E-rostering: the time is now

E-rostering has long been seen as a useful tool to ensure the optimum use of NHS staff in the delivery of healthcare, while supporting flexible working and minimising temporary staff costs. But the long-term plan has finally put a deadline – 2021 – by which time all clinical staff should be being deployed using an electronic roster or e-job plan.

This has been a long-time coming. The National Audit Office first called on trusts to explore the use of e-rostering systems in its Improving the use of temporary nursing staff in NHS acute and foundation trusts report in 2006. And encouragement to do more and better in this area has been pretty regular since then. In his work on productivity in acute trusts, Lord Carter said there was still significant variation in the use of digital systems such as e-rostering.

E-rostering and job planning technology allows trusts to improve their advance planning of their workforce, improving leave and rota management, and can also support daily decision-making about staff deployment to meet patient demand, while minimising the need for additional temporary staffing.

But Lord Carter found that even where trusts had invested in the technology, many ‘were not getting full meaningful use of it’. The message was the same when he turned his attention to mental health and community providers – make better use of e-rostering.

In response to the Carter recommendations, NHS Improvement last year updated its nursing e-rostering good practice guidance and unveiled a new system for trusts to measure their progress in adopting e-rostering software. These five ‘levels of attainment’ – stretching from level 0 (no attainment) to level 4 (organisational e-rostering) – are underpinned by meaningful use standards describing the processes and systems trusts need to meet each level of attainment.

NHS Improvement’s initial survey to assess e-rostering usage across acute and community trusts reinforced the Carter findings. It found 43% of trusts at attainment level 0 with just 59% of the clinical workforce deployed via an e-rostering system. It concluded there was a ‘significant opportunity to improve’.

This overall gloomy snapshot may reflect the fact that most trusts initially focused on their nurse staffing in taking forward e-rostering and are only more recently applying the same approach to their medical and allied health professional workforces. Level 1 requires at least 90% of clinical employees to be registered on an e-roster.

Simon Courage is director of product management at Allocate, which says 200 NHS bodies use its HealthRoster system for nurse staffing. ‘There is a huge variety from a staff group perspective,’ he says. ‘A huge amount of trusts are at a level 3 or 4 for nursing, but a level 0 or 1 for medics.’

In fact, he suggests there have been some great success stories in moving much of the nursing community onto e-rostering from a more or less standing start 12 years ago. This progress has seen rostering move beyond the electronic timetabling of nurses onto shifts and into areas such as ensuring safe staffing levels and supporting the flexing of staffing levels in real-time.

This was accelerated by the Francis report on failures in care at Mid-Staffordshire NHS Foundation Trust, which led to the development of guidance and tools to help trusts ensure there were enough staff to deliver safe care on a day-to-day basis, taking account of patient acuity. Mr Courage estimates that 70% of Allocate’s customers now also use its SafeCare rostering module, which enables trusts to take acuity into account when setting, monitoring and managing staff levels.

According to Mr Courage, this live managing of demand and staff capacity effectively equates to level 3 on the attainment scale and by level 4, e-rostering should be fully embedded across the organisation. This means having board-level accountability and using data from the rostering system to inform each department’s budget.

Staffing is recognised as one of the major challenges facing the NHS in the recent long-term plan. Significant new recruits are needed over the long-term to ensure the service can meet projected demand in a sustainable way. But in the short run, the NHS also needs to ensure it can retain its existing workforce and use this workforce in the most effective and efficient way to meet patient needs.

‘While investment is clearly needed to bolster staff numbers, employers accept there is more to do to make sure the talents of the people and teams who make up the NHS are properly utilised and retained,’ says Danny Mortimer, chief executive of NHS Employers, which last year collaborated on work to promote the uptake of e-rostering (see www.beyondtheroster.co.uk). Others have called for greater flexibility and predictability of working patterns to address high levels of staff turnover – both of which can be improved by the use of e-rostering.

If many providers are well along the road with rostering for their acute nursing workforce, Mr Courage says community nursing presents different challenges, particularly where nurses are making home visits. Sophisticated use of e-rostering software can help acute trusts to match staffing levels to demand, taking account of patient need and acuity.

