Case Studies

Case Study 1 – NHS Trust in the North East of England

About the Organisation

This NHS Trust was established in the early 2000s and is a large integrated health care organisation providing high quality acute secondary healthcare. The Trust employs 8,000 staff, some of whom are award winning and internationally renowned for their work and achievements. They treat over 700,000 patients a year from the most serious of emergencies to planned operations and procedures. Their high-quality healthcare services are offered across multiple hospital sites, and various community sites.

The Challenge

This Trust had a number of vacancies across a variety of specialisms. The Trust required 8 middle grade doctors within Emergency Medicine, 2 clinical fellows within Paediatrics and 4 middle grade doctors within Medicine. The Trust had utilised an International Recruitment Agency previously on a retained basis to recruit for a number of positions from India with a poor return on investment. They had been flown out to India and offered 15 doctors but 2 years later on, only 2 doctors had actually started with the Trust. We were contacted by the Interim HR Manager to help (as we had previously delivered on a similar project at another Trust that the interim HR Manager was contracted to). We knew that to deliver this project we would have to utilise our industry leading knowledge and experience to come up with a novel approach to recruiting for these “shortage occupation” posts.

The Process

We met with the HR Team in September 2017 to scope the requirements for this project. We assigned a Project Manager from BDI Resourcing who would be responsible for day to day interaction with the HR Team at the Trust, to ensure that key milestones were being met and the project was being delivered on time and to the satisfaction of the key-stakeholders at the Trust.

As these most of these vacancies were on the “Shortage Occupation” List and the Trust required the doctors to start as soon as possible, we knew that we would have to provide the Trust with an efficient methodology for getting the candidates GMC registered in the shortest possible time.

Our project manager briefed our individual specialist recruiters within Paediatrics, Emergency Medicine and General Medicine about the Trust’s requirements, timescales and expectations. They were also supplied with the Job Descriptions and Person Specifications. The Trust were looking for a mixture of doctors who had completed their Royal College examinations. Our first port of call as always is to create a tailored social media campaign for the individual NHS Trust that we are working with. We advertised the positions on our website (which receives more than 5,000 views from doctors per week), we also posted the positions on our social pages (which have an active membership of circa 10,000 doctors from all over the world). We also reached out to our contacts at our MCECM, MRCPCH and MRCP revision courses both in the UK and overseas. Within 7 days, BDI Resourcing created a short-list of interested candidates, who all fulfilled the Trust’s requirements in terms of both qualifications and years of experience.

We conducted an initial pre-screening call with all interested candidates. During our initial pre-screen it was critical to the success of the project to create real excitement about the Trust, the location and the job opportunity. This was done by utilising our notes from the scoping meeting with the key stakeholders and the detailed job descriptions and person specifications that the Trust had prepared in advance of undertaking this project. We also undertook extensive research of the local area, local schools, property prices, cultural landmarks, places of worship and researched the local demographics. We collated this information into a candidate pack that could be sent over to the short-listed candidates.

After our pre-screen conversation with our initial short-list of candidates we were able to then present to the Trust only the profiles who we were assured that if they were offered the position at the Trust they would accept it.

A final shortlist was sent to the Trust of suitable candidates in preparation for a Skype interview at a time organised by the Trust with a short biography of each individual candidate. We provided the Trust with all relevant documentation required to carry out the interviews – passports, copies of qualifications and Skype ID’s. Prior to the interviews, we made sure that we tested the Skype connection with all candidates 30 mins prior to their allotted interviews slots. We provided an NHS Skype preparation guide that we provide all of our candidates in advance, this will advise them of what to expect, ensures that they have done research on both the Trust and the department that they are interviewing with. It also contains some hints and tips that we have learnt along the way from our previous experience of interviews within the NHS. After the interviews had been concluded we ensured that we gathered detailed interview feedback from each candidate. This information was then relayed back to the medical staffing department in a timely manner.

