Achieved a 93% Bank fill rate, eliminating the need for agency workers in Bands 2 and 3
Agency spending dropped to 1.4% of the overall pay bill, significantly below NHS England’s target
Reduced the agency rate for admin and clerical staff from nearly 20% to 1.5%
The Situation
Buckinghamshire Healthcare NHS Trust (BHT) is a large integrated care provider serving a population of around 500,000 people and employing over 6,000 staff. The Trust provides a wide range of services, from emergency care and surgery to community nursing and rehabilitation.
NHS Professionals (NHSP) has worked with the Trust for a number of years and on an NHS Employers’ webinar in 2024, Bridget O’Kelly (Chief People Officer for the Trust), described the relationship with NHSP as ‘very mature’.
The contingent workforce is an important part of the Trust’s overall workforce and while driving down costs remains an issue, they are also focused on ensuring that their Bank and agency staff (as well as their substantive staff) are happy and supported, helping to deliver excellent patient outcomes. This means understanding what contingent workers want when they say they want to “work flexibly”. This can range from making it easy for them to book shifts that work around their lives, providing quick and easy access to shifts, and paying them promptly. It also means treating Bank staff as extensions of the substantive workforce.
I do think the psychological contract for a Bank worker, even when you have an outsourced Bank, is different from agency. So, the more people you have working and delivering care with your permanent workforce and your Bank workforce, the higher the quality of care.
Bridget O’Kelly, Chief People Officer, Buckinghamshire Healthcare NHS Trust
NHSP was asked to provide a solution of building the Bank workforce as an extension of the substantive workforce. That meant asking whether everybody working at the Trust had access to the Bank or could be migrated from agency to the Bank quickly.
The Solution
Starting with healthcare support workers, agency staff were migrated onto the Bank. This involved steady engagement and collaboration with both agency workers and Trust managers, the latter of which needed to feel confident that switching off agency would not be detrimental to safe staffing and patient care. Both the temporary staffing team at the Trust and staff from NHSP had one-to-one conversations with agency workers to explain that, in future, temporary opportunities would only be made available through the Bank and they were then individually supported through the transition. By June 2023, the Trust, having achieved a Bank fill rate of around 85%, was confident enough to shut off all unqualified agency in Nursing and Midwifery.
Following the success with Healthcare Support Workers, the focus turned to Admin and Clerical, where this process was replicated.
The Results
Across all staff groups, spending on agency is at 1.4% of the overall pay bill (well below NHS England’s target). The Bank fill for Band 2 and 3 nurses currently sits at 93% and there has been no agency usage since May 2023. Agency usage for Admin and Clerical has been reduced from nearly 20% to 1.5% and the programme is now being extended to Healthcare Scientists and Allied Healthcare Professionals.
The key factors that have contributed to this success of this partnership include:
- Access to live data through NHS Professionals’ Microsoft BI dashboards which gives everyone in the team visibility of the same information, in real time, to track and monitor Bank and agency usage, and spending.
- This data provides the ability to ‘future scope’ and consider how current patterns of usage may create risks in the future.
- Locating the NHSP team on the same corridor as the senior nursing team and therefore creating a ‘resourcing hub’ at Stoke Mandeville.
- Being really clear about the aims and ambitions of what we are trying to achieve – not just in terms of Bank and agency usage, but in terms of the total workforce.