Community considerations

‘In the community, you also have to consider what visits you have to make and who is being sent out,’ he says. ‘That’s a very different problem and it is only just starting to be solved.’ Scheduling solutions can help providers to optimise this – ensuring that, if a patient needs an insulin injection, you don’t send someone out who is not able to administer it.

Medical staff and AHPs are arguably the main focus right now for many providers in improving their use of rostering and other workforce software. The environment has changed from five years ago, when rostering for doctors was simply not talked about, to today where it is widely recognised as providing benefits for patients, staff and employers. The BMA is now a key proponent of its use to ensure junior doctors work compliant shifts, and has even produced rostering guidance.

The medical community can be looked at in terms of the consultant workforce and junior doctors. For consultants, there is an important first step in ensuring all consultants have an e-job plan, setting out the direct clinical care, on-call work and supporting professional activities that each consultant agrees to undertake.

A number of organisations have set out with intentions to move consultants onto an e-rostering solution, only to realise that existing job plans did not reflect what consultants were doing closely enough. 

For junior doctors, many trusts have focused on ensuring rotas are compliant with European Working Time Directive and junior doctor contract requirements. A lot of trusts have used the DRS (Doctors’ Rostering System) to achieve this, but the system’s provider – Skills for Health – says a number of its 100-plus trusts/health boards have taken the next step by also using its Realtime Rostering system.

Working patterns for both consultants and junior doctors can be entered into Realtime, enabling rosters to be produced from existing rotas. These take into account annual leave, study leave, shift swaps and unexpected absences.

According to Ben Marchini, product manager at Skills for Health, the benefits for the trust are clear. Clinicians can use smart phones to see at a glance where they need to be and when, and can submit their leave and swap requests anytime, anywhere.

As well as reducing the administrative burden in compiling rosters, the system has helped trusts to reduce spend on locums and to reduce theatre and clinic cancellations by avoiding typical paper-roster mistakes such as double bookings. It also supports trusts in compiling management information on how often a roster breaches the agreed safe staffing levels, meaning that understaffed areas have metrics to quantify the challenges they face.

Sherwood Forest Hospitals NHS Foundation Trust started working with Allocate in 2015 to improve the visibility of medical workforce issues. This started with implementing a three-stage job planning process that led to nearly the whole consultant community signing off job plans linked to annual activity.

Andy Haynes, the trust’s medical director, says: ‘Job planning is a fairly blunt tool really, because it’s all about time, not activity. But by agreeing annualised activity, you can start to agree variation between consultants that is acceptable. And you can standardise things like annual leave – generally medical leave is not as tight in most trusts as it is for other members of staff. By doing all this first, we could really understand where consultants should be.’

The trust followed this up with the introduction of e-rostering for junior doctors using an app. ‘We linked bank onto a weekly payroll so people were paid straight away for any bank work and this was all very positive,’ says Dr Haynes. ‘But again, on any given day we could see which juniors were in and which area of the trust they were based in and look at safe staffing ratios – something we hadn’t been able to do before.’

Job planning and rostering consultants, together with rostering juniors, have had significant benefits. The trust is filling more of its medical vacancies using its bank – up from 0% in 2017 to about 8% now, compared with a national average of about 5.5%. The process also helped identify where consultants were being under or overpaid – perhaps because their on-call supplement reflected old working arrangements. And making better use of all consultants’ available time has contributed to a reduction in the trust’s agency spend on medics from £350,000 per week to £140,000. It has also helped the trust to be better prepared for the contracting round.

With the job planning process undertaken in September, by February the trust is clear what capacity it has in each team to inform discussions about the activity it can deliver.

The new deadlines set for e-rostering in the long-term plan do not come out of the blue. Most trusts already have e-rostering systems. The real challenge will come with making more use of these systems, getting more information out of them to help optimise the use of staff and provide them with greater flexibility and convenience. Further support from NHS Improvement is expected in the near future.