A partnership approach to agency working

The way NHS Direct uses non-clinical agency staff on the frontline has changed significantly over the years and even more so in recent months. Agency staff have always been a consistent presence in our operational model with our use of them being centered around the fulfillment of short term gaps, and to provide resilience to our operation. For NHS Direct, the motivation for using agency staff has never been financial. Instead it has been about how this approach can help us to increase our flexibility and ability to meet peaks in patient demand so that we can continue to deliver a safe and effective service to our patients at all times. This was most notable in the period of pandemic flu in 2009 and in severe winters, where demand for our service has been unprecedented. The flexibility created through the use of agency and temporary staff in these periods has been instrumental in helping us to remain highly resilient and focused at a time of extreme pressure.

Breaking the mould

When NHS Direct launched 12 years ago it broke the mould in terms of the way healthcare is delivered. As a provider of remotely delivered healthcare advice and information, it has changed the way patients interact with the NHS and showed the value of using the telephone and web to access urgent healthcare advice at a time when face-to-face delivery was the norm. The service has continued to develop over the years. Now more people access NHS Direct’s services online than they do over the phone (around 4.7 million calls a year and over 10 million online interactions). As the way we deliver our services has changed, so too have the operational requirements and methods used to meet these demands.

Agency staff approach

Although the use of agency staff has been an important operational tool in helping to ensure consistent access to the service, it has only been in the last 12-18 months that we have seen a significant change in our approach. In early 2011 we entered into an insourcing contract with one of the leading providers of contact centre outsourcing and insourcing, Conduit, which today provides us with a complement of health advisor staff - these are non-clinical staff who answer the initial calls coming into NHS Direct. There are significant benefits to this approach and Conduit provides us with a fully-managed service, which means they manage every aspect of the relationship between the member of staff and NHS Direct, from recruitment and training to the day-to-day management responsibilities. This partnership approach has helped us reap huge benefits, including increased productivity and better motivations from staff.

The adoption of this approach has been heavily influenced by the changing nature of the way patients access our services over the years, and in response to unprecedented organisational change. In June 2013, our nationally commissioned telephone service (0845 46 47) will cease to operate, and will be replaced by the new, locally commissioned, NHS 111 service which will be rolled out across England. We have delivered four NHS 111 pilots since November 2010 and over the last 12 months we have bid for local NHS 111 contracts and have been selected by commissioners covering over 32 per cent of England’s population. During this time we have also seen a shift in call patterns to the 0845 service, much more to the out-of-hours and weekend period. In order to prepare for this change we have already undergone a major organisational-wide review of our substantive staff rosters and have, as a result of this, changed the shift and roster patterns for all substantive front line staff. This has made a huge difference to our ability to deliver a safe and effective service and has been very positive in ensuring we are available when our patients need us.

Resilience
The resilience we have built up through our insourcing capability has helped us to make these changes as smoothly and with as little disruption to patients as possible. It has also influenced the way that we have built our future rosters by experiencing different and highly effective models of delivery. Because of the move to locally commissioned NHS 111 services which will see significant organisational change, a decision was made in April this year to pause our substantive frontline recruitment process. Having an effective insourcing partnership in place has meant that we could make these important business-critical decisions without the risk of putting pressure on our existing substantive staff and without having a detrimental effect on our performance, ensuring that we could continue to provide a high quality and safe service for our patients.  It has also allowed us the time needed to make decisions about the staffing levels we will need for the future without making any premature commitments to staff joining the organisation in this interim period.

Complex Nature
Engaging with Conduit to understand the unique and complex nature of our organisaiton has been really important. You can easily draw comparisons between NHS Direct and a typical contact centre business (30 contact centres across England, operating 24 hours and day, seven days a week, efficient scheduling of frontline staff to meet forecasted call volumes). However, the fact that NHS Direct is an NHS Trust delivering clinical services means that we can never conform fully to the typical contact centre model. The challenge for us was to ensure that Conduit could use the best practice elements of contact centre management whilst operating in the very different environment NHS Direct presented, respectful of the unique skills required for telephone clinical assessment and triage. Key to the success was the development of a strong relationship with Conduit, and we have worked closely with them to ensure their approach is closely aligned with our organisational objectives, values and vision. Conduit and the staff they appoint need to have a thorough understanding of NHS Direct, and equally important is for us to understand the different motivations of people who choose agency work over a substantive role. We must be mindful that agency staff have actively chosen this type of work as part of a lifestyle choice for varied reasons and we have to be respectful of that. For us, it is about achieving a balance between the choices staff make to take on agency work and our requirements to meet the patient need. This is where having our insourced staff fully managed by the agency is really effective as it allows the agency to set the agenda with the focus completely on the interests of their specific staffing group.

Part of the team
Insourced staff are valued members of the team and we are committed to ensuring that they feel part of the NHS Direct family. Our agency staff have exactly the same training and ongoing support as our substantive staff. They are also offered the same incentives, learning and development opportunities that helps them to progress their knowledge and skills. The feedback we receive from Conduit about the environment we create and the support we provide is excellent. The relationship we have developed with Conduit has been crucial to our capability to manage the current service and our patients’ needs in these changing and often challenging times. There are lessons that other NHS organisations going through equally challenging times can take from our approach. Central to this is the benefits of a true partnership between organisation and agency. Creating a partnership that is transparent and supportive, and which takes into account the working environment, the people affected and the interdependencies between all parties, results in an approach that benefits staff and patients.

 

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