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Trust deploys a finance improvement team to enhance capital sustainability and clinical performance, introducing electronic rotas for staff and decreasing administrative burden


    • Trust was facing financial issues and did not agree on a control total
    • Aim for financial recovery, providing high quality care and maintaining monetary sustainability
    • Ensure best practice is followed and skills of staff re enhanced
    • Implement interventions to enforce cost saving solutions and uplift workforce standards


    • Deployed a Finance Improvement Team (FIT) to enhance financial governance
    • Redesigned standing financial instructions and emergency department rotas
    • Introduced a new annual leave system, allowing medical staff to book leaves electronically
    • Created an electronic system for extra clinical payments, actively allocated staffing groups and replacing paper based rotas
    • Implemented a recruitment and retention premia in hard-to-recruit specialities


    • Delivered a return on investment of £22 for every £1 invested
    • Saved 5000 pieces of paper, ensuring records are audited and automatically uploaded into payroll
    • Resulted in less administrative burden and freed up clinicians time
    • Improved 42 week productivity, reducing additional payments
    • Resulted in increased staffing within the ED, where the number of middle grade doctors doubled


The Finance Improvement Team (FIT) was established in April 2018 following recognition that the trust had been in financial recovery and had not agreed a control total the year prior and would benefit from a dedicated resource to support delivering efficiencies and best practice. The team is made up of financial, operational and clinical members of staff to ensure that it is both dynamic and collaborative.

The team is led jointly by the Deputy Director of Finance and the Deputy Director of Operations to encourage challenge, learning and innovation whilst ensuring decisions are well balanced between providing high quality patient focussed care and financial sustainability. It is expected that the team will deliver £22 for every £1 invested but also has also:-

a. Improved financial governance by leading the redesign of Standing Financial Instructions.

b. Introduced a new annual leave system that allows medical staff to book leave electronically but also clear processes for booking leave.

c. Redesigned the Emergency Department rotas that resulted in more clinical facing time with no increase in cost. One of the key values has been to ensure that best practice is shared and to ensure skills and processes are embedded across the Trust.


Clear key performance indicators (KPIs) were developed so that the team could easily be monitored on performance. They were developed and agreed in line with areas whereby efficiencies could be made, these were:

a. Return on investment of £8 for every £1 invested in year and recurrently.

b. To implement an electronic medical annual leave system across the trust and jointly agree a process with Clinicians to ensure consistent counting and recording of annual leave.

c. Review and implement a system to record Waiting List Initiatives, known as Extra Clinical Payments c. £2.5m and 5000 pieces of paper across the organisation.

d. Have a signed off business case and roll-out plan for a new E-Roster system for key staff groups in line with national planning guidance.

e. A qualitative questionnaire to ensure FIT had landed well across the organisation and is promoting the Trust’s values and behaviour.

f. To have all consultant job plans signed off and recorded in an electronic solution.

g. A review of both the Frequency and Intensity of

On call payments will be underway with clear objectives and completion dates.

h. To share learning and best practice. All objectives are on track to be delivered.


FIT are currently delivering a return on investment of £22 for every £1 invested in year and £18 for every £1 invested recurrently. Introduced and electronic system for Extra Clinical payments, this has saved 5000 pieces of paper and ensures records can be audited, automatically uploaded into payroll and has taken an administrative burden from clinicians.

FIT are actively rolling out allocate to all staffing groups across the trust which replaces paper-based rotas with an electronic system giving staff 6 weeks’ notice of work rosters in line with Lord Carter. The recording and counting of Medical annual leave was recognised to be inconsistent and through the medical staff negotiating committee, supported by the BMA, FIT have agreed, working with clinicians how leave should be counted and implemented an electronic solution that makes it easier to book leave.

This is improving 42-week productivity and reducing additional payments. FIT has supported delivery of 5% of the overall trust efficiency programme, a programme which has been highly commended by NHSI. FIT has stepped into support a number of failing schemes and improved delivery and staff morale. The Associate Medical Director has redeveloped the job planning guidance and FIT are currently leading job planning training across the Trust.


FIT liaise with not only the executive board via regular presentations to finance committee but also work with ward managers and clinicians by attending a number of specialty meetings and working groups to ensure they are aware of the support the team can offer. The Trust Efficiency Programme (TEP) is currently broken down by theme groups, of which each has its own governance forum where ideas are collated, discussed and actioned.

FIT have actively attended each group acting as an additional resource to support operational and clinical staff to implement and embed new ways of working and challenge whilst ensuring efficiencies are realised. FIT challenge themes in line with information from key benchmarking reports such as Model Hospital, Lord Carter and GIRFT reports. This is shared with teams and support is provided to ensure individuals feel at ease using and understanding the data.

The 2019/20 Themes have been developed in line with feedback obtained by FIT and via national benchmarking tools. The Trust has a significant number of vacant Radiologists. FIT, listening to the Radiology team put a business case together to recruit advanced reporting Radiographers and have since recruited two posts reducing the pressure on both Radiologists and finances.


As a results of the actions FIT have taken we have increased clinical presence across the trust providing a higher quality of care to patients at no extra cost. The team implemented a recruitment and retention premia in hard to recruit specialties and a new recruitment pack, resulting in increases in staffing. Within the Emergency Department (ED) the number of middle grade doctors has now doubled. The team implemented an electronic rota system in ED which outlined the financial implications depending on how it was staffed, this resulted in:

a. More senior representation across ED at no extra costs

b. More expensive staffing were no longer being offered shifts, consequently, this staff group have agreed to renegotiate rates, saving as much as £40 ph.

c. A plan to develop the system in other medical specialties.

The above actions have also supported to ensure that the trusts operational performance across all standards is one of the best within its STP. FIT have actively led on the rollout of revised standing financial instructions ensuring that systems and processes were embedded within clear timeframes. Individualised communication was shared with each budget holder to ensure they were aware of the changes and the rational.


FIT was developed to support the whole organisation in terms of making efficiencies, this involves working with internal and external stakeholders. Most of the team was established from credible staff who previously held other internal roles which utilised strong relationships that were already in place across the trust.

The team actively redesigned clinical engagement meetings to promote joint working and the sharing of ideas which have been recognised both regional and national as good practice. Within these forums the team utilises peers to convey and promote any key messages, such as whilst reviewing the current job planning policy this was undertaken by an associate medical director.

The team actively lead by example and maintain credibility by ensuring actions that they say will deliver are achieved, the different levels of seniority within the team also helps to ensure stakeholders are supported not only with delivery but also overcoming any potential issues and ensuring FIT recently led on a market day whereby external suppliers were invited in to meet with a panel to negotiation current expenditure opportunities for the trust. The open and honest relationship between the panel and the suppliers meant that they were able to agree on potential savings.