Introducing greater flexibility into NHS contracts can create feelings of uncertainty for rota managers. But as Dr Anas Nader writes, doing so can support greater staff retention, and go hand-in-hand with higher shift-fill rates, reduced staff turnover, and cost savings for the NHS.

In the twelve months to September 2023, it’s estimated that up to 23,000 doctors left the NHS prematurely. Burnt out and exhausted after years of increasing pressures, many clinicians have simply had enough. As the NHS Long Term Workforce Plan recognises, embracing flexible working is a crucial tool in tackling this staff retention crisis. Without better flexibility and more routes to deliver a healthier work-life balance, staff will continue to leave.

However, in some quarters, there’s an ingrained assumption that embracing this evolved working culture might involve staff working fewer hours, thereby creating new staffing headaches as well as increasing costs. This couldn’t be further from the truth. As many NHS trusts are discovering, embracing a more flexible approach doesn’t have to be a cost centre, nor does it necessitate a huge additional hiring drive or create fresh rota gaps. In fact, staff retention can come hand-in-hand with higher shift-fill rates and cost savings. 

The cost of rigidity

The current workforce crisis is costing the NHS billions. Recruitment to replace the thousands of talented clinicians leaving the health service costs a staggering £2.4 billion a year. Meanwhile, managers are having to increasingly rely on third-party staffing agencies to source temporary workers to fill staffing gaps. In 2022-2023, this resulted in an eye-watering £4.6 billion agency spend to keep services safely staffed. 

Rigid rotas, unsustainable hours and inflexible leave policies are one of the biggest drivers behind this record number of resignations. It’s a vicious cycle. As more clinicians leave, pressure increases on those who remain, intensifying staff shortages and increasing agency and recruitment spend as a result. 

Agency staff and recruitment are both integral to maintaining a healthy and effective NHS workforce. But the current firefighting approach is leading to an overreliance that is resulting in unsustainable costs and failing to solve the root problem. 

In short, a lack of flexibility sits at the heart of this financial burden. 

Flexibility keeps people in post. With better work-life balance, NHS staff stay in their roles for longer, report lower levels of sickness and absence, and are able to perform better at work. Collectively, retaining a healthier, more efficient workforce reduces reliance on third-party agencies, radically cutting costs. 

Removing the rostering headache

However, as trusts pursue this approach to reduce their agency reliance and the associated costs, you’d be forgiven for thinking this boost to individual autonomy could present a fresh headache for rota managers. Yes, they might have better retention rates and a more secure workforce, but won’t they instead be trying to fill shifts with more part-time staff or those with complicated rota preferences? With the right systems, however, flexibility for staff shouldn’t create new rostering challenges. 

One of the key barriers to implementing effective flexible working policies and unlocking genuine cost-savings is a lack of appropriate tools. Currently, many NHS workforce teams are still having to rely on outdated, admin-heavy and data-blind staffing systems which make it impossible to give staff the flexibility they need while maintaining safe staffing levels. This leaves retention on the back burner and intensifies over-reliance on recruitment and agency usage to fill the gaps. 

Smart, interoperable and data-led digital workforce systems can unlock more streamlined and strategic workforce planning with flexibility at its core. Digital rostering solutions are giving managers quicker, more comprehensive workforce oversight, enabling them to factor individual clinicians’ preferences into their rotas while deploying staff more effectively in line with fluctuating demand.

Data produced by these digital systems can also give workforce teams a much richer oversight of long-term staffing trends. These can elicit more accurate predictions on future staffing levels, absences and shift vacancies, enabling teams to plan ahead more effectively and avoid cost hikes caused by last minute staffing gaps and pay rate escalations. 

Reasons to be hopeful

Alongside technology, we are also starting to see encouraging examples from across the NHS of where culture-shifts are driving improved retention rates and boosting staff satisfaction. 

On the Wirral, a dedicated staff engagement plan is helping to improve wellbeing and bring down exit rates. In Derbyshire, innovative efforts have been made to develop a more positive culture among community health staff. And in Milton Keynes, changes to staff benefit programmes have brought down vacancies and seen staff turnover fall by almost 4 per cent. 

Change is within our grasp

To truly tackle the NHS staff crisis and stop costs spiralling, we must embrace the right tools and open our minds to a new way of working. Such change is not only needed, it’s also within our grasp. By embracing a more flexible approach to staffing and acknowledging the link between retention and work-life balance, we can get NHS staffing on a surer, more sustainable footing that safeguards its future.