TEMPLATE: Board dashboard M o n t h

TEMPLATE: Board dashboard M o n t h

TEMPLATE: Board dashboard M o n t h ly t o t a l a g e n c y e x p e n d it u r e ( m ) Medical locums. Spend, volume and prices A: How is the trust performing against total agency spend ceiling in 2016/17? Commentary YTD performance YTD % reduction in total agency spend required YTD % reduction in total agency spend achieved YTD % reduction in medical spend achieved Safety 25% 24% No reported safety issues due to agency. 17% YTD spend 3m under ceiling 40 Ceiling 2016/17 30 Include projections by staff group if available 20 Total agency spend Medical agency spend B: Has the volume of medical agency shifts changed? Medical shifts per month 5,959 6,035 5,432 5,771 6,503 6,036 5,924 M a r-1 7 F e b-17 Ja n-1 7 D e c-16 N ov-16 O ct-1 6 7 Total agency ceiling profile 5,661 5,530 30,000 15,792 15,849 16,391 15,626 15,921 16,662 17,043 17,440 17,124 17,638 20,000 22,470 22,223 21,820 20,967 20,812 21,643 20,930 19,557 19,165 19,559 10,000 0 5 -1 ep 5 6 6 15 15 16 16 16 16 t-1 r-1 r-1 vcynbnc a p o e a a e u J J O A D F N M M Requets not filled Requests filled by bank Requests filled by agency over price caps Requests filled by agency under price caps Board level dashboard Biggest issues Particular challenge with X service/site. [Action taken] Poor take-up of electronic request system in X service/site. [Action taken] 10,615 10,591 11,336 10,977 10,450 11,816 11,371 10,636 10,682 12,324 40,000 S 1 5,980 8 M3 spend is 20% lower than previous year. 22 C: How have the prices paid for medical staff changed? 60,000 50,000 8 M a r-1 6 A v e r a g e p r i c e p a i d f o r m e d i c a l s t a ff A p r-1 6 0 10 25 S e p-16 9 10 25 A ug -16 9 34 Ju l-1 6 9 29 Jun-1 6 9 29 M a y-1 6 9 F e b-1 6 A ug -15 9 Ja n-1 6 Ju l-1 5 30 D e c-15 Jun-1 5 30

N o v-1 5 9 30 O ct-1 5 9 10 31 S e p-15 9 9 M a y-1 5 31 30 A p r-1 5 33 29 29 17% reduction in medical spend vs. 24% reduction in total agency spend. Data concerns? 100 90 80 70 60 50 40 30 20 10 0 65 52 36 26 F1-F2 Registrars Specialty Doctor / Staff Grade Consultant Medical locums. Key summary statistics and action plan D: What are the key summary stats? F: What actions are required? Latest week/month* Last month/4 week average YTD average Proportion of agency vs. bank shifts 30% 40% 45% Medical price cap overrides 400 500 500 Number of locum requesters 60 70 70 Set up weekly meetings with MD, FD and COO to discuss performance and agree Terms of Reference for group. COO 01/08/2016 Medical director to agree plan with the board and have a process in place to obtain the information they need from the divisions and hold them to account for locum use. MD 01/08/2016 Set up good quality real time data to identify hot-spots (specialities, grades, individuals) to target COO 01/08/2016 Head of temporary staffing 20/09/2016 Develop and communicate clear processes for booking Associate locums, including locum booking form. MD 01/10/2016 Establish workforce establishment needed and ensure that all plans and locums requested are assessed against this. Associate MD 01/10/2016 48% Centralise locum booking and price negotiation Head of temporary staffing 01/10/2016 28% 25% Set up a working group, led by executive level staff, across trusts in your local health economy focused on bringing down locum spend across the area. MD 01/10/2016 40 20 20 40% 40% Proportion on framework 98% 96% 95% Proportion booked within 48 hours 98% 96% 95% P ric e c a p o v e rrid e ra te Risk Completion date rating 01/08/2016 50% 1) Long term sickness (X%) 2) Vacancies (X%) 3) Training (X%) E: How have weekly medical overrides (rate of agency shifts) changed? Develop locum bank. 70% 60% 50% Owner MD Proportion of direct booked shifts 1) Short term

