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Transforming the Hire to Retire process across NHS Wales

A case study by NHS Wales Shared Services Partnership                         

NHS Wales Shared Services Partnership is a dedicated shared services organisation sharing common operating standards and systems. The use of one workforce system – the Electronic Staff Record (ESR), across NHS Wales provides significant opportunities for standardising processes, providing more efficient services and lowering costs. However an audit of recruitment and on-boarding processes for new employees across NHS Wales revealed unnecessary delays and duplication of processes.

The delay in Occupational Health (OH) clearance along with the manually dependant process of notifying Recruitment of eligibility to commence work lead to significant delays within the recruitment chain, resulting in a higher dependency on agency and locum staff, often adversely impacting the variable pay bill.

More than ever, the necessity to maximise efficiencies, reduce the variable pay bill and maximise digital resources is critical if NHS Wales is to provide safe, effective, world class health services to its patients.

Coupled with this was significant variation in the use of OH systems and processes, duplication of data entry, inconsistencies in processes, no standardisation of data sets and processes were manual and paper driven. These issues combined and resulted in lengthy delays in OH clearance and delays to appointing new employees into posts.

The Project

With evidence of waste, including duplication and delays in the on-boarding process, a scoping exercise was undertaken to benchmark existing processes against a world class solution.  With the automation, standardisation, portability and workflows that ESR provides, full deployment of ESR was defined as our world class standard across NHS Wales.

An ESR ‘world class Hire to Retire’ vision was developed that defined the process from confirmation of preferred applicant to Occupational Health clearance and readiness to commence in post. This became the blueprint for the project.

We initially undertook a process mapping exercise with key stakeholders including the NHS ESR Team, Occupational Health and Recruitment staff and an OH supplier to determine the degree of variation that existed. This exercise provided us with robust evidence around the differing processes, duplication of data entry, dependency on manual and paper based processes and lack of standard operating procedures across the various organisations. We established a stakeholder group to identify how the ESR OH module and use of ESR Interfacing technology could be used to streamline and automate the processes, and three pilot organisations were identified to test and implement the solution.

Some of the required functionality was already available within the ESR solution, but additional functionality was identified that would enable a bidirectional exchange of information between ESR and the OH system. This required co-production and partnership working. We developed a specification outlining the data exchange required and how the process could work.  For us as a team this was not without challenges; implementing this innovative solution within a live environment introduced high risks because we didn’t have a testing environment, so agile project management was required to ensure services would not be adversely impacted for any length of time.  The Recruitment and OH staff required significant training, support and IT support as infrastructure varied significantly between the three pilot organisations - with different solutions often required. 

This was not a straightforward ESR implementation project to deploy existing capability.  This project was bold and transformational, taking the existing ESR solution and enhancing it to achieve greater efficiencies.  One of the keys to the success of the project was the resilience and commitment of all the project stakeholders which included the three large NHS Wales organisations, Medgate, the Occupational Health provider and the NHS ESR Systems Integration Team to implement a cost effective solution with no additional resource or expenditure.

Benefits

There has been a wide range of benefits identified as part of this project;

• Standardisation and embedding of robust operating processes between Occupational Health and Recruitment resulting in time savings of 23,835 hours per annum within both processes, which equates to efficiencies of approximately £40K per annum across the pilot organisations.
• An 80% reduction in duplication of data entry for Occupational Health administration teams.
• A 20% reduction in the Occupational Health process steps.
• Establishment of standard data sets, significantly reducing variation.
• Portability has resulted in pre-employment data being available to Occupational Health at an earlier stage in the recruitment process, speeding up on-boarding for new employees.
• ESR workflow notifications removed approximately 3,000 clearance emails per annum from the process.
• The project has significantly raised the profile of Occupational Health services.
• The deployment of ESR Self Service has been progressed by organisations to ensure the data in ESR is current and correct.
• Improved visibility about the OH interventions and immunisations required for staff groups.

Potential learning and advice for other Organisations

This project will act as a blueprint for the deployment of the ESR/OH bi-directional interface across all remaining Wales NHS organisations. Lessons learned have been meticulously documented with standard operating procedures created and process maps developed, improved and refined.

