Case Studies - DRC Locums

Revalidation

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GMC Revalidation Case Study

We were one of two locum agencies selected for the GMC’s Revalidation pilot project. To view the case study on the GMC website please follow the link: http://www.gmc-uk.org/doctors/revalidation/13400.asp

Background

In August 2011, we were successful in our application to take part in an NHS Revalidation Support Team pilot to test its new Medical Appraisal Guide (MAG). We were keen to assess how well the appraisal guide would work for some of their doctors who, because of their location, were likely to find it more difficult to engage in appraisal and revalidation. RST needed around 30 locum doctors for the pilot who qualified outside of the UK and work in England.

It was decided to run the pilot with locums who live abroad and come to the UK infrequently. The group was made up of doctors with fifteen different nationalities who had qualified in some seventeen different countries - including India, Romania, South Africa and the Sudan.

The pilot began in September 2011, and prior to the pilot commencing we created a code of conduct, appointed and trained a team of appraisers, and identify a number of doctors willing to travel to the UK. We trained 7 appraisers from our senior locums as we were keen to have appraisers who understand the nature of locum work.

Challenges

One of the main challenges in the preparations for the revalidation pilot was the small number of locum doctors who had previously taken part in appraisals. At the time locum doctors were required to provide the date of their last appraisal, which was expected to have taken place in the last 12 months. However, it was estimated that more than half of new recruits that had not recently worked in the NHS had not had a recent appraisal and in many cases had never been appraised at all.

For the pilot this challenge was exacerbated as the team had no experience of medical appraisal, not being clinical staff themselves, and therefore knew they would have to seek external support to help them develop a system of appraisal for those doctors who will revalidate with the organisation.

At the time we were responsible for the revalidation of approximately 200 of the doctors in our candidate pool. However, because of the nature of their work, keeping track of the number of locum doctors who will revalidate with the organisation was a major challenge to overcome.

Results

The feedback from doctors who took part in the pilot was very positive and many found the template RST materials particularly useful in guiding them through the process of appraisal and the information they need to collect.

One of the key issues identified was that many of the locum doctors feel excluded from CPD events and as a result unable to collect the supporting information required for medical appraisal and revalidation. In response, we have adapted the list of information doctors can provide to be more flexible.

Colleague and patient feedback is one area that can be more challenging. Some doctors will not come into contact with patients very often, while others may only see them for a short space of time, such as pathologists or anaesthetists. It was discovered that provided there are procedures in place peer feedback can be collected reasonably easily.

In response, we host a variety of events with locum doctors and clients across the country. These events are open to all and aim to provide candidates with an overview of what is involved in revalidation and the support available to help them prepare. Client specific events focus on working together to find joint solutions to challenges such as patient and colleague feedback, for best practice in sharing information or concerns.

Key Findings

We understand the challenges that locum doctors may face in collecting supporting information and keep our arrangements as flexible as possible, such as accepting supporting information in different formats to make it simpler for doctors to demonstrate they are keeping up to date with their practice.

We believe the systems which are in place for revalidation and for dealing with concerns about doctors are giving our clients greater confidence in the services we provide.

Some doctors may find it more challenging than others to collect supporting information for appraisal. Having appraisers who have experience of these challenges or understand them is hugely important.

Medical Services

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Client

Public Health England: Port Medical Inspectors at Heathrow and Gatwick Airports.

Purpose

The purpose of the Port Medical Inspector is to determine if a passenger from outside of the EU is entering the country with the intention of misusing the NHS. We provide suitably qualified and trained doctors on a retained basis and run a staffed service 24 hours a day 365 days a year.

Service

Within the contract, we provide backup support between the hours of 7am and 10pm every day of the year with the ability to respond within 4 hours. The provided staff are primarily required to respond to a singular examination and once the examination had been completed report the results to the appropriate officer prior to leaving. However, the agreement also requires cover for leave and other absences.

The main functions of the health units are to: provide MI services giving advice on the health status of migrants and if the rules for admission into the UK are met; provide screening for tuberculosis for long-term migrants from countries with a high incidence of TB; respond to public health incidents and emergencies; in emergencies provide immediate clinical assistance as a ‘Good Samaritan’. The main areas for advices included: infectious diseases, mental health assessments, pregnancy assessments, and cost of medical or surgical procedures for treatments. We provided fully qualified specialist doctors to fulfil and requirements.

In the provision of the service we have utilised a dedicated phone line as well as a dedicated client manager to ensure that all requests were responded to within the 4-hour response period. We developed a client pool of candidates within a commutable distance to be able to respond in all situations including adverse conditions.

Nurses

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Client

Northampton General Hospital NHS Trust

Key drivers

The Trust wanted to regain control over agencies to be able to successfully implement the NHS Improvement (NHSI) Agency Rules; a key part being the complete eradication of off-framework usage. To comply with the NHSI Rules required a drastic reduction in the number of agencies used to maintain tighter control. In addition, they wanted to implement a Preferred Supplier List (PSL) to ensure pay parity across the agencies and continuity of care through the regular supply of nurses.

Successful Tier 1 supplier bid from a Tier 2 supplier in August 2014; the main reasons being quality and quantity of nurses.

Solution

An aggressive campaign was carried out to educate candidates regarding the new PSL and register as many as possible to DRC. As part of this exercise we carried out several open days at the Trust and provided free compliance workshops to ensure candidates were fully registered and compliant to work through us.

