E-rostering the clinical workforce

September 2020

NHS England and NHS Improvement

Contents
Introduction ...............................................................................................3
Benefits of e-rostering ...............................................................................5
Governance ..............................................................................................8
Implementation .......................................................................................12
E-rostering process .................................................................................15
Appendix 1: E-rostering levels of attainment ...........................................21
Appendix 2: Definition of terms ...............................................................23
Appendix 3: Governance: roles and responsibilities ................................25
Appendix 4: Board level e-rostering KPIs and metrics ............................27
Appendix 5: Pre-implementation checklist ...............................................28
Appendix 6: E-rostering policy checklist ..................................................29
Appendix 7: Pre-approval e-roster checklist ............................................32
Appendix 8: E-rostering audit tool ...........................................................33
 Introduction
The NHS Long Term Plan1 (LTP) committed that “by 2021; NHS Improvement will
support NHS trusts and foundation trusts to deploy electronic rosters or e-job
plans”. NHS Improvement subsequently published the national Levels of attainment
and meaningful use standards for use of e-rostering software, outlining best
practice when adopting this software.1 This document provides more detailed
guidance for NHS provider organisations on implementing these systems and their
governance, so that they can meet the highest level of attainment in e-rostering.

Lord Carter’s 2016 and 2018 reports on operational productivity in the NHS
recommend all NHS provider organisations use an e-rostering system for all clinical
staff groups. His reviews found that organisations have not always used the full
potential of e-rostering systems to maximise the productivity of their workforce and
reduce administrative time spent planning rosters.

NHS provider organisations also need to be increasingly versatile as they manage

challenges such as changing demography, new technologies and changing patient
needs and expectations. E-rostering enables organisations to respond dynamically
to these challenges.

This guidance will enable organisations to achieve the Carter recommendations by

identifying areas of improvement in e-rostering practices. It reflects the increased
implementation of e-rostering in all provider sectors (acute, acute specialist, mental
health and community trusts) and across all in-scope clinical workforce groups. It
also recognises the importance of e-rostering as a tool to improve workforce
productivity not only within a single organisation, but also at integrated care system-
level as these systems continue to develop.

1 https://www.england.nhs.uk/workforce-deployment-systems/

3 | E-rostering the clinical workforce

 Scope of the guidance
In line with the LTP commitment, we expect all clinical workforce groups to
use e-rostering systems to schedule activity by 2021.

This guidance covers the principles that apply to all clinical workforce groups.
It should be used alongside existing and workforce-specific guidance 2 3 4 5 to
ensure that individual workforce nuances are accounted for.

It is relevant to all provider sectors – acute, mental health, community and

specialist NHS provider organisations.

This document outlines the necessary techniques to e-roster staff efficiently to

deliver high-quality patient care, while minimising operational and clinical risk. It
also introduces the concept of ‘levels of attainment’ (Appendix 1), providing an
objective tool for measuring the maturity of an organisation’s e-rostering processes
against the potential operational capabilities.

Open and transparent e-rostering processes improve employee engagement,

autonomy and satisfaction, and can have a positive effect on retention. When used
alongside e-job planning, they mean the right staff will be in the right place at the
right time, so that patients receive the care they need, and organisations can better
manage their workforce and financial efficiency.

The NHS clinical workforce has the necessary skill, capability and compassion to
deliver world-class patient care. As recommended by the NHS Long Term Plan and
Lord Carter, the meaningful use of workforce deployment software can ensure
these qualities are deployed to best effect, across all clinical professions, in all
healthcare settings.

2 www.nhsemployers.org/case-studies-and-resources/2011/07/a-guide-to-consultant-job-planning
3 www.nhsemployers.org/jobtoolkit
4 https://improvement.nhs.uk/documents/919/Final_AHP_job_planning_FINAL_3a.pdf
5 https://www.england.nhs.uk/workforce-deployment-systems/

4 | E-rostering the clinical workforce

 Benefits of e-rostering
Staff are our biggest asset, and NHS provider organisations have an obligation to
strike the right balance between patient safety, cost and efficiency. Used the right
way, e-rostering can influence culture change and give staff the evidence they need
to make changes at the front line. It gives an overview across the organisation, not
only monthly but daily, highlighting hotspots requiring intervention to ensure
appropriate staffing levels and efficient deployment of staff.

Having an effective e-roster empowers roster creators and senior clinical staff to
make informed decisions. The benefits of e-rostering include:

• details of staffing levels, which aids intelligent planning and deployment of

available resources to meet patient needs within each clinical area
• effective management of budgeted establishments to drive efficiencies in the
workforce organisation-wide to reduce under and over staffing and the reliance
on temporary and agency staff

Leicestershire Partnership NHS Trust

Leicestershire developed a training programme to help managers get to grips
with the rostering system and make measurable improvements in staffing
levels.

What were the benefits?