Tips for other Organisations:

• Ensure you understand the ‘as is’ process before developing new processes to maximise capabilities.
• Engagement with key stakeholders from the outset – particularly IT - is critical. Many of the issues we encountered resulted from local IT infrastructure, security settings, fire wall settings etc.
• Regular project meetings are very important so that you can manage issues and risks.
• Develop testing scripts and establish a robust testing process of the technical solution.
• Ensure that you provide training for your OH and Recruitment teams so that everyone across those teams understand the new processes, roles and the impact to each service.

The Next Steps

We now plan to fully deploy the ESR/OH bi-directional interface across NHS Wales and our business case has recently been approved by NHS Wales Shared Services Committee.  The next step is to get our project initiation document (PID) developed outlining the timeline and the sequence of on-boarding for the remaining five organisations. 

We are currently developing a specification that will enhance the interface between ESR and the recruitment software (TRAC) that we use to further remove duplication of OH clearance data entry by recruitment staff.

We are going to implement electronic pre-employment health questionnaires. This will require additional data portability from the interface to pre-populate position requirements, but it will reduce delays in pre-employment health information by approximately 50%, leading to quicker on-boarding of new employees and further removal of Recruitment and Occupational Health process steps.

For More Information

For more information about the project and associated benefits please contact Helen Thomas, NHS Wales ESR Hire to Retire Programme Manager at Helen.Thomas7@wales.nhs.uk, or Vanessa Davies, Head of Occupational Health, Hywel Dda UHB at Vanessa.davies2@wales.nhs.uk.

 

 

 

Expanding the use of ESR to Junior Doctors

A Case Study by St Helens and Knowsley NHS Foundation Trust

Background

St Helens and Knowsley have been the sole Lead Employer Organisation for Cheshire and Mersey Deanery since 2010 and manages 2100 junior doctors who rotate not only to any one of 27 Host Trusts but across specialties within Trusts.

400 GP trainees based in any one of 175 GP practices located from Cumbria in the North to Derbyshire in the South form part of the 2100 junior Doctors, and management of this group of staff presents a range of challenges; not only geographical but also around areas such as IT infrastructure and the lack of ESR knowledge.

In April 2016 the trust was invited to tender for Lead Employer Services for GP trainees from Health Education West Midlands (HEWM).  Our experience of managing the GP trainees for Cheshire and Mersey Deanery provided us with the knowledge to manage this group of staff, and although the numbers of trainees were higher the basic principles of our Lead Employer ESR model was seen as transferable.

The GP trainees within HEWM were employed directly by the individual GP practices and managed by the practice managers, with payroll outsourced to numerous external providers. They did not appear on the national ESR Database.

The practice managers would carry out a range of administrative tasks for each trainee; 

• Carry out ID Checks and maintain records.
• Carry out DBS Checks and maintain records.
• Calculate Pay, Grade, Banding paperwork for Payroll Providers.
• Calculate Leave entitlement.
• Complete Absence information, Holidays/sickness/special leave for Payroll Providers.
• Completion of Training/Appraisal data.
• Complete the Termination Process.

The above process would be necessary each time a trainee rotated (up to two rotations per year per surgery) X 470 surgeries.

Our tender involved becoming the lead Employer for the GP trainees and utilising eSolutions such as ESR, not only because of our previous experience with Cheshire and Mersey but also the much larger geographical footprint of the GP locations (Crew to the North and Gloucester to the South).  We demonstrated the need for change and how this could be managed by the streamlining of services and the use of ESR.

Our approach included identifying the benefits of:

• HR and Payroll services provided directly through ESR
• Managing Training and Appraisals through OLM
• Greatly improved Absence Management through ESR
• ESR BI Reporting
• E-Expenses via ESR
• Occupational Health clearance using ESR
• DBS/Right to Work recorded and monitored through ESR
• MSS and ESS and the planned remote Access via My ESS

The reporting capabilities of ESR and in particular absence reporting were an area of interest for the tender panel. With 470 GP practices all independently recording sickness assurance around the reliability, detail and accuracy of this information is a key challenge.

