With a growing shortage in our medical workforce, rota-gaps and locum shifts are becoming more and more common. Trusts are struggling to fill these shifts whilst coming under increasing pressure to reduce agency spending. The impact on doctors morale is also significant. - a recent survey showed that doctors are asked to fill their own rota gaps on average six times per month.

At Messly, we work with NHS Trusts to help manage these temporary workforce demands and reduce agency spending, through a combination of technology and engagement. Here are some of the best practices we've seen in the Trusts we with work when it comes to filling locum vacancies.

1. Building a trusted bank of doctors

The Trust bank is only as effective as the number of active doctors within it. Building a large and engaged pool of doctors goes a long way towards tackling your locum deficit. The is by far the most critical step - we recognise this takes a time investment and is by no means a 'quick fix'. But the hospitals with the best fill rates and low reliance on agency are always the ones that have built up a reliable and engaged bank of their own doctors.

Where can you find these doctors? The best doctors to work in your hospital are those that have already worked there before. So we suggest beginning the process of building your 'black book' when new doctors rotate through your hospital.

Messly Locum makes it straightforward to build your bank. You can easily target and invite existing bank doctors directly to your Messly bank with just their email address. They will receive an email invitation to register, which takes them 30 seconds. Once they are registered, we handle getting them into your Trust's staff bank so they stay connected and can easily book shifts in your departments when they've left. 

In addition Messly helps you find doctors in your region to strengthen areas you're weak in. Through our Bankbuilder service you can connect to our medical community of over 16000 doctors and recruit directly into your Bank. We support with the onboarding process to make the experience and smooth for the doctors and the staffing managers. 

Being organised and opportunistic with getting doctors in your bank can be the difference between having a bank of 50 doctors and 500 doctors, and improving your internal fill rate from 20% to 90%.

2. Allow your doctors to book shifts flexibly  

Our experience has shown that email is not an effective method for sending out locum shifts, for the following reasons:

i. At any one time only a handful of your doctors can fill a shift; on average doctors are likely to receive 2-3 locum emails from their old departments and agencies, most of which are not available for. Thus doctors often don't read them, or even worse mark them as spam. This means they frequently miss shifts that they may have actually wanted to sign up for.

ii. There is no real-time availability on locum shifts. A locum doctor may be interested in a shift they saw in an email 3 weeks ago, but now has no idea whether this shift is available and is unlikely to chase it up.  This often leaves rota coordinators in limbo on how frequently to email updates on their shifts. The short answer is - there's no right answer! Sending weekly updates on locum shifts to a whole mailing list is a surefire way to get on a doctor's spam list. 

Messly Locum helps by showing realtime availability of all available shifts across the Trust through our mobile app. Doctors can log on whenever they want to see what shifts are available and apply for them whenever they like, rather than trawling through old emails.

Doctors set notifications on what type of shifts they are interested in on the app so they only get alerted about specific shifts. If a locum shift is becoming urgent, we can send notifications to a doctor on their phone, so we know they'll see it. Doctors can easily turn on/off these notifications at any time so our alerts only go to doctors who are interested in locum work.

By providing a flexible booking system and a wide range of shift times and lengths, we've seen that Trusts can increase fill rate by 2-3x with their existing doctors!

3. Post locum shifts with plenty of notice

This sounds like an obvious one but you'll be surprised how often rota gaps will only go out the week before a locum shift is due to start. The more notice you give doctors, the more likely the shifts will be filled and the less likely you will have to rely on agency to fill them.

Our learning shows that a minimum of 4 weeks notice is best practice for posting shifts. We appreciate for some shifts (e.g. last-minute sickness) this isn't possible, but there's no excuse for rota gaps which are known about at the beginning of the rotation!

Messly Locum helps here by making it easy to post all your locum shifts as soon as you know they're available. If you have a list of shifts on your spreadsheet rota you can post them directly to Messly Locum, or send them to us and we'll post them on your behalf. We also integrate with a number of rostering providers to make this process even more seamless. We also make it easy for anyone in the Trust to post shifts via our web and mobile app, which is useful for last-minute vacancies!

4. Keep your doctors engaged

This is a tricky one. We all know that doctors have a soft spot for friendly and helpful rota coordinators - who can wield their charm and persuasion skills to cover shifts!

The problem is that this places a huge burden on these coordinators - they have to frantically text and call in as many favours as they can to fill their shifts, much to their guilt and stress! In a world of increasing rota gaps, this isn't a sustainable solution. 

Doctors feel engaged when they have a personal connection with a department and an effective means of communication with them. Both aspects are critical. Sending a bulk email to list of doctors is unlikely to be a high engagement method, because it is a poor and impersonal means of a communication.  The same message sent as a personal text or phone call can make a huge difference. 

Messly helps to preserve this personal touch by keeping you in control. Any shifts you post are sent from you; every staffing manager, rota coordinator and doctor has their own personal profile and we always provide a means of communicating with the hospital outside of the app.

Aside from our locum services, doctors are strongly engaged with Messly though the Messly Community, which supports doctors with career development and training choices. 

Finally we ensure every doctor who registers on Messly is assigned a Messly ambassador, who looks after and supports them with their training. This means we always have someone in the background who can help nudge our doctors to book shifts. This hybrid service gives doctors the benefits of easy-to-use technology with the personalised service that's necessary to keep them engaged!

5. Get feedback from your doctors

Knowing what doctors' opinions are of working in your hospital will allow you better cater to their needs. If doctors don't feel safe working in your hospital, are having issues getting IT access, or simply think your locum rates are far too low - this is all useful knowledge to implement changes to make your locum shifts more desirable and often safer for patients.

The challenge is getting doctors to respond and finding time to collect this feedback. Messly Locum helps by collecting a feedback survey at the end of every shift completed by a locum doctor. This feedback is shared with the Trust and is available for other Messly doctors to read. Just like with TripAdvisor, if doctors can see that your hospital is a desirable place to work they are more likely book shifts!

6. Know your hard-to-fill shifts

All locum shifts are not created equally.  A last-minute A&E night shift on a bank holiday is not the same as a rota-gap day shift on a well-covered ITU, and doctors know this. You will probably have a good idea of which shifts in your Trust are hard to fill. We suggest agreeing a clear escalation policy for last-minute and bank holiday shifts. This prevents a last-minute call to agencies - who will inevitably charge you more than your escalated rate!

Messly Locum helps you understand which of your shifts by giving you a monthly report of your locum activity, which includes identifying any patterns of shifts that seem difficult to fill. Our system can set clear escalation rates for specific shifts and prevent modifications to these rates to prevent 'rate creep'.

Dr Abrar Gundroo is an anaesthetics registrar and founder of
Messly.co.uk - a digital platform support the careers of doctors and the needs of Trusts by introducing smarter ways of recruiting, retaining and managing doctors.

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