• reduction in unused hours leading to a better use of substantive staff

time
• effective rostering supporting consistent staffing levels with the correct
skill mix resulting in a reduction of risk and improved patient experience
• shared learning and constructive challenge between managers across
different services
• a significant step towards compliance with Lord Carter’s
recommendation to approve rosters six weeks in advance, moving from

5 | E-rostering the clinical workforce

 approving rosters an average of 3.4 weeks in advance to 5.37 weeks,
despite adding 25 rosters to the system in that period.

• improved use of staff through clear visibility of contracted hours and staffing
levels to provide fair and transparent platforms across all services and activity
• flexibility as the situation changes daily and hourly, promoting the effective
redeployment of staff across the organisation to maintain appropriate staffing
levels
• improved recording, transparency and management of planned and unplanned
non-working time, eg annual and study leave

Bedford Hospital NHS Trust

Bedford introduced electronic rostering for their entire pharmacy workforce.
This gave these staff more notice of their duties, enabling them to better plan
their lives outside work “leading to a reduction in sickness and unauthorised
absence”. The e-rostering system employed also gives the trust “key
information on missing cover and missing skills enabling strategic decision on
priority redeployment and recruitment”.

• detailed information about clinical staff, such as: skill mix and leave and absence
records
• payment of paperless staff timesheets, including unsocial hours, bank, on-call,
call out and locum payments, through data being entered at source on e-rosters
and signed off for payment
• increased autonomy for staff as they are able to choose their duty and off duty
and request leave via mobile devices.

Despite these potential benefits, our work with trusts shows that many
organisations are not using the full functionality of e-rostering tools to maximise
workforce productivity. We therefore developed the levels of attainment in Appendix
1 to help trust boards objectively assess their use of e-roster tools. These levels
can be achieved by following the meaningful use standard guides and NHS
provider organisations should plan to achieve level 4 to fully exploit the potential of
e-rostering tools.

6 | E-rostering the clinical workforce

 Interdependency with e-job planning
For most workforce groups effective e-job planning is a key part of achieving the full
potential of e-rostering. E-job planning enables accurate definition of the workforce
availability and capacity in line with service objectives. This information can then be
used to create an e-roster. This guidance document should therefore be used in
conjunction with its e-job planning counterparts.

For some workforce groups, notably staff who work exclusively in one clinical area
(eg purely ward-based staff) and doctors in training, e-rostering alone is sufficient
because the service requirements for clinical capacity have been defined.

Sussex Community NHS Foundation Trust

Sussex Community procured and implemented an e-rostering system for its
inpatient and community teams. Implementation included training staff to
transfer the existing roster and reviewing any under-utilisation.

What were the benefits?

• rosters could be published to staff six weeks in advance

• increased quality of roster information available to staff and managers
• extended lead times available to temporary staffing office improving
shift fill and increasing patient safety and staff satisfaction
• reduced potential for roster errors, saving managers’ time and
decreasing payroll errors
• enabled analyses of agency use, facilitating changes to reduce spend
• identified areas for development of e-job planning capability for
community nursing, therapy and medics to support workforce
transformation projects.

7 | E-rostering the clinical workforce

 Governance
Governance structure
Implementing e-rostering software represents a significant change in culture for
staff; therefore, board level leadership and engagement are vital for successful
implementation. It is vital that the Caldicot Guardian and Chief Information Officer
endorse the implementation plan and its compliance with the Data Protection Act
and local information governance policy. Our detailed e-rostering projects
demonstrated that NHS provider organisations with high levels of board
engagement, alongside a regular focus on implementation, were more successful at
implementing e-rostering and realising its benefits.

We therefore advocate that organisations implementing e-rostering software create

an e-rostering workforce group led by a single accountable officer and, meeting
regularly. Once in place, this governance structure should be maintained to ensure
that effective ‘business as usual’ (BAU) use of the software is sustained at a high
standard. Over time, data from e-rostering systems will become a core element of
regular workforce management information packs for the board.

A full list of the roles and responsibilities associated with e-rostering can be found in
Appendix 3.

Single accountable officer

Board-level engagement can be facilitated by a clear line of accountability reporting

to the board. This can be provided by a single accountable officer who is a member
of the board or at a senior level reporting directly to the board. The single
accountable officer would be expected to chair the e-rostering workforce group and
may also be responsible for e-job planning.

The e-rostering workforce group

The e-rostering workforce group is responsible for both implementing e-rostering

process and managing BAU use of the software.

8 | E-rostering the clinical workforce

 Every NHS provider organisation will be structured differently, so it may be
appropriate for the e-rostering workforce group to be merged with its e-job planning
equivalent. It may also be appropriate for it to form part of a wider workforce
programme including groups around workforce recruitment and retention, training
and development, and workforce planning. Whichever organisational structure an
organisation decides to adopt, we strongly recommend that the chair of the e-
rostering workforce group reports directly to the board.

