The staffing challenges within the NHS are at crisis point. 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, this drastically affects frontline specialties, particularly anaesthetics, critical care, and emergency medicine. This is due to an ever-increasing number of rota gaps and unfilled shifts across our NHS departments - and despite the lack of staff available, demand for acute services is higher ever.

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 from overseas is more expensive and less viable as a potential Brexit looms.

Our analysis of NHS departments across the UK reveals that the majority of departments have no coherent or well-defined process to manage rota gaps and unfilled shifts. There is a massive 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.

These inefficiencies include:

1. Poor choice of communication tools

There is a reliance on basic communication tools such as WhatsApp, Facebook, and lengthy email chains. This results in doctors being spammed or not being aware of shifts on time - and leads to coordinators having to hassle doctors, especially at the last minute.

2. Limited access to doctors

The pool of doctors that receive alerts about new shifts and rota gaps is usually limited to the ‘black book’ of the rota coordinator. These black books vary dramatically, and are frequently lost when coordinators change over.   

3. Delays with administration

Registering with each Trust is a huge, paperwork-heavy process. This can really disincentivise doctors from applying to fill shifts with a Trust in the first place - and reduces the pool of available doctors in spite of most departments having frequent rotations of trainees.

Traditionally, temporary cover within the NHS has been managed through locum agencies, which are not only expensive, but can be unreliable. NHS Improvement (NHSi) are advocating that departments move away from using locum agencies in favour of managing their own locum needs ‘internally’. This leaves departments stuck between a rock and a hard place - prevented from using agency employees by NHSi, and unable to reliably source doctors themselves.

When a department has to be self-sufficient without a well-defined process in place, it has serious ramifications on: 

1. Medical Training

Pressure is placed upon trainees to fill gaps in their professional training, which impacts upon their morale, health, and career progression.

2. Consultants

Consultants must maintain safe staffing levels within theatres and critical care wards, so they have to spend more time on non-clinical than clinical duty - and frequently have to cover trainee shifts.

3. Patients

It’s becoming more and more common for departments to postpone procedures due to lack of cover. Moreover, inadequate staffing levels is placing patients at higher risk to adverse outcomes.

Where does Messly come in?

The solution to our inability to fill vacant shifts is rooted in collaboration, communication and technology. 

1. Collaboration

Trainees must have better opportunities to work flexibly and move fluidly between between departments without a cumbersome administrative load. Collaboration is necessary here, as neighbouring departments can build up shared sources of reliable doctors. 

2. Communication

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 - and alleviates the burden on trainees and consultants.

3. Technology

Technology is pivotal to facilitating these processes and reducing friction in administrative processes. By providing a purpose-built solution for departments to manage their banks and communicate with them, we make it easier for doctors to book work flexibly within the NHS.

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