When Mid Essex Hospital Services NHS Trust wanted to identify savings on its use of locum and agency staff it asked Medacs Healthcare to help. We provided an onsite expert to provide a full managed service, exploring all areas of agency use and permanent recruitment for opportunities to cut costs. By the end of the second quarter we are on track to deliver savings of £2 million within the year.
Mid Essex Hospital Services NHS Trust provides a comprehensive range of acute and community based services. It hosts regional plastics, head and neck and upper gastrointestinal surgical services and a supra-regional burns service to a population of 9.8 million people.
The Trust employs more than 3,800 staff and provides services from five sites in and around Chelmsford, Maldon and Braintree, including Broomfield Hospital. It enjoys a strong clinical reputation and provides a wide range of services including A&E, emergency medicine and surgery, elective surgery in most specialties, and maternity and paediatric services.
No one would accuse Mid Essex Hospital Services NHS Trust of lacking ambition. Led by Malcolm Stamp, Chief Executive, the Trust wanted to respond decisively to the government's cost efficiency challenges.
Medacs Healthcare approached the Trust with a new managed service proposition underpinned with technology and onsite support that promised to deliver cost savings which would be measurable, sustainable and rapidly realised.
Following a careful procurement process, Medacs Healthcare was invited to run a pilot programme focused on locum doctors.
Medacs Healthcare had already conducted an informal audit of existing agency worker processes within the Trust as part of its proposal. This revealed a number of opportunities for improvement.
Critically, the Trust lacked the management information required to make informed decisions about its use of locum and agency staff. This stemmed from a system which was largely paper based and devolved to line managers, resulting in inconsistent processes and no real overview.
The use of off-framework agencies and a strictly limited number of specialist providers in various specialties meant the Trust was paying a premium for candidates who could otherwise be booked at lower, on-framework rates. In other areas, long term locums were in place on rates that had remained unchallenged for some time.
It became clear that a managed service could deliver significant savings for the Trust. The Medacs Healthcare team quickly established the systems, processes and infrastructure needed to make this happen.
A Medacs Healthcare Client Manager was embedded in the Trust to establish the service. Becoming part of the Trust team, our Client Manager reported directly into the Board. She was supported by an onsite Administrator to handle bookings.
The onsite team is available between 8am and 6pm on Monday to Friday. In between those times the Trust can access Medacs Healthcare's 24 x 7 out-of-hours team.
of dependable suppliers with an excellent compliance record and a willingness to negotiate rates. A shortlist of 15 agencies was selected, providing sufficient competition to keep rates affordable, whilst ensuring each agency would receive enough demand to make their participation worthwhile.
No one agency is given preferential treatment or early sight of roles, ensuring each has an equal opportunity to fill roles.
We integrated our exclusive vendor management software suite into the Trust to provide reliable management information for the Trust leadership. This information is presented to the Board on a regular basis, with analysis and interpretation.
We also introduced consolidated invoicing so the Trust could see with accuracy how much it was spending on agency staff across the organisation for the first time.
Inefficient rotas were being used in some departments, resulting in unnecessary expense. Our Client Manager redesigned the most inefficient rotas, building in study leave and annual leave in such a way that they no longer had to be covered by locum staff.
Medacs Healthcare has also been advising on the recruitment of permanent staff, often as an alternative to the long-term locums established in the Trust.
We have recruited seven A&E doctors, to replace the same number of locums, saving the Trust £625,000 per annum. Similar per head savings are being made in other specialties.
Medical locum cost per hour has reduced by 26% year on year.
Projected savings of £2 million for the year.
Demand for locum staff reduced through effective onsite management.
Reduced rates with all agencies.
Agency rates are now much more realistically levelled, so much so that it is currently even more cost effective for the Trust to use agency staff than its own staff bank.
The consolidated invoicing process alone reduced administrative demands on the HR team, enabling the department to focus on more value-added activity.