Once the Trust had been in touch with their choice of selected candidates we ensured that this was intimated to the candidates in a timely manner, our experience of international recruitment is that in order for NHS Trusts to secure successful applicants then a formal offer letter should be sent to the candidate within 24 hours. The offer letter should detail the exact salary (Completed Incremental Credit Form should be provided by the candidate to allow a full assessment of their experience when deciding upon their salary), the position in which the applicant has been offered a position and the exact rota for the candidate and details of any relocation policy). We would then ensure that the candidates formally accept the offered position by signing and returning the completed conditional offer letter. We would ensure that the applicants were aware of the potential consequences of formally accepting a position and withdrawing in the future.

We then liaised with both the Trust and the Applicant to form a clear timeline in terms of their relocation to the UK and what steps should be taken in which order. The Trust applied for the certificates of sponsorship on the 5th of the month, with a decision from the Home Office on whether the COS had been successful on the 12th of the month [since this case study the COS process has changed]. Once approved the applicants then safely resigned from their posts. We then talked the candidates through everything that needed to be completed from their side of the application (IELTS UKVI, score of 4 or above), 10 years International Police Check for both themselves and their spouse, TB Check if living in a country that is defined as TB prevalent by the Home Office for more than 6 months)

Once the applicants had submitted their applications to their respective embassies we then assisted them with arranging their temporary accommodation at the Trust. This gave them time to settle into the UK and take care of various other appointments that were to be completed prior to them commencing work in the UK. For example, collection of their BRP from the local post office, setting up a UK bank account, Occupational Health appointment with the Trust, searching for a long-term rental property in the UK or Trust induction. BDI Resourcing organised for taxis to pick the applicants up at the airport and drop them off at their destination (Hotel or Hospital accommodation)

BDI Resourcing called the candidates on their first day of work to ensure that everything was fine and that they were settling in well, as well as scheduling a weekly follow up call with each candidate to make sure that both they and their family members were settling into the UK well and to address any specific issues that they may be facing. Our dedication to providing pastoral support to all our successfully placed doctors ensured that any specific problems were addressed early and resolved to the satisfaction to both the Trust and the doctors.

Outcomes

Due to working in a true partnership with the Trust we were delighted that all successful candidates accepted the positions offered to them. We were able to assist a Trust that previously had very limited success with international recruitment to secure 8 middle grade doctors within Emergency Medicine, 2 clinical fellows within Paediatrics and 4 middle grade doctors within Medicine, realising savings in excess of £756,000. By utilising our expert knowledge were able to fill every single requirement that the Trust had within a 6-month period in extremely difficult specialisms to recruit for.

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Case Study – NHS Trust located in the North West of England

About the Organisation

This NHS Trust provides healthcare in hospital and the community to over a quarter of a million people in the geographical region. Acute care is provided at the two main Hospital sites. This includes adults’ and children’s accident and emergency services, intensive care and a range of medical and surgical specialities. Women’s and children’s services, including maternity, are provided at the smaller of the two sites.

The Challenge

This Trust had a heavy reliance upon temporary staffing across various specialisms, particularly within Paediatrics, Trauma and Orthopaedics and Medicine. The Trust had advertised the positions on NHS Jobs portal without any success and had little experience of using an international permanent recruitment agency.

The Trust instructed us to source 2 x Middle Grade and 1 SHO within Paediatrics, 2 x SHO Trauma and Orthopaedic doctors, 1 x speciality doctor in Obstetrics and Gynaecology, 4 x SHO General Surgery and 4 x Speciality doctors within General Medicine. The Paediatric department and Surgery department were reliant on expensive locum agency staff to fill their gaps on their Tier 1 and Tier 2 rota’s. With this came significant risk in terms of continuity of patient care (Locums not turning up for shifts etc) and the inevitable issue of escalating costs associated with employing temporary staff).

