Published: 11/03/2004, Volume II4, No. 5896 Page 32 33
Tasked with supplying staff cover across the health service, NHS Professionals has the potential to become the UK's second largest employer.
Mary-Louise Harding reports
It has not had any easy incubation period, but the move to establish NHS Professionals as a special health authority, with eventual power to monopolise the supply of temporary nurses and allied health professionals to trusts throughout England, will greatly increase its influence.
If NHS Professionals fulfils its potential it is likely to become the largest employer in the UK after the NHS itself, particularly if it expands to provide temporary cover for all doctors, allied health professionals, administrative and clerical, professional and technical staff and possibly other healthcare professionals such as paramedics.
It launched officially as an SpHA on 1 January under the stewardship of former McDonald's US human resources chief Carmel Flatley, and becomes operational from April. It is tasked with ensuring that all trusts source their temporary nurse contracts exclusively through NHS Professionals by April 2005.
It will expand to include all allied health professionals at a later, unspecified date.
The Department of Health's move to establish 'stronger national direction and leadership' for NHS Professionals followed its investigation into the breakdown of the service in many areas when a contract to provide the service to 36 acute trusts was being managed by West Yorkshire Metropolitan Ambulance Service trust.
Late and missing payments to nurses led to defections back to commercial agencies in many areas. Trusts ditched arrangements with NHS Professionals and returned to previous arrangements with agencies, as they found they were paying WYMAS a fee to manage their old direct contracts with private providers.
After the subsequent failure to get anywhere near the national implementation deadline by last April, despite relatively steady progress at providers in London and Oxfordshire, it is hoped that the new body will eventually move to establish a nationally branded service that sets audited standards for quality and clinical governance. It should ultimately rein in spending on commercial agency nurses and 'other healthcare staff groups' last estimated at upwards of£1bn across the NHS.
At the moment, most NHS Professionals sites are concentrating on nurses as the largest part of the workforce, but there is also a service for doctors, and some sites provide temporary staffing for AHPs, administrative and clerical staff and executives.
DoH human resources director Andrew Foster has said he expects the new authority to 'promote partnership working with commercial agencies, building on the success of the London agency project', which sub-contracts to approved agencies for the supply of different groups of healthcare staff following a tendering process. (It is set to announce winners of its phase-three tender process to supply nurses, midwives, health visitors and healthcare assistants by the end of April. ) Mr Foster has promised that development of the service will continue to be supported by 'further central investment until 2005' -£11m was pumped into the project in the 2003-04 spending round - when NHS Professionals is expected to become self-financing.
Implementation is being phased across England, with priority being given to high agency-spending areas such as London and the South East, and specific investment in some areas of the Midlands, East and North.
The DoH says the money is intended to support the costs of 'creating the necessary infrastructure', particularly IT and telephone booking services for NHS staff banks, and to meet the 'transitional costs' before they can become self-financing.
In London and the South, NHS-led transitional project boards are overseeing the work, and the DoH hopes similar bodies will be established elsewhere as implementation gets under way.
There are now more than 80 shareholder organisations and four operational regions - North, Midlands and Anglia, South and London - with 18 service centres.
Around 50,000 staff will transfer to NHS Professionals' employment from 1 April. These services are providing roughly 91 per cent fill rate (100,000 shifts filled per month) of bank and agency staff.
The vision for NHS Professionals is that the eventual fill ratio for nurses will be 90 per cent bank and 10 per cent agency across the country.
View from the front line: Hampshire and Isle of Wight's experience of NHS Professionals
Hampshire Ambulance Service trust won its bid to provide an NHS Professionals service for trusts in the Hampshire and Isle of Wight strategic health authority region in November 2002.
A team of 30 is employed at the local NHS Professionals contact centre, which is managed by NHS D irec t . Five of 16 eligible trusts in the SHA area have implemented the new system since January 2003.
The main benefits include access to full reports on how temporary staff are being used, which means usage patterns can be identified and any issues tackled.
We also take care of timesheets, payments and invoicing to agencies, meaning that a ward manager can replace the customary frantic phone calls trying to find someone to cover a shift with a call to NHS Professionals.
There are a number of obstacles in implementing the service with five local trusts.Trusts'personal data on temporary staff is rarely accurate, with essential information such as home telephone numbers and addresses either missing or incorrect. Incorrect data can delay implementation by months.
Ensuring that nurses'occupational health files were up-to-date has been a major challenge, and we discovered a number of temporary staff working in areas requiring Criminal Records Bureau clearance who had never been checked, or whose clearance had lapsed.Up to 80 per cent of temporary staff had out-of-date mandatory training.
Trusts handing over management of NHS Professionals work to a separate organisation should go through a checklist before implementation:
Get data cleansed and culled.
Nominate a lead manager responsible for liaising with the NHS Professionals implementation team.
Establish competency requirements - get each specialty to list skills/ experience they require for each grade of nurse.
Find out if there are anomalies in pay, ie staff on specialist rates.
Establish training needs for temporary staff.
Communicate with staff as soon as possible.
Get activity data on fill rates and overtime so NHS Professionals has a benchmark to work from.
Agree a date for NHS Professionals will take over the recruitment process.
We also advise a checklist for trusts or organisations planning to manage an NHS Professionals operation:
Build relationships early on with trust staff and inform them in advance of likely problem areas.
Set up a training database.
Allow time to ensure staff can receive training and clearance.
Aim for a standardised, tariff-based pay policy.
Ensure you know about any anomalies in pay.
Get access to trust internal communications.
Alyson Stainer is general manager of NHS Professionals for Hampshire and Isle of Wight
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