centre was increasingly picking up on best practice and exemplars and sharing information on these. “If we respect every trust as its own, respect ICSs as its own I think we will get there eventually. Slowly, slowly build the one NHS, one staff bank approach but we can’t get there overnight,” he said.

“This is where technology does help and you do need modern tech that is flexible in the way it works,” But you should not expect to reach perfection on day one – if you expected to start with harmonised pay rates and health and safety training, nothing would get up and running, he added.

But he said that the experience of Locum’s Nest covering hundreds of thousands of shifts showed small pay discrepancies did not matter: doctors did not move for higher rates of pay they worked for trusts which respected them, where they got decent levels of training and felt safe at work.

But how can the NHS ensure bank staff get the best possible experience? Ms Rolewicz said it was important to understand the motivations of agency staff to see how they could shift to bank and Ms Nightingale said the NHS needed to be prepared to be flexible to making changes and step away from “we have always done it like this.” She stressed no one was alone in making changes.

Interoperability of systems is key, said Dr Shahrabani: “We can’t get to one NHS. One staff bank without that happening,” he said. “The data belongs to the NHS. The tech suppliers need to understand that.”

And he ended by saying: “Grassroot innovation is just as powerful as topdown innovation. If you have an idea which can help, speak to someone in your organisation who can help. We have a 10 trust collaboration which started with the idea of two junior doctors.”

This webinar is now available on demand.

For those who had previously registered for the webinar, click here to view the on demand recording.

For those who have yet to register click here.