The Process

In the first instance, we met with the Trust to find out more about their experience of recruiting for difficult to fill vacancies. We met with key stakeholders from the Trust such as the Resource Planning and Medical Recruitment Strategist, Procurement and also the Rota Co-Ordinators within Paediatrics, Surgery and Medicine.

The Trust usually would advertise on NHS jobs or on the TRAC system. Their job advertisements were detailed but unfortunately were not attracting the quality and quantity of candidates to fill their vacant posts. We discussed in detail with the Trust about how we would manage the process for them in attracting and securing suitably qualified doctors from across the world for these positions. We nominated a project manager from BDI Resourcing to be the key contact within our organisation who would be liaising principally with the key stake-holders at the Trust.

Once we had identified the individual roles that the Trust were looking to hire for and received the detailed job descriptions/person specifications from the Trust, BDI’s project manager passed on the requirements to our individual specialist recruiters within Paediatrics, Surgery and Medicine.

The Trust were looking for a mixture of doctors who had completed either the PLAB examination and, for the more senior positions, doctors who had completed their Royal College examinations. Our first port of call as always is to create a tailored social media campaign for the individual NHS Trust that we are working with. We advertised the position on our website (Which receives in excess of 5,000 views from doctors per week), posted the positions on our social media pages (which have around 10,000 active followers) and also posted in our Paediatrics micro-site (which has an active membership of over 3,000 Paediatricians).

We also reached out to our contacts within PLAB Revision courses in the UK and also to our contacts at MRCS, MRCPCH and MRCP revision courses both in the UK and overseas.

Within 7 days, BDI Resourcing created a short-list of interested candidates, who all fulfilled the Trust’s requirements in terms of both qualifications and years of experience.

We conducted an initial pre-screening call with all interested candidates. During our initial pre-screen it was critical to the success of the project to be realistic with the candidates about their expectations and whether or not they were well aligned with the needs of the departments and the Trust as a whole. As always, we were careful to ensure that the candidates had full knowledge about the local area, schools, property prices, demographics and even things like local places of worship. By creating ‘marketing literature’ about the area and the Trust we were quickly able to create a real excitement about the roles.

After our pre-screen conversation with our initial short-list of candidates we were able to then present to the Trust only the profiles who we were assured that if they were offered the position at the Trust they would accept it. We take great care in understanding the importance of taking time out of busy NHS clinicians days to interview candidates, we want to see a return on their investment of time. Any candidates during the pre-screen call who were unsure about the opportunity or could not physically start in the UK within the timescales outlined by the Trust were not carried forward to the next stage.

A final shortlist was sent to the Trust of suitable candidates in preparation for a Skype interview at a time organised by the Trust with a short biography of each individual candidate. We provided the Trust with all relevant documentation required to carry out the interviews – passports, copies of qualifications and Skype ID’s. Prior to the interviews, we made sure that we tested the Skype connection with all candidates 30 mins prior to their allotted interviews slots. After the interviews had finished we gathered detailed interview feedback from each candidate. This information was then relayed back to the medical staffing department in a timely manner.

Once the Trust had been in touch with their final selection of candidates we ensured that the offers were verbally extended to the candidates straight away. Our experience of international recruitment is that in order for NHS Trusts to secure successful applicants then a formal offer letter should be sent to the candidate within 24 hours. The offer letter should detail the exact salary (Completed Incremental Credit Form should be provided by the candidate to allow a full assessment of their experience when deciding upon their salary), the position in which the applicant has been offered a position and the exact rota for the candidate and details of any relocation policy). We then ensured that the candidates formally accepted the position by signing and returning the completed conditional offer letter. We ensured that the applicants were aware of the potential consequences of formally accepting a position and withdrawing in the future.

Moving forward we then worked with the Trust to form a clear timeline of when the candidates would join the departments. As part of that we offered guidance on the certificate of sponsorship application process and the requirements from the HR department on their side. We then supported the full pre-employment check stage by ensuring that the doctors had full support in completing all of their forms and obtaining things like international police checks or their Tier 2 visa applications. Our compliance and relocation executives offer dedicated support to both candidates and clients to ensure that both sides always have access to expert knowledge.