Some NHS provider organisations may decide to set up profession-specific

operational groups for e-rostering to delegate responsibility for implementing,
monitoring and auditing the e-rostering process within a specific professional group.
If this decision is taken, then we recommend these committees report directly to the
organisations e-rostering workforce group.

E-rostering takes account of an organisation’s own rules and policies as well as

national legislative rules such as the European Working Time Directive (EWTD) and
workforce contractual terms and conditions. NHS provider organisations should
ensure they understand and reflect local variations, referring to our Workforce
Safeguards guide.

E-rostering policy
We recommend NHS provider organisations have an organisation-wide
e-rostering policy, agreed, reviewed and updated by the e-rostering workforce
group. Ultimately the director of human resources (or equivalent) will be
accountable for ensuring all workforce policies, including the e-rostering policy, are
up-to-date (Appendix 6, a checklist to help organisations review their policy). They
should pay attention to the following:

• Where it benefits safe and effective handovers, certain shifts can be

standardised across staff groups; this should include reference to work‒life
balance and flexible working, to ensure safe patient care.
• E-rosters should be approved and published at defined periods; these periods
can vary depending on clinical workforce. The approval and publishing process
should be monitored and reported to the trust board as a key performance
indicator (KPI). Approval is a two-level process with initial approval by the e-

9 | E-rostering the clinical workforce

 roster creator and final approval by an identified senior member of clinical staff.
This procedure will help with identifying gaps in service in advance and planning
the appropriate staff for the service, helping to reduce temporary staffing.
Approving and publishing the e-roster should follow analysis to ensure it is within
budget, fair, safe and efficient, and within the specified headroom and booked
leave tolerances.

County Durham and Darlington NHS Foundation

Trust
County Durham and Darlington has worked hard to increase how far in
advance rosters are approved and fully use systems capabilities for
monitoring.
What benefits have been achieved?

• all off-duty rosters are now finalised at least six weeks ahead
• flexibility for staff ensuring they can look ahead 18 weeks to get home-
work balance right
• the trust board is now assured the right staff with the right skills are in
the right place at the right time.

How were these benefits achieved?

• four-week block of rosters allow planning for long-term absence,

securing the best possible fill rate
• buy-in and continued support from trust senior executive and care
group management
• close working partnership with e-rostering matron and the rostering
team
• effective rostering and bank policies developed
• rostering calendar used, with a copy of the calendar and user guidance
provided for staff
• monitoring and KPI protocols in place to ensure full compliance with
rostering timing
• shifts standardised to ensure cost-effective working
• weekly paid bank instigated to reward employees quickly has attracted
more staff to join the bank

10 | E-rostering the clinical workforce

 • constant reviews to identify further efficiencies.

• Temporary staffing and the safe staffing risk assessments should be used when
additional staffing is requested. Additional shifts should be formally recorded in
real time in accordance with a clear definition of what generates an additional
shift and the associated escalation process.
• Real-time e-roster recording, and the roles and responsibilities of staff
accountable for rostering, are important. Explicit attention should be paid to out-
of-hours redeployment and support.
• It is good practice to have an organisation-wide calendar for approval processes
and a clear, defined process to escalate the issue if an e-roster is not in line with
organisational policy.

Reporting
E-rostering KPIs and metrics need to be owned at all levels, from frontline staff to
trust board. They should be integrated into operational management processes that
are reviewed monthly and at board level. For example, board level KPI reports
please refer (Appendix 4).

It is good practice to set up regular ‘check-and-challenge’ meetings to improve e-

rostering for all workforce groups. These should consist of senior clinical and
operational staff who are responsible and accountable for approving e-rosters.

11 | E-rostering the clinical workforce

 Implementation
Strategic case for change
Before procuring software a clear vision for the programme or project needs to be
agreed. This would usually be outlined in a strategic business case. It will provide a
preliminary justification for the work based on a strategic assessment of business
needs and a high-level assessment of likely costs and potential for success. To be
successful, it is important software procurement is linked to a robust implementation
plan and a sufficiently resourced project team. A pre-implementation checklist of
early considerations is included (Appendix 5).

Providers are encouraged to consider systems that support a multi-professional or

competency-based approach to workforce planning and deployment, where there
are a variety of benefits associated with workforce alignment and efficiency.

A workforce deployment system will support development of a productive and

engaged workforce, but ultimately success will depend on a robust implementation
plan and active benefits management.

Detailed project plan

Once the organisation has signed up to implementing new software or switching
supplier(s) it can develop a detailed project plan. Careful consideration should be
given to the phasing and life cycle of the project plan and transfer to the resulting
BAU model.

Procurement

When purchasing software, providers should procure against our Workforce

deployment systems: Software requirements specification, which stipulates core
and value-added system requirements. Software should be procured from a
workforce deployment systems framework and use the contract toolkit to set up the
contract. This will ensure relevant issues, such as data ownership, standards of
customer service and standard contract break clauses, are covered. This will also
help with effective contract management once the contract is agreed. Following
these steps will ensure the software procured is fit for purpose and able to

12 | E-rostering the clinical workforce

 interoperate with related software systems, such as other workforce deployment
modules, the electronic staff record (ESR) and bank and agency systems.

