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Case Study - Medical Productivity and Job Planning

Acute Healthcare

Medical Productivity and Job Planning


  • Large general hospital based in the Midlands required a review of its medical productivity and job planning as part of a wider CIP programme.
  • The Trust recorded revenue of £317m in FY13/14 and a deficit of £2.5m.
  • The Trust required specific skills and knowledge to support them in the process of improving job planning and medical productivity.
  • The Trust was under financial pressure and required savings from various areas across the Trust, but medical staffing job planning had been considered a priority further to a review by Deloitte which had identified a significant opportunity (c.£4m) in this area.

Key issues and requirements


  • Lack of job planning policy or guidance.
  • Out of date job planning data – many job plans missing, out of date or not fit for purpose
  • No regular job planning reviews.
  • Lack of clarity/understanding of actual medical activity/productivity within services.
  • PA allocation for Consultants and programmed activities requiring a streamline to meet the needs of the service – on-call, routine work, DCCs, SPAs and CPD.
  • Pay bill increasing year on year without increase in activity levels.
  • Temporary staffing spend increasing significantly year on year and not well controlled.
  • Usage of APAs with little obvious justification and lack of regular review.

Kingsgate’s Strategy – Diagnosis


  • Initial diagnosis period (6 weeks) comprising:
    • Assessment of job planning data, process and policies
    • Desktop review of consultant job plans and junior staffing
    • Triangulation of job plan data (Zircadian) with payroll (ESR) and actual medical rostered/planned activity (NB this data was gathered through a series of meetings with service leads/management)
    • Took appointment as Turnaround Director and latterly Chief Operating Officer
  • Reported an initial (risk adjusted) opportunity of £2m in relation to job planning, SPAs, on-call allowances, temporary staffing and theatre productivity.
  • Reported weak controls and processes around job planning and temporary staffing expenditure.

Key issues and requirements

  • Implemented new job plan policy and guidance.
  • Highlighted SPAs in numerous areas (leadership, audit, other roles) which could be removed from job plans in line with the new policy.
  • Implemented temporary staffing challenge board sessions and vacancy controls in order to increase grip over high expend, premium cost area.
  • Helped the Trust implement 247 Time agency booking system which enabled the Trust to reclaim VAT in relation to locum doctors.
  • Led training sessions for management on job planning best practice.
  • Led various ‘difficult doctor’ sessions with trust staff to negotiate and agree changes to job plans where there had been disagreement/conflict.

Results and achievements

  • Achieved total agreed savings of £1.3m.
  • Re-aligned SPAs for leadership, audit etc releasing 43 SPAs (£0.5m) in total which could be saved.
  • Provided the trust with detailed plans around removing waiting list sessions (paid at enhanced rates) and improving theatre productivity (removing unused sessions) and improving utilisation. This would provide significant further financial benefit upon successful implementation.