At the latest HTN Now: Digital Primary Care event, we were joined by Dr Surina Chibber, Co-Founder of My Locum Manager (MLM), and James Stephenson, Commercial Director at Agilio Primary Care.
Surina and James delivered a webinar on the staff retention challenges currently facing primary care, discussing how their respective organisations are tackling these challenges and the keys to a successful and more sustainable workforce.
“To understand the keys to success for any project, we know that it is important to understand the underlying challenges that we’re trying to solve.” Surina said.
Surina created a picture of the primary care landscape, explaining that the challenges being faced are multi-layered with a foundational issue of staff shortages at the core.
In the video below, a graph at 02:28 NHS Digital (now merged with NHS England) depicts the current demand for GPs and staff alongside the numbers of staff working in these sectors. The data conveys a shortfall of 4,000 doctors, which has resulted in fewer doctors looking after a greater number of patients, increased staffing costs and mounting workloads – culminating in a stretched system struggling to cope with the ongoing demand for primary care.
“As a result of the initial shortage, the drive has been to move from the traditional model where GPs were delivering frontline care, to moving to a wider practice team model where patients are being seen by other staff types alongside GPs. That would mean a wider network team comprised of community-focused providers, nurses, admin, and so on to help deliver the patient care that is required.”
Staff scheduling is another significant challenge which requires improved coordination, the introduction of additional roles, and the adoption of a data-driven approach to help match the staff to the demand.
Surina highlighted how the NHSE launched the Flexible Staffing Pools Framework, which aims to deliver ICS-wide staffing and improve staff retention and wellbeing.
She said: “The idea was that each ICS would be provided with £120k worth of funding to put in place a digital solution. This would allow them to have an infrastructure to deliver better care because they would have better access to sessional GPs.”
The framework is supported by the NHS People Plans commitment, through which a team were looking at the underlying causes of NHS staff shortages and burnout. Surina explained: “They felt that if we had a way of offering primary care workers a way of working flexibly, this would attract more of them into the profession and keep more of them there. They would be able to offer safer staffing levels and more services, and we’ll be able to better match supply and demand to take that pressure off delivering day-to-day care.”
As a result, several suppliers were given a place within the framework to begin working with ICBs to tackle these challenges, including MLM.
Flexible Staffing Pools Framework
The purpose of this initiative was to enable ICBs to have a digital system so that they could reduce the administrative burden on practices and clinicians by improving access to clinician availability and facilitating the long-term retention of staff with a happy and healthy workforce.
In addition, it intended to reflect the increasing role and responsibilities of PCNs within an ICS and cater for scheduling different staff types.
Surina and James emphasised that there is no ‘one-size fits all’ approach to the current primary care challenges, and as such the framework utilises three models of action:
- Marketplace style model: here you would upload your locums and they can work from anywhere and everywhere, choosing jobs based on the rate that is being offered or the location.
- Chambers model: GPs collaborate with an administrator to oversee the work that they access.
- Community model: this offers an opportunity to put in place digital ring-fencing to support GPs in prioritising their area of work, supporting them with CPD and incentivising them to stay working at that practice.
It is also important to consider adoption, sustainability, and efficiency when deploying a particular model across all staff types.
Case study: Nottingham and Nottinghamshire ICB
MLM was chosen as the flexible staff pool provider for Nottingham and Nottinghamshire ICB.
Surina said: “This ICB was interesting because they were also utilising an HR system team across their entire ICB. Now they have a flexible staff pools provider which is dealing with managing the temporary workforce, scheduling, and building a workforce that is going to provide resilience for the future, as well as having a system across the entire ICB that manages all the HR governance and other staff types.”
She drew our attention to a quote from Dr Manik Arora, GP Clinical Lead and Clinical Editor at Nottingham and Nottinghamshire ICB, who said: “We have an innovative vision across our ICS to have a better way to manage the evolving challenges of workforce management, benefitting from TeamNet and My Locum Manager’s single, seamless system.”
James then highlighted the work of TeamNet and the services they have provided for the ICB. Firstly, he explained that the Agilio system has been in place for around three years and in that time has been rolled out to all 133 member practices and 23 PCNs. Practice and PCNs use the platform for distributing clinical support information whilst the locum portal provides access to key system knowledge.
James added: “As a primary care system, they saw the benefits from a single workforce platform to install resilience in the practices and standardised back-office processes. Both of these things are important precursors to the launch of a flexible pool, and they laid down some important foundations for success – for example, practices in PCNs using familiar scheduling tools through a single platform creates resilience in the practice management community.”
The ICB wanted to build on the foundations already put in place rather than investing in a new platform, so they rolled out MLM as an add-on to TeamNet which “aligned with their single platform vision and offered a complete workforce solution.”