Peer learning from other providers can provide insight into different software
systems and standards of customer service. A variety of supplier packages are on
offer, so we recommend providers investigate items such as training, pricing
models, emergency support and data storage solutions to learn from other NHS
providers.

Depending on workforce in scope, switching software suppliers is likely entail the

parallel running of two or more systems during transition to allow for data migration
and could require a phased roll out. It is advisable to allow time for testing of new
systems before full implementation. Thought should also be given to storing data
safely in compliance with the organisation’s information governance policy and legal
requirements.

Project team

Plan the new workforce deployment systems project according to project duration
and the number of staff and types of professional groups in scope. Scope can vary
greatly, so it is beneficial to learn from peers.

Once a project plan has been approved, create a communications plan to optimise
staff awareness and engagement throughout the project lifecycle. This will clearly
identify the clinical leadership, case for change and schedule for briefing and
training sessions- which should be planned with clinical staff shift patterns in mind.
Investing in appropriate staff training is key to the successful implementation of e-
rostering, ensuring that staff have the skills and knowledge to e-roster effectively.

A stakeholder map will help to involve affected teams in project planning. Close
liaison with clinical, finance, information management and technology (IM&T) and
workforce teams will enable them to:

• undertake any preliminary work, such as ESR and staff establishment reviews
• agree key project milestones, benefits to track and success criteria
• plan business over critical periods and arrange backfill where required
• set expectations.

13 | E-rostering the clinical workforce

 The project team will require both workforce and system expertise and a proven
ability to manage change. Individual roles will be related to unique skillsets. The
inclusion of frontline staff in the project team is key and will help bridge the gap
between software experts and clinical staff.

The project team should be linked into the organisation’s change governance
structure. A phased roll-out will help resolve issues through a ‘test and evaluate’
approach. When planning a phased roll-out, consider the BAU requirements arising
at different project phases, including ongoing monitoring, training and post-
implementation support. As the project progresses, resource will need to be
converted into the newly established BAU model.

Training

Following initial training, an ongoing programme of training will be required, tailored

to individual roles and responsibilities (Appendix 3). This could range from basic
system training or e-learning at induction for all system users to advanced
configuration and reporting training for workforce personnel. System users, rota
coordinators, clinical leads, professional leads, workforce information managers
and board members will all have different training needs. The operational manager
can play an important role in bringing financial, performance and contract
considerations into the rostering process, especially as they will also be able to
support multi-professional rostering across a service line.

It is a good idea for the education or organisational development department to

consider how the skills relevant to workforce deployment systems will fit into their
existing leadership training programme. This will encompass many general
management skills, such as handling difficult conversations, but should also include
finance, workforce and analytics training to ensure shared understanding and goals
between workforce and leadership teams.

14 | E-rostering the clinical workforce

 E-rostering process
Clear understanding of the service needs is a prerequisite of effective e-rostering.
Without clarity about the demand for staff, an organisation can never e-roster
effectively. The ESR must be regularly and accurately updated, to help in regular
reconciliation with the e-rostering system and vice versa.

The budgeted establishment and required ward, department, clinical areas and
service roster templates must be aligned. They must be determined by factoring in
headroom and regular reviews of staffing establishment. For nursing and midwifery,
these reviews should use the National Quality Board (NQB) evidence-based
guidance, which recommends acuity and dependency modelling tools. For other
staff groups, the relevant guidance on safe/appropriate staffing levels published by
Royal Colleges, Societies and other professional advisory bodies should be taken
into consideration, in combination with local knowledge, experience, professional
judgement and individual job plans. Publishing rosters 6-12 weeks in advance
allows employees to better plan their work life and annual leave. Publishing rosters
early also helps managers to identify gaps in service and arrange suitable cover in
line with organisation policy. Early publication of rosters helps in covering the gaps
using bank temporary workforce rather than agency workers therefore reducing the
agency expenditure. Once the e-roster has been created and before final approval,
it is good practice to complete a checklist (Appendix 7) for an example of a
checklist.

Safe, sustainable and productive staffing: NQB’s guidance, Supporting NHS

providers to deliver the right staff, with the right skills, in the right place at the right
time: Safe, sustainable and productive staffing, can be found on NHS England’s
website.5

Service specific guidance material is listed below:

• maternity services6
• adult inpatient wards in acute settings7

5 www.england.nhs.uk/ourwork/part-rel/nqb/
6 https://improvement.nhs.uk/resources/safe-sustainable-productive-staffing-maternity-services/
7 https://improvement.nhs.uk/resources/safe-staffing-improvement-resources-adult-inpatient-acute-
care/

15 | E-rostering the clinical workforce

 • mental health settings8
• neonatal care and children and young people's services9
• urgent and emergency care10
• district nursing services11
• learning disability services12
• case studies13
• an update on safe staffing improvement resources for specific care settings14

Once the establishment is agreed with senior clinicians, managers and finance
colleagues, it can be measured as an output into Direct Clinical Care (DCC) and
Care Hours Per Patient Day (CHPPD- https://improvement.nhs.uk/resources/care-
hours-patient-day-guides/).