We have developed suites of BI absence reports which we run for the Cheshire and Mersey Deanery.  Being able to provide this level of detailed reporting from ESR was seen as a big positive in our tender and we were successful in our bid, being awarded the contract by Health Education West Midlands starting in August 2016.

The Project

With the contract for GP Services in West Midlands commencing on the 1st August 2016, we initially set a target of introducing ESR MSS and ESS within 12 months.

A Project Team was established involved Key Stakeholders from HEWM to develop a project plan which enabled the implementation of ESR and the Streamlining of services.

One of the major challenges was the geographical spread of the 470 GP practices and their lack of knowledge and understanding of ESR.   Working with HEWM the project team attended GP Practice Manager and Medical Staffing Manager events throughout the West Midlands to present our proposals for the introduction of a Lead Employer model and the streamlining of services through the use of ESR and eSolutions.

These events were well attended with upwards of 50 to 100 Managers attending each event. The response was excellent; with Managers quickly buying in to the proposal, seeing how the model of using ESR as HR and Payroll solution would greatly improve efficiency allowing them more time to manage other areas of the Practice.

We use a Web Based information portal called HR Direct for Managers and Junior Doctors in Cheshire and Mersey Deanery and agreed that this would be ideal platform for training Practice Managers on the functionality of ESR. We uploaded the ESR captivate training video’s onto HR Direct and provided each Practice Manager with access to the captivate files.

The trainee GP’s were set up with access to ESR ESS using a Username and Password, and from September 2016 the trainees began accessing MyESS by first logging into ESR through the secure N3 connections within their practices, and then setting up remote access to ESR ESS via smartphones or iPads.

By adopting this approach to implementing MSS and ESS through remote e-Learning, 80% of the practices were accessing and interacting with MSS and ESS within 4 months of the contract starting, way ahead of the original 12 month target.

The Benefits

There are many benefits of implementing a Lead Employer model using ESR as the main driver for change; these include:

• We have reduced the time needed by Practice Managers on the administration of GP Trainees. This has been conservatively estimated at 12 hours per trainee per rotation. This equates to 12 hours per trainee X 470 Surgeries X two rotations per year X £24 per hour based on Band 8 = £270,720 Per Annum Savings;
• GP trainees appear within the National ESR Data Warehouse, enabling greater scope for central workforce planning for trainee GP’s;
• Central control of absence data enables staff with underlying medical problems to be identified quickly and interventions planned;
• Enables ‘hot spots’ of sickness to be identified, these could be individuals or problems within certain practices;
• Access to MSS and ESS for Managers and Trainees;
• Access through MyESS remotely via Smartphone/iPad empowers GP trainees and managers to access to their own data remotely; they can manage their own information in a quick and easy way; giving them more time to focus on delivering high quality care.

Shared Learning

Our innovative use of ESR functionality has now become the driver in developing the Lead Employer model for managing Doctors in training on behalf of HEE.  With NHS England keen that the remaining other five HE regions for GP’s in training should have a Lead Employer Organisation by the end of 2017, we are working alongside them to promote the model and highlight the vital role that ESR plays within that.  Part of that work involves us developing a help desk facility that the other five HE regions can access for help and guidance whilst they are establishing their Lead Employer model.

“The benefits of using Self Service has enabled us to view and input trainee data in real time. Being able to view sickness history means we can monitor activity and act swiftly should the need arise.  We can also keep track of annual leave and ensure that a trainee has taken the correct allowance.”

Julie Stokes Practice Manager Audley Health Centre North Staffs

The Next Steps

Having recently become the Lead Employer for HE East Midlands with circa 750 GP’s based over 208 GP practices and 14 Acute Trusts we plan to roll out Manager Self Service across these organisations, including a Trust that doesn’t currently use ESR.

As part of the new portal release we will also be looking to implement MSS via the internet to add flexibility of access.

For more information

 If you would like to talk to the team about our Lead Employer model please contact Joanne Powell Head of Workforce Planning ESR and HR Systems Development on 0151 290 4342 or email Joanne.Powell@sthk.nhs.uk.