Complete Workforce Solution
At 12:37, James presented a detailed flow chart which maps the fundamental structures of a complete workforce solution.
He said: “Importantly, from a CQC perspective, this provides the practices with access to the ARRS (Additional Roles Reimbursement Schemes) rules and HR information. The MLM add-on allows practices and PCNs to create two distinct communities within the workforce, staff pools, and staff banks, with each practice and PCN using the same interface for managing their internal and external staff. For pools, we see this as the salaried employees taking on additional work outside of their core hours. This applies to any role within the workforce, from receptionist to GP partner.”
Pool workers can log availability, browse sessions within the pool, and use tools to store key compliance information that is also visible to employers. Traditional locums such as GPs and nurses can send invoices, manage their finances, and become part of a holistic community. Agilio, in partnership with the ICB, provides CPD and support to retain this important and growing part of the workforce.
James explained: “It supports the salaried and self-employed workforce, caters for all roles within the workforce and it is one place for organisations to go to plan their scheduling and manage their HR info.”
“The project scope has thus far proven to be cost-effective and user-friendly, promoting a versatile and ready-to-go workforce,” Surina said.
By offering a more efficient way for ICSs to build locum communities and enable them to work flexibly on one system, MLM and Agilio have made it easier for practices to source cover with over 1,772 shifts being filled within Nottinghamshire in the last six months.
At 16:18, Surina and James shared various graphs demonstrating the improvement in service, staff retention, and average hourly rates.
Surina added: “This has resulted in better staff morale through peer support, easier access to mandatory training, clinical knowledge, faster onboarding, and better system knowledge through accessible locum packs. This is expanding to encompass all staff types, meaning other staff types can be catered for. Therefore, it offers the ICB a very flexible approach because they can incentivise and optimise staff recruitment of locum communities as well as their self-employed community.”
As a result, they have been looking at the other potential impacts: “We’ve been able to collate through feedback reports of better staff morale because they are accessing the peer support that is delivered. The skill base and quality of care they’re delivering can be optimised and their clinical knowledge is better because they have better, faster access to this. Onboarding new clinicians is much faster than other systems and because these staff members have access to the knowledge base through the locum portal, they’re able to get to work quicker and be more efficient in other practices.”
Case study: Derby and Derbyshire ICB
Surina noted that the work with Derby and Derbyshire ICB was very different from Nottinghamshire as they do not have a team network across the whole area. They secured MLM as a standalone local platform for all their practices across the entire ICB.
“Their aim was slightly different; this ICB has 114 practices and 17 primary care networks with a patient population of approximately 1.7 million,” Surina explained. “The delivery of flexible staff pools was done in collaboration with the ICB, the GP task force, MLM, Agilio, and other key stakeholders. They also wanted a very seamless system, but their focus was on GP wellbeing – to help GPs feel valued and to increase recruitment and retention for the longer term, better staffing levels.”
The key focus for the ICB was to help increase GP and staff numbers and to support the growing pressures. “Having a digital system in place with MLM would reduce the admin burden and overall workload, reducing agency fees, and building a local community of staff that were knowledgeable about the system.”
The results showed a significant uptake with 6613 sessions booked over a five-month period, which demonstrates a fill rate of up to 93 per cent. This is further illustrated by a graph at 20:07.
The average rate of pay was £95.00 an hour which Surina explained is significant because “when surveys were done on an ICB level of locum rates across the area, staff working outside of the platform – found through agencies and so on – were charging significantly more. Practices were saying that those higher rates outside the MLM platform were unaffordable for them. Again, that provided us with intel for getting those practices on board and getting them access to our locums.”
A key benefit of MLM is that they do not charge agency or booking fees on session rates, therefore saving the ICB £94,325.25 in the first year alone.
Surina then drew focus to some important user feedback from Gemma Markham, a Senior GP Commissioner at Derby and Derbyshire ICB.
Gemma said: “Something that attracted the ICB to MLM was their ethos around looking after staff. Ultimately, doctors are patients too. MLM taking care of staff’s wellbeing helps them to be healthy and means they can deliver their job well.”
Concluding their session with a focus on ‘what success looks like’, Surina and James shared a short video clip of the feedback they have received which can be viewed at 22:13.
Surina explained the important role feedbacks play in their work, noting that they gather it regularly. They often send out surveys, working in line with the vision that the ICB has for their area because “We understand that each area is different, and their challenges are different.”
Finally, Surina and James left us with another quote from Gemma Markham which encompasses their vision for future success: “It’s so much more than just filling the shifts. It’s about getting the locums to feel like they are part of our workforce, they should be just as valued as a partner that has been in the practice for 20 years. That’s what success would look like to us.”
The floor was then opened to questions at 23:46.
Many thanks to Surina and James for taking the time to join us.