1. Medical locums. Spend, volume and prices
TEMPLATE: Board dashboard
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
25%
YTD % reduction in total agency spend achieved
24%
YTD % reduction in medical spend achieved
17%
Safety
No reported safety issues due to agency.
YTD spend
£3m under ceiling
17% reduction in medical spend vs. 24% reduction in total agency spend.
M3 spend is 20% lower than previous year.
Biggest issues
Particular challenge with X service/site. [Action taken]
Poor take-up of electronic request system in X service/site. [Action taken]
Data concerns?
Ceiling 2016/17
Include projections by staff group if available
B: Has the volume of medical agency shifts changed?
C: How have the prices paid for medical staff changed?
Board level dashboard

2. Last month/4 week average
TEMPLATE: Board dashboard
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
Number of locum requesters 60 70
Number or approvers 40 20
Proportion of direct booked shifts
50%
Proportion on framework
98%
96%
95%
Proportion booked within 48 hours
Most common reasons for booking locums
1) Short term sickness (X%)
2) Increase in acuity (X%)
3) Vacancies (X%)
1) Annual leave (X%)
2) Vacancies (X%)
3) Training (X%)
1) Long term sickness (X%)
Action
Owner
Completion date
Risk rating
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). MD
01/08/2016
Set up weekly meetings with MD, FD and COO to discuss performance and agree Terms of Reference for group.
COO
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.
Set up good quality real time data to identify hot-spots (specialities, grades, individuals) to target
Develop locum bank.
Head of temporary staffing
20/09/2016
Develop and communicate clear processes for booking locums, including locum booking form.
Associate MD
01/10/2016
Establish workforce establishment needed and ensure that all plans and locums requested are assessed against this.
Centralise locum booking and price negotiation
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.
E: How have weekly medical overrides (rate of agency shifts) changed?
Board level dashboard
* Colour reflects change compared to 4 week average/previous month

3. Sickness and absence rate (%)
TEMPLATE: Working group dashboard
Medical locums. Agencies and workforce management
G: Which agencies have the highest volume of shifts over the price caps?
H: Which specialties/sites have the highest requests?
Latest week
4 week average
Requests (Shifts)
% within caps*
% within caps
Agency x
1,000
75%
60%
911
50%
850
100%
800
20%
500
54%
52%
400
94%
36%
Total
4,061
55%
58%
Latest week
4 week average
Specialty/site
Volume of requests*
Proportion approved
Volume of requests x
415
75%
300
285
50%
402
180
221
104
65% 78 65
40% 72 45
100% 50 20 55 18 22
Total
1,132
63%
1200
I: Which services have the highest sickness and absence rates?
J: Which services have the highest vacancy rates?
Sickness and absence rate (%)
Actions
Specialty/site
This month
Last month X
30%
25%
20%
18%
15% 0%
14%
Vacancy rate (%)
Actions
Specialty/site
This month
Last month X
30%
25%
20%
18%
15% 0%
14%
Additional dashboard for working group
* Colour reflects change compared to 4 week average

4. 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?
Grade
Department
# months service
Hourly rate
Monthly cost
Reason for locum usage
Action taken
Risk Rating
Update
Speciality
doctor
Geriatric Medicine 25
£140
£22,400
Very specialist doctor that have struggled to recruit to
Regular meetings with Medical Director
Locum reluctant to renegotiate rate or be employed via bank
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.
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 performing individual unwilling to take on substantive role.
Offered substantive role
Advertising post but hard to fill role
Two applications for role, interviews week commencing 6 September. F2 14
£50
£8,000
Change in Deanery posts allocated to trust.
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.
Speciality doctor
Gastroenterology 17
£72
£6,450
Long term vacancy
Ophthalmology
£42
£4,200
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.
Additional dashboard for working group