A Perfect Storm for Rota Gaps

The staffing challenges within the NHS are fast becoming a crisis. Nearly 1% of doctors are leaving the NHS every month, and in the last year alone unfilled NHS medical posts rose by 10% and unfilled specialty training spots by 31% .

Within the NHS the problem is being felt most acutely in frontline specialties, particularly anaesthetics and intensive care departments. This comes at a time when demand for peri-operative services is growing fast than ever in the UK.

The corollary of this is an ever-increasing number of rota gaps and unfilled shifts across our Anaesthetics departments.

There are a number of actions the NHS are looking to take to address these challenges. Training more doctors is a viable long-term solution, but will not have an impact for another decade. Recruiting more heavily from overseas will be harder if and when we leave the European Union.

An analysis of anaesthetics departments in London and the South East reveals that the majority of departments have no coherent or well-defined process to manage rota gaps and unfilled shifts.

This creates great inefficiency in a system which is already at breaking point.

There is a huge opportunity to better manage our existing workforce as the most beneficial and cost-efficient solution to our staffing challenges over the short and long-term.

The most prominent examples of these inefficiencies are:

1. Poor Communication Tools

There is an over-reliance on basic communication tools such as WhatsApp, Facebook, and lengthy email chains. This results in doctors not being aware of shifts on time and coordinators having to hassle doctors, especially for last minute shifts

2. Limited access to doctors

The pool of doctors alerted to shifts is usually limited to the ‘black book’ of the rota coordinator. These black books vary dramatically with high attrition rates and are frequently lost when coordinators changes over.

3. Administrational Delays

There is huge friction for doctors to register internally onto the bank which has to be repeated at every Trust. This disincentives applications and reduces the pool of available doctors despite most departments having frequent rotation of trainees.

Traditionally, temporary cover within the NHS has been managed through the locum agency model. Financial ramifications apart, external locums have become synonymous with inconsistent quality and reliability. NHS Improvement (NHSi) are now advocating a move away from the locum agency model and are requiring departments to manage their own locum needs ‘internally’ at a Trust and departmental level.

This is leaving anaesthetics departments stuck between a rock and hard place; prevented from using agency employees by NHSi and unable to reliably source anaesthetists themselves. This heady cocktail of factors has become more powerful than ever in the context of increasing staff shortages and rota gaps.

Having to be ‘self-sufficient’ without a well-defined process is having implications on:

1. Anaesthetics trainees

Increasing pressure is being placed on trainees to ‘fill their own gaps’ which impacts upon on their training, morale and health.

2. Consultants

Similarly, under pressure to maintain safe staffing levels within theatres/ICU, which is resulting in them spending more time on non-clinical than clinical duty and frequently having to step down to cover trainee shifts.

3. Patients

Postponing of operations due to lack of cover is becoming more common. Inadequate staffing levels, particularly overnight, is placing them at higher to adverse outcomes.

The solution to filling vacant shifts must be routed in collaboration, communication and technology.

Trainees must be able to move fluidly between between departments without a cumbersome administrational burden. Collaboration within the specialty is needed to enable this, as neighbouring departments build up shared sources of reliable trusted doctors. With closely knit knit and trusted training schools, anaesthetics is best placed in these regards to lead the way for the NHS.

Better communication is essential between departments, doctors and the staff bank to allow doctors to be matched quickly to available shifts with plenty of notice. This enables doctors out of training to continue to engage and provide services to Trusts to alleviate the burden on trainees.

Finally technology is pivotal to facilitating these processes and reduce friction in administration process; by providing a purpose built solution for departments to manage their banks of trusted doctors, communicate with them regarding availability and for doctors to be able to able to book work flexibly in anaesthetics departments.

We must create a more sustainable solution to managing the workforce crisis, which is desperately needed to safeguard the quality of our training, the morale of our workforce and the safety our patients. Anaesthetics must lead the way for the rest of the NHS.

About Us:

Messly is a healthcare startup providing software that enables hospitals departments to find and manage trusted locum doctors more efficiently. Learn more about us here

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