To overcome the low rate card implemented and then further reduced by NHS Improvement, we embedded a continuous price conditioning function within all negotiations. This process ensures that candidates are fully aware of the Trusts financial restrictions and the margin we are making. All Recruitment Consultants receive quarterly negotiation training to aid with this process.

Many local Trusts to Northampton have historically not had a tight control over agencies which has led to increased rates and off framework usage, to ensure that candidates would not look to transfer to these Trusts we carried out a business development exercise across the local region to increase market presence. This exercise involved us promoting the positive work and results achieved at Northampton and putting a supply & rate proposal together for the local Trusts to create a standardized regional approach and ultimately work towards pay parity.

To create a long standing trustworthy relationship and ensure contract adherence from both parties a series of meetings was scheduled at contract implementation. The Trust has visited our office to meet key stakeholders, the Account Manager, and the Finance team so that we fully understand the Trusts requirements and booking process.

Results

Since being appointed as a Sole Tier 1 agency by Northampton General we have assisted the Trust with the successful implementation of their PSL and adherence to the NHSI Agency Rules. This has been assisted through the reduction of the number of agencies creating a stronger partnership approach.

We have assisted with a more efficient process for the management of requirements and forecasting. We were given complete access to Allocate and through the full utilisation of the system centralised the booking process; all bookings were done electronically on the system allowing for maintenance and adherence of the Tier 1 and Tier 2 policy.

Working in collaboration with the Trust we streamlined the invoice process. Full utilisation of Allocate ensured the accuracy of invoices and no rate discrepancies creating time savings for the Trust. We developed and implemented with the Trust a paperless timesheet process and provided consolidated invoicing. With the Allocate system driving the invoicing it provided full visibility and eliminated human error as there was only one version of the truth.

Mental Health

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Client

Humber NHS Foundation Trust

Key drivers

Humber were looking to reduce their agency spend through an effective implementation of the NHS Improvement (NHSI) Capped Rates. They also wanted to create savings through revising the permanent recruitment process and strict enforcement of Direct Engagement.

Solution

Included within our Master Vendor strategy are regular review meetings, during those with Humber we discussed having greater control over the Master Vendor. This has included, but not been limited to, more accurate feedback regarding spend, regulation of the secondary agencies supply, proof of process such as step by steps during outsourcing, and the implementation of the NHS Improvement (NHSI) Cap Rates.

We worked with Humber to formulate an approved list of secondary agencies which was based on their regional presence and ability to work in line with NHSI rules.

Results

We have proactively price conditioned candidates who are proposed to Humber to ensure that they are aware of market conditions. Several bookings followed the introduction of the capping process during the phased period and while some remain at the NHSI February Cap Rate bookings are also occurring at the NHSI April Cap Rate. Escalations above capped rates are only approved when required and we work with Humber to ensure that they remain within the previous capped rates and all required information is obtained to assist with NHSI reporting.

The use of secondary agencies has been limited with Humber ensuring that control has been maintained of the supply chain. A step by step process is being created and will be provided to them for a fuller understanding.

As standard within our Master Vendors we provide monthly Management Information (MI) covering all aspects as required by the client; effectively acting as feedback to bookings, costs and term of the vacancy. The insight that the MI gives can create savings and improve process efficiencies as it is an empirical account of the functionality of the processes so areas of improvement can be identified and solutions created.

Our fill rate within the Master Vendor is consistently above 90%.

Doctors

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Client

James Paget University Hospitals NHS Foundation Trust

Key drivers

This Trust is in a very challenging geographic location which has historically made it difficult to recruit the necessary volume/quality of candidates. This is further compounded by the NHS Improvement (NHSI) Agency Rules meaning that the Trust required a full remodel of the Medical Locum management process.

We successfully proposed a Master Vendor contract for the supply of Medical Locums through the creation of cost saving initiatives as well as the reduction and ultimate elimination of off-framework agencies. Assisting James Paget in the fulfilment of the rules and guidelines proposed by the NHSI Agency Rules was also crucial in the implementation and management of the agreement. Due to the success of our nursing Master Vendor in fulfilling these criteria we were consequently awarded the Master Vendor contact for Medical Locums.

Solution

Throughout the implementation and management of the Master Vendor contract, key factors for consideration were the creation of tangible cost savings, time saving and the eradication of off-framework usage.

We proposed and implemented the following in collaboration with James Paget:

Standardised rate card in line with NHSI April Cap Rates
Standardised agency commission
Centralisation of the booking process
Centralisation of the financial process
Secondary supplier management

In addition to the above we would be able to assist James Paget in regards to NHSI reporting. Due to the centralisation of the booking process we are able to collate required information when approved use of escalations is authorised.

Results

Since the implementation of the Master Vendor we have completely eradicated the use of off-framework agencies for medical locums. Any staff which the Trust identified to be protected who were working through off-framework agencies were notified of the Master Vendor contract and offered a variety of solutions to ensure they could remain at the Trust.

The centralisation of the booking and finance process created time and cost savings from an increase in process efficiency. They are provided with a consolidated invoice creating time savings as there are fewer invoices to process. Via the management of the booking process we are able to ensure a high quality level of compliance for the agency workers supplied. The dedicated Account Manager has regular visits providing on-site support for process and booking management.