Staff availability
Required e-roster templates

• Required e-roster template staffing levels should be determined in conjunction

with finance and clinical departments. It is essential the required template aligns
budgets with each clinical area.
• It is important budgets are aligned with the required e-roster templates with
attention paid to how establishment is converted into a roster template.

Headroom

• Headroom is the % uplift to establishment applied to take account of predictable

absences including annual leave, study leave, sick leave and maternity leave.
• Other discretionary leave will result in non-working time and should be
referenced in the organisation’s e-rostering policy guidance.

8 https://improvement.nhs.uk/resources/safe-staffing-mental-health-services/
9 https://improvement.nhs.uk/resources/safe-staffing-neonatal-care-and-children-and-young-
peoples-services/
10 https://improvement.nhs.uk/resources/safe-staffing-urgent-emergency-care/
11 https://improvement.nhs.uk/resources/safe-staffing-district-nursing-services/
12 https://improvement.nhs.uk/resources/safe-staffing-improvement-resources-learning-disability-
services/
13 https://improvement.nhs.uk/resources/safe-sustainable-and-productive-staffing-case-studies/
14 https://improvement.nhs.uk/resources/safe-staffing-improvement-resources-specific-care-settings/

16 | E-rostering the clinical workforce

 Staff leave and non-clinical time
Working restrictions

• All working restrictions, less than full-time training or flexible working

arrangements, should be formally agreed between the education authority,
managers, HR and the employee, so all parties agree with the working pattern.
This should be regularly reviewed – at least annually – in line with organisation
policy in case circumstances change.
• The policy for working restrictions aligns with the organisation e-rostering policy,
and each should contain a link to the other so staff are clear about the
organisation’s expectations.
• Lifting working restrictions for some employees as their needs change, makes it
more likely you will be able to accommodate new restrictions for other employees
whose circumstances may have also changed.

Annual leave management

• It is essential that annual leave is appropriately planned throughout the year to

maintain sufficient staffing levels. This will ensure that staff take regular rest
periods and avoid excess leave accumulating at the end of the leave year.
• Managing annual leave effectively throughout the year will mitigate the need for
excessive additional temporary staffing. If a ward, department or service line has
too few staff taking annual leave every month, it will have a problem when staff
request leave at the same time, leaving duties inadequately covered. Poorly
managed leave makes an overspend highly likely.
• The e-roster system allows you to build into the roster a maximum or minimum
amount of staff who can be on leave. It will flag when too many or too few staff
have been allocated to take leave.
• Organisations with good processes for annual leave management have clear
rules for taking leave. They often have a set percentage of leave that needs to
be taken at certain points of the year: for example, 50% by six months into the
year. This process improves staff wellbeing and ensures leave is appropriately
planned throughout the year.

17 | E-rostering the clinical workforce

 Sickness leave management

• Sickness rules can help highlight when sickness has gone above specific
headroom percentages or KPIs. They should be managed in line with local
organisational policies specific to managing staff sickness. It is important to
record sickness correctly so that flagged events can be case-managed
appropriately as soon as possible.
• Organisations should have auditable, consistent and transparent return-to-work
policies. They should be supported by clear, fair and consistently applied
practices: for example, a minimum amount of sickness absence before
withdrawing an employee’s access to bank or locum shifts. The e-roster system
should flag if this is not observed while booking temporary staff.

Study leave management

• Organisations should regularly review study leave policy, which should cover all
workforce groups.
• Organisations should convert study leave policy into rostering software rules, to
effectively manage study leave levels in accordance with service continuity.

Supporting professional activity (SPA)/non-clinical days

• Non-clinical days are when staff are on a designated clinical area but not
providing direct patient care.
• The organisation must agree a definition of a non-clinical day; the e-roster should
provide the facility to customise the reasons.
• Reasons on the e-roster system for non-clinical days should be reviewed every
six months. A review of the number of days should be part of the monthly KPI
report.
• Organisations should monitor SPA time – this includes, but is not limited to,
activities such as appraisal, teaching, training, mandatory training, research,
audit, clinical management and continuing professional activities (CPD).

Supernumerary

• Supernumerary refers to staff who are not counted in the clinical numbers ‒
usually new starters on induction. The supernumerary option should appear as
part of the working-day.

18 | E-rostering the clinical workforce

 • The e-roster system should record staff as supernumerary only, and not record
them as additional duties.

