Bridgewater Community Healthcare NHS Foundation Trust (Bridgewater) is a leading provider of community health services in the north west of England, operating a network of 180 different locations.

Bridgewater provides high quality community and specialist services to almost a million people living in Bolton, Halton, Oldham St Helens, Trafford, Warrington and Wigan Borough.

The majority of services are delivered in patients’ homes or at locations close to where they live, such as clinics, health centres, GP practices, community centres and schools.

They employ 3,400 staff and have an income of £140 million which comes from their commissioners, who include Clinical Commissioning Groups (CCGs), NHS England and local authorities.

The challenge

Set against a backdrop of a growing demand for 24/7 access to health and social care professionals and increasing financial challenges within the NHS, Bridgewater’s first and foremost objective is to fulfil its contractual NHS obligations and deliver high quality, safe and effective care which meets both individual and community needs.

With a growing need for around-the-clock, quality, appropriately qualified, staff at competitive rates – and after a particularly demanding internal audit – the senior management team at Bridgewater identified a number of challenges, regarding their temporary recruitment.

They approached our team for a simple, compliant, cost-effective and sustainable solution that could be implemented across their various community sites, addressing the following:

  1. Limited visibility of expenditure and a lack of important Management Information – resulting in poor central management control and not being able forecast effectively.
  2. The requirement for visible in date compliance, employment checks that adhered to NHS employment standards and framework requirements and quality control, to ensure none of their 180 locations were left vulnerable to patient care and CQC inspection risks.
  3. The logistical, commercial and legislative risks arising from dealing with multiple recruitment agencies, operating under separate terms and separate commercial arrangements.
  4. The lack of transparency caused by agencies invoicing charge rates only, with charges varying agency-to-agency and location-to-location. This issue was compounded by some agencies charging differing rates for the same type of worker from the same agency at different locations.
  5. The high dependency on agencies operating off the NHS Improvement-approved national/regional framework agreements – contravening the recently introduced rules, regarding the use of agency staff brought in by Monitor/TDA.


The solution

In order to ascertain a true understanding of the situation, we offered to carry out a ‘deep dive’ detailed analysis of Bridgewater’s current position, using their dedicated project management resource.

Our model works by creating a compliant, agency panel whereby all supplying agencies agree to transparent, standardised terms and conditions and rates. These are locked down in our proprietary software system, known as e-tips®. All staff bookings are ordered through e-tips® – a simple, easy and quick way to track and manage the recruitment process.

Following the analysis, we presented a detailed operational and cost reduction proposal that suggested an innovative, sustainable model that could be implemented across all of Bridgewater’s sites. Importantly, this could be delivered whilst Bridgewater continued to fulfil their contractual NHS obligations, and deliver the very best patient care and wellbeing.

When the contract went live, the implementation process took just eight weeks, with a dedicated Contract and Performance Manager appointed to visit sites, train staff on systems and understand the service requirements, supported by an out-of-hours fulfilment service.

Since going live just ten months ago, the results of the partnership have been outstanding:

  • With spend now over £2.2 million, nearly 60,000 hours of quality care have been delivered, whilst achieving £203,100 in cost savings. Most crucially, this has not been at the expense of patient safety.Bridgewater now has a single agreement and single set of rates/terms and conditions. Through setting and monitoring KPIs and implementing NHS Improvement rate caps, supplying agencies now compete on quality rather than price.
  • The amount of spend going “off framework” has dramatically reduced, with a relentless focus to eradicate completely. Use of our electronic ordering system, e-tips®, enables hiring managers to contact multiple framework compliant agencies in seconds, with just a few clicks of the mouse.
  • Bridgewater now has access to an increased talent pool of GPs, prison nurses, physios, practitioners, pharmacists, IT engineers and admin staff – with over 40 compliant agencies on their panel.
  • In a recent monthly analysis, nearly 10,000 worker hours (266 FTEs) were recorded and a fulfilment rate of 95% was achieved, with the majority of rates being compliant with rate caps. This control and visibility would not have been possible without e-tips®.
  • Compliance is managed via the system and meets NHS Employment Check Standards and framework requirements. In addition, it is backed up by rigorous supplier audits carried out by our team on Bridgewater’s behalf. Workers cannot be put forward for a role on the booking system without full compliance checks.
  • Prior to using the e-tips® system, Bridgewater did not have assurance that their agency workers had correct compliance checks. A recent internal audit confirmed they now have ‘significant assurance’ on the compliance of their agency workers.
  • e-tips® has also provided Bridgewater with much-needed visibility and control of their temporary staffing spend, enabling them to forecast efficiently with access to real-time Management Information.
  • The system has reduced thousands of invoices to a single, consolidated, weekly invoice. This has saved a considerable amount in terms of administration and resource – allowing Bridgewater to refocus their time and energy elsewhere.
  • So far, by implementing our model, the Trust has saved around 8% from the previous cost in real cashable savings, whilst ensuring the very best temporary staff are working with patients. In addition, there have been savings related to back-office processing and temporary staff ordering.

Next steps

We are working with Bridgewater to introduce an online staff bank management service. This will help to not only build their bank of workers, but manage their availability and bookings through e-tips®, which has recently been updated to reflect NHS requirements. This will aim to increase bank usage and effectively reduce the use of agency staff. Phase one of this project will be rolled out with community and district nursing.

Mark Duffy, Senior Procurement Partner at Bridgewater Community Healthcare NHS Foundation Trust, comments:

“I would highly recommend this approach to any NHS Trust or healthcare operation with a high dependency on temporary staff, wishing to gain greater control, transparency and quality whilst ensuring best overall value.

“Before our partnership began, major issues we faced surrounded the lack of Management Information available in a timely manner, and managing a large number of temporary recruitment agencies all working to differing Service Level Agreements. We now work with a select number of agencies that have signed up to our standard terms, meaning we can continue to deliver consistent levels of high quality care at all times, across all our 180 locations. The cost savings generated since late January have also been impressive.

“Our dedicated Contract and Performance Manager works closely with our operational teams, providing continuous support and expertise in those areas experiencing challenges, related to supply or quality.”

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