The Royal College of Physicians (RCP) has published guidelines to help those who are organising core hospital medical services understand how many healthcare professionals they need to provide safe and effective care.
The Guidance on safe medical staffing report outlines that trusts are being encouraged to measure their own staffing levels against the recommendations made by the RCP.
NHS Providers currently employ ‘1.1 million whole time equivalent staff but that they have 100,000 vacancies’, according to official data by NHS Improvement.
Recently, recruitment of doctors has become one of the most pressing issues in the NHS and patient care has also become jeopardised by staff shortages and low morale. The RCP census shows that 45% of posts are going unfilled.
The guidance in this report outlines how the various core medical services of a hospital should be staffed to enable safe patient care.
RCP president Professor Dame Jane Dacre said: ‘We hope to work with NHS colleagues to refine the method in different hospitals, so that it can help ensure that patients are not put at risk by medical workforce shortages.’
So, how can you make sure your trust is adequately staffed to meet patient’s needs?
Here is our pick.
1. Time is precious
Think about how much time your staff need to diagnose, treat and manage patients within their given job.
The RCS guidance divided clinicians into three tiers according to what their jobs involve.
- Tier 1: Competent clinical decision makers – doctors who can make an initial assessment of a patient
- Tier 2: Senior clinical decision makers – doctors who can make a clinical diagnosis
- Tier 3: Expert clinical decision makers – ‘clinicians who have overall responsibility for patient care’
For example, the RCS calculated that for the safe medical staffing of a 30-bed medical ward by day (Monday to Friday) without a Tier 2 or Tier 3-led ward round, approximately 14.5 hours of Tier 1 time is needed, which corresponds to two full-time Tier 1 clinicians being present on the ward daily.
You can access the full list of RCS recommendations here.
2. Agree an effective escalation protocol
Trusts should have an effective escalation plan in place, as there could be considerable variation ‘in both the availability of clinical staff and the number of patients who require medical care’, according to the RCS.
It is essential that Trusts adopt robust processes in place to respond to surges in activity that could compromise delivering safe care to patients.
The RCS recommends that hospitals:
- Calculate routine staffing requirements on 80% of maximum activity
- Adopt mechanisms to monitor surges in activity that could compromise safe patient care
- Adopt mechanisms to respond to those surges
- Review routine staffing requirements if surge triggers are activated on a frequent basis
3. Use e-rostering
Implementing an e-rostering system will allow your trust to reduce spending on agency staff and make efficiency savings.
Through e-rostering, managers can hold information on their employees’ shift patters in one place, enabling them to check their preferred shift patterns, when they booked their annual leave, and information on sickness absence.
Having access to this type of information will enable managers to build rotas to better meet patient demand.
Trusts should monitor staffing levels on a daily basis, along with the level of sickness and dependency of their patients.
A quick way to effectively monitor staffing levels could be implemented by using an app, as Nottingham University Hospitals NHS Trust did to monitor their nurse staffing levels.
Nurse leaders went from relying on the manual collection of nurse staffing levels at key points in the day to collecting data through an app.
The app is pre-programmed with details of planned staffing for each shift for every ward and at handover the nurse in charge updates the app with the accurate staffing numbers and relevant information.
A red flag system is also used that allows staff to raise their concerns about staffing levels.
You can access the full case study, compiled by NHS Improvement, here.