Once the applicants had submitted their applications to their respective embassies we then assisted them with arranging their temporary accommodation at the Trust. This would give them time to settle into the UK and take care of various other appointments that would have to be completed prior to them commencing work in the UK. For example, collection of their BRP from the local post office, setting up a UK bank account, Occupational Health appointment with the Trust, searching for a long-term rental property in the UK or Trust induction. We organised for taxis to pick the applicants up at the airport and drop them off at their destination (Hotel or Hospital accommodation). As a standard part of our process, we ensure consistent contact with our candidates throughout the relocation process and after they arrive. This means that they have access to an impartial party who can give them advice or help them with anything they need. The requests are varied and sometimes just asking questions about recommendations for where to eat or places to visits however occasionally we act as an unbiased mediator if there are any queries about things like rotas or working hours.

Outcomes

Due to working in a true partnership with the Trust we were delighted that all successful candidates accepted the positions offered to them. We secured 3 x paediatric doctors, 2 x T&O doctors, 4 x SHO General Surgeons, 4 x medicine doctors and 1 x speciality doctor within Obs and Gynae. The process enabled the Trust to successfully fill long-term vacancies that their previous advertisement campaigns had failed to do. We estimate that we saved the Trust in excess of £690,000 over the course of a 12-month period. We also ensured that services could function normally, providing safer continuity of patient care than the Trust’s previous reliance on agency locum workers.

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Case Study 3 – NHS Trust based in the South West

The Organisation

This district general hospital located in the South West of England has an A&E department, Intensive Care Unit (ICU), Oncology and Haematology Day Unit, and a Day Case Unit. This Trust is one of the smallest Trusts in the UK and is based in a geographically challenging area of the country.

The Challenge

The board of this Trust had faced multiple challenges including temporarily closing the A&E department during certain hours every day due to insufficient staff levels required to safely run the department. This meant diverting patients to other trauma units in the region until a successful recruitment project and service re-design could be completed. At the time, the A&E service was rated “Inadequate” and the overall service “Requires Improvement” by the Care Quality Commission (CQC). In addition to the original request for 3 additional A&E Speciality Doctors, another 2 A&E Speciality Doctors were requested three months later. The Trust have also faced staff shortages in General Medicine, also requested a Consultant Geriatrician and a CT1 General Medicine doctor, followed by another 9 General Medicine ST3+. Given the lack of sufficiently skilled people in the local area to carry out these roles, BDI Resourcing were contracted to source these doctors from the international medical community.

The challenge for BDI Resourcing was in finding multiple staff members for several niche and shortage occupation specialities, who would work in a small district general hospital which cannot offer educational support, has a relatively poor CQC rating, had department closures, cannot offer exposure to complex cases and is located in a relatively rural area.

The Process

Shortly after the decision to close the A&E department was taken, BDI Resourcing were contacted and asked to meet with key stake holders within the Emergency Directorate. This meeting was arranged following an initial email and telephone introduction which was used to establish a basic understanding of the challenge outlined above. We sent 2 representatives to the meeting which took place on-site with the General Manager (ED), Department Manager (Acute Medicine) and the Clinical Director (ED & Acute Medicine). During this meeting we discussed and agreed a project implementation plan, key milestones in the recruitment process, various alternative and dynamic candidate attraction techniques and the expectations of all parties involved from end to end in each workstream.

Having ensured stakeholder engagement and agreement of process in the initial meeting, our first step in the implementation was to assign a project manager responsible for each niche speciality – as each medical discipline has its own idiosyncrasies, specialist knowledge is required to deliver the most successful project outcome. The relevant recruitment manager for BDI Resourcing was then attributed a contact within the clinical department and HR department and asked to begin the campaign by conducting an information gathering exercise. This involved the collection of full job descriptions for each role, expectations regarding specific candidate experience and skills/procedure desired, relocation packages available, educational support offered and any additional responsibilities any successful candidate may be required to undertake. All of this information was then distributed and discussed with the specialist recruiters for each speciality area.

