Case study: Using e-rostering to improve staff wellbeing and retention (NHS England, October 2022)

Summary

NHS trusts have often reported emergency department doctors having low levels of satisfaction and high rates of burnout, leading to a high turnover.

In 2017, Brighton and Sussex University Hospitals (BSUH) and Western Sussex Hospitals merged to form University Hospitals Sussex NHS Foundation Trust. The Trust found that the organisation of shifts at Royal Sussex County Hospital (RSCH) and Princess Royal Hospital (PRH) and lack of flexibility were adding to the strain already felt by doctors working in the high pressure emergency department.

To combat the pressure consultants and other doctors were under, the Trust implemented a system to help improve rota design and flexible working. The hope was that the system would help the trust retain and recruit staff, whilst saving locum costs and improving patient care.

Content

University Hospitals Sussex NHS Foundation Trust identified two main solutions:

1. Annualised self-rostering/self-preferencing rotas so staff had more control over their working hours.
2. Introduction of a clinical fellow role with 25% non-clinical time to allow these staff to undertake other projects – for example, teaching medical students.

These two solutions were initially started for the A&E departments and then medical juniors whilst implementing the same systems but also allowing for continuity of ward care.

The Trust decided to use the HealthRota system, to implement an annualised system for consultants (using a period-of-activity contract), middle grades (using a combination of period-of-activity and hours contract) and junior rotas (using hourly contracts), alongside self-rostering or self-selecting preferences, with staff choosing the amount of clinical work they wish to do.

The Trust now benefits from 24/7 A&E consultant cover at Brighton, and cover between 8am and 10.30pm every day of the week at the Princess Royal Hospital. In five years, the Trust went from seven consultants and seven registrars on A&E (for two sites) to 23.8 full-time equivalent consultants and 20 registrars. In addition, the costs of using locum doctors have been massively curtailed. For example, before the annualised rota system was introduced, in A&E alone £1.3M was spent on locums at RSCH and PRH. For 2022-23, the only locum need has been for sickness cover.