Real-time e-rostering
A delegated roster lead should review daily staffing levels in real-time– staff, skills,
and patient acuity and dependency – to support evidence-based decisions on safe
and effective staff redeployment to clinical areas. Currently acuity and dependency
tools are available for much of the nursing workforce and other professional groups
are working to establish these tools.

Operational changes that may occur daily need real-time responses to redeploy
staff. These must be reflected in the e-roster system at the earliest opportunity.

E-rosters need to be updated as a live system and should always reflect the
availability and deployment of all staff at any given time.

In the Introduction, we outlined why ensuring the policies and rules are fit for
purpose is vital. E-rostering should take account of each organisation’s rules and
policies as well as national legislative rules such as the EWTD. An organisation’s e-
rostering policy should be developed to reflect these rules.

Local rules should be implemented with reference to evidence, national guidance,

contractual terms and conditions and legislation. Where local rules diverge from
national guidance, evidence and auditable transparent governance arrangements
should be in place.

Policies should state escalation procedures. Increasingly, organisations are

developing formal, visible and audited escalation processes triggered by both
exception data from rostering and benchmark data comparing wards, clinical
services and even organisations.

Organisations are ultimately responsible for the rules and policies and for how they
respond if expectations are not met. Note that not all rules apply to all areas: for
example, the policy on weekend working may differ for each department, clinical
area and speciality.

All organisations should have clear processes for updating e-rosters and who is
responsible for updating. Changes, and why they were made, should be reviewed

19 | E-rostering the clinical workforce

 in monthly staffing meetings. E-rosters should be maintained as changes occur in
real time, so that national staffing information returns are accurate. Staff who have
responsibility for updating e-rosters should be trained and updates required include:

• recording sickness

• changes to the start and end time of shifts

• shifts or sessions that have been swapped or redeployed from/to other

areas

• requests for temporary staffing

• requests for emergency leave.

It is important that handover time is built into shifts, this may vary depending on the
type of clinical areas and requirements. This time is used to discuss clinical
concerns and escalation processes if a risk to staffing levels is identified.

20 | E-rostering the clinical workforce

 Appendix 1: E-rostering
levels of attainment
Each level of attainment is associated with meaningful use standards outlined in E-
rostering the clinical workforce: levels of attainment and meaningful use standards.

No attainment: E-rostering software may be being procured or in

Level 0 place, but fewer than 90% of employees are fully accounted for on
the system. E-rosters may be in place (eg paper-based or
Microsoft Excel) but not recorded on dedicated e-rostering
software.

Visibility of the individual on the e-roster: The organisation has

procured e-rostering software, ensuring paperless payment
mechanisms, and trained staff in its use. All contracted hours are
Level 1 recorded on the system, ensuring safe working hours and
appropriate skill-mix. Organisation-wide policies detail the e-
rostering process, ensuring consistent roster rules are applied. At
least 90% of employees are registered on an e-roster.

Timetabling: The software is used to capture shift preferences

and staff personal working patterns via a remotely accessible
application. The software can automatically generate rosters, with
Level 2
final roster publication at least six weeks before the roster start
date. Unfilled shifts are identified through regular roster reviews.
The software reports KPIs for use at all organisation levels.

21 | E-rostering the clinical workforce

 Capacity and demand: Teams analyse capacity and demand,
using evidence-based tools where available. Team ‘capacity and
Level 3 demand’ meetings ensure rosters reflect service needs and team
objectives. Software is used to report productivity and deployment
metrics.

Organisational e-rostering: There is board-level accountability

for monitoring e-rostering across all workforce groups, ensuring
Level 4 audit and review. Team objectives, departmental budgets and the
organisation’s objectives are aligned, so the organisation can
respond dynamically to services’ changing needs.

22 | E-rostering the clinical workforce

 Appendix 2: Definition of
terms
Commonly used terms Definition of term

Clinical workforce groups Nurses, doctors, AHPs (allied health

professionals) health scientists, pharmacists and
other clinical groups

Clinical areas Includes wards, clinical specialties, outpatients,

therapies, pharmacy, theatres, accident and
emergency, and other areas where clinical
activity is performed

Senior executive level Human resource director, director of nursing,

medical director, director of procurement, director
of finance, chief information officer

CHPPD care hours per patient day

DCC direct clinical care

SPA supporting professional activity

MD medical director

HR human resources

DoN director of nursing

CA chief AHP (allied health professional)

CP chief pharmacist

SLR service line reporting

Roster approval times All workforce: at least six weeks before due to
work

Doctors: for ‘doctors in training’ a generic work

schedule should be sent out at least eight weeks
in advance with an opportunity to request leave
at this point. A personalised roster should be
received at least six weeks in advance as per the

23 | E-rostering the clinical workforce

 ‘code of practice’ agreed between NHS
employers and the British Medical Association.