1) Annual leave (X%) sickness (X%) Vacancies (X%) 2) Increase in acuity 2) 3) Training (X%) (X%) 3) Vacancies (X%) Action Board to assign responsibility to a senior named individual for reducing medical locum spend (usually this is the medical director, with support from the finance director and HR director). Number or approvers Most common reasons for booking locums TEMPLATE: Board dashboard 40% 30% 20% Nov-15 Dec-15 F1-F2 2 Jan-16 Registrars Board level dashboard Feb-16 Mar-16 Apr-16 Specialty Doctor / Staff Grade May-16 Jun-16 Consultant * Colour reflects change compared to 4 week average/previous month TEMPLATE: Working group dashboard Medical locums. Agencies and workforce management G: Which agencies have the highest volume of shifts over the price caps? Latest week H: Which specialties/sites have the highest requests? Agency x Agency x Requests (Shifts) 1,000 911 % within caps* 75% 50% Requests (Shifts) 1,000 911 % within caps 60% 50% Agency x Agency x 850 800 50% 50% 850 800 100% 20% Agency x Agency x 500 800 50% 50% 500 800 60% 54% Agency x Agency x Total 500 400 4,061 50% 94% 55% 500 400 4,061 52% 36% 58% I: Which services have the highest sickness and absence rates? Specialty/site X X X X X 3 Sickness and absence rate (%) This month Last month 30% 25% 20% 30% 18% 20% 15% 0% 14% 20% Additional dashboard for working group Latest week 4 week average Specialty/site x x x x x x x x Total Volume of requests* 415 285 180 104 65 45 20 18 1,132 Proportion approved 75% 50% 50% 65% 40% 100% 75% 50% 63% 4 week average Volume of requests 300 402 221 78 72 50 55 22 1200

Proportion approved 75% 50% 50% 65% 40% 100% 75% 50% 63% J: Which services have the highest vacancy rates? Vacancy rate (%) Actions Specialty/site X X X X X This month Last month 30% 25% 20% 30% 18% 20% 15% 0% 14% 20% Actions * Colour reflects change compared to 4 week average TEMPLATE: Working group dashboard Medical locums. Long term locum bookings K: Who in the trusts have been working on a locum basis for more than one year? # months service Hourly rate Monthly cost Geriatric Medicine 25 140 22,400 Very specialist doctor that have Regular meetings with Medical struggled to recruit to Director Consultant A&E X site 36 120 19,200 Long term vacancy in A&E Offered substantive role Advertised for role Renegotiated lower rate and will be employed via trust's bank. Consultant Paediatrics 13 115 18,400 Maternity cover Offered substantive role (rejected as wants to maintain flexibility). Offered flexible bank role within the trust Doctor agreed to join bank at a lower rate, with further review of pay in 6 months. Registrar Cardiology 28 64 10,240 To cover illness initially, high substantive role performing individual unwilling Offered Advertising post but hard to fill role to take on substantive role. Negotiating with Deanery about larger allocation in future years. Trying to bring member of staff onto bank. Member of staff unwilling to go onto bank. Will need to advertise for role. Offered substantive role (rejected as wants to maintain flexibility). Offered flexible bank role within the trust Renegotiated lower rate and will be employed via trust's bank. Offered substantive role Advertised for role Member of staff unwilling to go onto bank. Will need to advertise for role. Grade Department Speciality doctor Reason for locum usage F2 A&E X site 14 50 8,000 Change in Deanery posts allocated to trust. Speciality doctor Gastroenterology 17 72 6,450 Long term vacancy F2 Ophthalmology 13 42 4,200 Action taken L: Commentary Agencies: Agency x is now offering 100% of shifts below price caps and has been rewarded with Tier 1 status. Agency y refusing to meet the caps. Phased reduction in reliance on this agency is continuing (2 months until complete). Specialties/sites: Support needed on emergency care ward on negotiations with long term locums. Excellent work by Y site in terms of swapping shifts among junior doctors has reduced number of requests filled by agency. Individual meetings with MD and top 5 requesters and top 5 authorisers arranged to discuss drivers of high locum usage. 4 Additional dashboard for working group Risk Rating Update Locum reluctant to renegotiate rate or be employed via bank Two applications for role, interviews week commencing 6 September.

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