The Medacs Healthcare Client Manager is now seen as an important and integrated member of the Trust's HR leadership team. Now co-located with the medical staffing team, she regularly participates on interview panels and in board meetings.
We are in discussions about widening the scope of the support we provide. We have already introduced a tiered agency structure for nursing, negotiating rates which, based on the current demand, would save the Trust more than £13,000 each week.
This highly successful relationship has only been made possible by the incredibly supportive and open nature of the relationship between the Trust's board and Medacs Healthcare.
"I am always surprised by organisations that have been the subject of repetitive NHS turnaround, lack robust information and performance metrics.
I therefore wanted us to be ahead of the curve when it came to sustainable efficiency. If we were placed in a position where we had to play catch up it would be an unwelcome distraction from our main focus, which is delivering high quality patient care cost effectively.
Medacs Healthcare approached us with a compelling proposition and we gave them an opportunity to prove themselves.
With revalidation for doctors being introduced in late 2012, the NHS Revalidation Support Team was keen to ensure the processes and frameworks it proposed to use met the needs of all doctors. After a competitive tendering process Medacs Healthcare was selected to run the pilot for doctors who do not fall within traditional clinical governance systems. The project was delivered within budget and on time, meeting all the RST's objectives and receiving excellent feedback from the client and the participants.
The NHS Revalidation Support Team (RST), part of Guy's & St Thomas' NHS Foundation Trust, is a Department of Health funded body, which exists to support the implementation of revalidation.
The RST works in partnership with the Department of Health for England, the GMC and designated bodies, to deliver an effective system of revalidation for doctors in England.
With revalidation for doctors being introduced in late 2012, the NHS Revalidation Support Team was keen to ensure the processes, materials, including their model appraisal form, and frameworks it proposed to use met the needs of doctors from all backgrounds. After a competitive tendering process Medacs Healthcare was selected to run the pilot with locum doctors in England who do not fall within traditional clinical governance systems.
The RST immediately helped to create a supportive and collaborative relationship, setting clear goals and guidelines, and providing information and input rapidly.
A full-time project manager was assigned to the project from the start. She rapidly developed a project plan and monitoring system which was agreed with the RST.
We then recruited and trained 40 appraisers from our extensive database of locum doctors. A responsible officer was appointed for the project to oversee the whole process and provide feedback.
'Full-time' locum doctors on the Medacs database were given the opportunity to be appraised in the pilot. The offer proved to be very attractive and a group of 125 volunteers quickly established.
A dedicated administrator scheduled meetings between the appraiser and appraisees to ensure the process ran smoothly and effectively. Most appointments occurred at the weekend in Medacs Healthcare offices in London and Manchester, for the convenience of both parties.
At the end of each appraisal the participants were encouraged to provide their feedback on the materials and the process direct to the RST. The RST received a 100% response from Medacs Healthcare's pilot.
Throughout the pilot, the project manager provided regular updates and feedback to the RST, including a monthly steering group meeting which included representatives of several stakeholder groups. This meant the RST always felt reassured the project was on track and would meet their needs.
Medacs Healthcare took 125 locum doctors through the appraisal process – exceeding the target by 25%. We facilitated feedback on the locums experience to ensure the RST had a clear view of what worked well and what needed further development.
The project was delivered well within the deadline and on budget, receiving excellent feedback from our client.
In addition, the locum doctors and assessors who had been through the process found it to be a useful part of their development and preparation for the introduction of revalidation.
"We selected Medacs Healthcare to deliver this pilot following a competitive tendering exercise. They had a strong reputation in the locum industry and it was clear they had access to an extensive database of candidates and would be able to deliver the required number of appraisals.
Our contract required the completion of 100 appraisals. Medacs Healthcare surpassed our expectations by completing 125 appraisals – within the scope of the contract and well before the deadline.
We were on a very tight deadline for this pilot so it was important the project was delivered on time. Medacs Healthcare's project management was exceptional and the delivery of the project was smooth and painless. It's an exemplar of a well run pilot."