Non-working time Annual leave, study leave, parenting, all other

leave, etc

ESR Electronic staff record

WTE Whole time equivalent

Headroom Headroom where identified is the % uplift to

establishment applied to take account of
predictable absences, including annual leave,
study leave, sick leave and maternity leave

24 | E-rostering the clinical workforce

 Appendix 3: Governance:
roles and responsibilities
The organisation e-job planning policy may outline the roles and responsibilities of
those involved in the e-job planning process:

Chief executive and organisation board

The chief executive and organisation board have overall responsibility for ensuring
adequate, effective and efficient rostering of all staff groups throughout the
organisation. They are also responsible for ensuring that all organisation policies
such as annual leave, flexible working and sickness/absence align with the
organisation generic rostering policy. In addition, they should understand how their
organisation performs against the e-roster levels of attainment for all staff groups,
and establish improvement plans to reach level 4.

Executive directors

Accountable to the organisation board for ensuring organisation-wide compliance,

with the e-rostering policy and responsible for the e-rostering system.

General Managers, Operational service managers and Matrons

Responsible for implementing the e-rostering policy in their areas and ensuring the
compliance of all staff groups.

Lead clinicians and department managers

Responsible for implementing the policy locally and ensuring compliance with the
rostering policy when approving e-rosters. This also includes responsibility for
approval lead times and regular reviews of staffing restrictions.

25 | E-rostering the clinical workforce

 Ward managers, department managers, clinical leads, medical
staffing teams, temporary workforce office

Responsible for ensuring e-rosters are produced in line with the organisation e-
rostering policy. Specifically, publishing the e-roster a minimum of six weeks – but
ideally 12 weeks – in advance is critical.

All employees

All employees must be familiar with the organisation’s e-rostering policy,

understanding both the expectations and implications. This should be reinforced
during all organisation staff inductions.

Employee inductions should include what software is used for e-rostering. It should
contain training material on how the e-rostering mobile application works (training
on how to request shifts, annual leave and study leave), including a quick hands-on
demonstration of the system.

Wherever possible, all staff should use the mobile application function or a web
portal to make e-rostering requests.

26 | E-rostering the clinical workforce

 Appendix 4: Board level
e-rostering KPIs and
metrics
E-rostering level of attainment: this should be broken down by professional group
and monitored at organisation level. It should be reported at least quarterly.

Percentage of staff on the e-rostering system: the organisation records the

percentage of clinical staff who have an account on the e-rostering system.
Organisations are aiming for more than 90%. This should be broken down by team
and professional group and monitored at organisation level. It should be reported at
least monthly.

Percentage of e-rosters approved six weeks before the e-roster start date: this
should be reported at least monthly. It should be broken down by team and
professional group and monitored at organisation level.

Percentage of system-generated e-roster (auto-rostering): this is the

percentage of shifts filled by the system-generated functionality. It should be
reported at least monthly. It should be broken down by team and professional group
and monitored at organisation level.

Planned versus delivered hours (net hours) per WTE: cumulative variance
between the number of planned contracted hours and actual delivered hours per
WTE per roster period, excluding doctors in training. The organisation should aim
for less than a variance of 13 hours per WTE. This should be reported at least
monthly, broken down by team and professional group and monitored at
organisation level.

For nursing staff: percentage of actual clinical unavailability versus

percentage of budgeted clinical unavailability (headroom): this should be
reported at least monthly. It should be broken down by team and monitored at
organisation level.

27 | E-rostering the clinical workforce

 Appendix 5: Pre-
implementation checklist
Item

Strategic fit of different software solutions across the

sustainability and transformation partnership (STP) or
integrated care system (ICS) and alignment with
organisation objectives

Fit with related workforce improvement programmes,

such as staff retention, temporary staffing reduction and
clinical pathway redesign

High level outline of project scope, timeframe, phasing,

resourcing and potential clinical and financial benefits

Overview and understanding of the range of systems on

the market and associated benefits

Organisational capability of IT infrastructure and

hardware, workforce skill base and competing organisation
priorities

Identification of preliminary work required, such as basic

IT training for staff, interoperability of related software
systems and review of ESR data quality and processes

Chief information officer, chief clinical information

officer and Caldicott Guardian endorsement

Stakeholder identification and engagement, including:

clinical, operational, finance, IM&T, workforce and analytics
leaders

Shared expectations around markers of success and

metrics for tracking implementation

Organisation should complete the Equality Impact

Assessment (EIA)
1.

28 | E-rostering the clinical workforce

 Appendix 6: E-rostering
policy checklist
This template is a checklist for organisations reviewing or developing their e-roster
policy. It highlights good practice from all organisations in both Carter reviews. This
checklist should be owned by clinical heads, DoN, MD, HoT and CP.

Number Action Yes/No

1 Does the policy highlight:

• the scope
• executive summary
• purpose?

2 Does the policy clearly describe responsibilities

including those of:
• chief executive and organisation board
• DoN, MD, CPhO, HoT
• general managers, operational service managers
and clinical heads of departments
• ward managers, department managers or
deputies
• all employees?

3 Does the policy include rules for producing e-rosters

including:
• timetables for roster approval times
• organisation agreed headroom where identified
• organisation agreed KPIs for annual leave,
sickness, training, maternity leave, carer’s leave
and other leave?

4 Does the policy include rules highlighting that high

priority, hard-to-fill shifts should be filled first when
producing the e-roster?

29 | E-rostering the clinical workforce

 5 Does the policy link to organisation policies on:
• working restriction/flexible working policy
• sickness/absence policy
• training and development policy
• annual leave policy
• study leave policy
• equality and diversity policy?

6 Does the policy highlight the process for validation and

approval of rosters:
• by roster creators as the first level to validate and
approve
• by clinical heads and managers for second
validation and approval?

7 Is there an escalation process when e-rosters are not

approved on time and how is it monitored?

8 Does the policy cover the process for staff changing

published e-rosters, including:
• the importance of keeping e-rosters up to date
• process for audit
• the requirement to keep shift changes to a
minimum?

9 Does the policy clearly state the maximum

supernumerary period available to staff, with guidance
on taking account clinical areas requirements and
individual needs?

10 Does the policy have a section on skill mix, including

ensuring appropriate cover on each shift and specific
competencies depending on the workforce groups?

11 Does the policy include a section on how staff make

requests:
• with maximum number of days off within e-roster
period
• requests considered in the light of service needs
• working restrictions/flexible working needs
• fairness in allocating shifts?

12 Does the policy include a section on shift patterns and

EWTD (European Working Time Directive), including:
• shift patterns worked in the organisation
• time-owing process – for booking and taking it
back, with guidelines on limits
• rest periods highlighted for workforce groups?

30 | E-rostering the clinical workforce

 13 Does the policy include rules on taking unpaid breaks?

14 Does the policy highlight the process for effective use of

temporary staff, including:
• bank staff or/and locum staff
• escalation process for agency staff
• process for recording and reporting the
monitoring of temporary staff?

15 Does the policy include the process for booking annual

leave with guidelines on how much leave should be
booked each quarter/half-year to avoid accumulating
large amounts of leave towards the end of the leave
period?

16 Does the policy ensure all leave is authorised in line with

the e-rostering timetable and must therefore be booked
before the e-roster is approved?

17 Does the policy set out annual leave requests for

Christmas and new year and key areas of school
holidays such as summer?

18 Does the policy state any rules on working additional or

bank hours after returning from short-term sickness?

19 Does the policy state requirements for regular e-

rostering policy audits (using a tool like the one in
Appendix 5)?

20 Does the policy have a clear review date?

31 | E-rostering the clinical workforce

 Appendix 7: Pre-approval
e-roster checklist
We developed this template from feedback from organisations for use before final
approval of an e-roster. The organisation e-rostering lead contact details can be
added at the end to offer local support.

Number Action Yes/No

1 Check all shifts have been filled and the contracted

hours are fully assigned.

2 Check annual leave hours are accurate and no

anomalies.

3 Check sickness hours are accurate, and episodes of

sickness have been recorded accurately.

4 Check staff leavers have been removed and the net

hours adjusted accordingly.

5 Check staff starters have been added to the e-roster,

supernumerary shifts have been entered and net hours
adjusted accordingly.

32 | E-rostering the clinical workforce

 Appendix 8: E-rostering
audit tool
This audit tool should be used by the roster manager to monitor compliance with
the e-rostering policy at least every six months. An action plan should be agreed for
areas requiring improvement, as recommended in the Carter reviews.

Ward/department:

Audit completed by:

Date completed:

Yes/No Comment Action

Has the e-roster template

been reviewed on a six-
monthly basis to ensure it is
current, aligned to the
bi-annual staffing review,
realistic and reflects the
staffing required?

Are all the staff aware of the

e-roster policy?

Do the shift and break times

conform to EWTD and
workforce contractual terms
and conditions?

Is the approved minimum

number of staff e-rostered for
each shift/clinical area?

Is the skill mix maintained?

Is annual leave allocated as

per policy?

Is study leave allocated per

policy?

33 | E-rostering the clinical workforce

 Are there any working
restriction/flexible-working
practices for any person in the
clinical areas?

Have these working restriction/

flexible-working practices been
reviewed in line with
organisation policy or at least
annually?

Is the request system used in

accordance with the policy?

Do e-rosters follow the lead

times making it available for
staff to review?

Are unused hours monitored

monthly?

Are break-time guidelines

followed?

Is there evidence of annual

review of existing work
patterns?

Are at least three months’

e-rosters available for
requests?

Is there a process in place for

second-approval of e-rosters?

Do the organisation policies

for e-rostering, flexible
working, annual leave and
sickness/ absence reporting all
align and reference each
other?

Are staff encouraged to use

mobile technology to view their
e-roster, to request leave and
to book bank/locum shifts?

34 | E-rostering the clinical workforce

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