Given that the usual recruitment method used was to advertise online for their vacancies and this had been largely unsuccessful to date, a decision was taken to move towards more innovative and proactive practices of attracting suitable candidates. Only those holding specific post graduate qualifications, completed in conjunction with UK Royal Colleges would be suitable for the required roles, our first step was to reach out to various MRCEM/MRCP communities, courses, coaches and tutors. We have strong connections with a number of Royal College and English Language (both IELTS and OET) revision/study services based both in the UK and overseas, which we leveraged to reach potential candidates – the candidates acquired via these routes are highly motivated to move to the UK and are pursuing such qualifications for the sole purpose of gaining a UK medical license via the GMC. 

After just 7 days our first shortlist of candidates for the original demand of 3 A&E vacancies was submitted. All prospective candidates were pre-screened via telephone and Skype, sent all job specifications and briefed on the local area to ensure that they were completely comfortable with the offered opportunity and that it was aligned to their professional and personal objectives. By researching the local area and providing information about quality of living, local schools for children, social activities, house prices, etc. we can guarantee a much higher acceptance rate post interview – this also ensures that the clinicians who are removed from front line services to conduct interviews receive a better return on investment in relation to their time. Any candidates unsure about the role or unable to meet the timescale expectations at this stage were not progressed to formal interview. Successfully shortlisted and approved candidates were then invited to Skype interviews at times convenient for both parties – this was arranged by BDI Resourcing and included providing necessary information to the interviewing team (short candidate bio’s, updated CV copies, passports, primary medical qualifications, etc.). Connection tests were conducted with each candidate 24 hours prior to all interviews, attendance was reconfirmed, and interview tips were given on what to expect based on our past experience.

Following completion of the interviews, both Trust and candidate feedback was obtained within 48 hours and provisional offer letters (including rota information and salary offering) distributed via HR to any successful applicants. After discussing the offer with each candidate, we ensured a formal acceptance was provided in writing and that candidates were aware of the next steps, the timeline we were working to and what would be expected of them during the remaining part of the process. At this stage we also reinforced that they were making a commitment to one Trust and the potential ramifications of a subsequent withdrawal.

The next step was to support HR in obtaining all relevant pre-employment documentation and information required to apply for certificates of sponsorship (required for candidate Tier 2 visa applications) in a timely manner. We talked through all documentation with the candidates to clarify that they understood the necessary requirements, compiled the information when returned and then walked them step by step through their visa application to point of submission. At that point, we were able to finalise a start date and began to help with the logistics of the move itself – sending flight options, arranging airport pick up and transfers, assisting with booking temporary and/or long-term accommodation, instructions on where to collect the BRP and information on opening a bank account, getting a national insurance number, buying a mobile phone, etc. Finally, we sent information and provided support for where to go and what to bring on their first day.

BDI Resourcing ensured that candidates received a phone call after day one, week one and month one to check that the transition both clinically and personally was being completed smoothly – again reducing the likelihood of placed candidates departing prior to the Trust realising a return on their investment. 

Outcomes 

By fully understanding the needs of the Trust, creating a clear recruitment plan based on the scope of the challenge and working in close partnership with them, we have completed the successful recruitment of the initial order (3 A&E Speciality Doctors, 1 Consultant Geriatrician and 1 CT1 in General Medicine) and recruited 2 A&E Speciality Doctors and 3 General Medicine ST3+ doctors for the second order more recently received (2 A&E Speciality Doctors and 9 Medicine ST3+’s). Based on the staff we have secured so far, we estimate that we have provided savings in excess of £787,389.12 (compared to equivalent locum in post for 12 months at “capped” agency rates), with a further £471,744 to be recognised upon completion of the second order of staff. Not only is the Trust realising significant financial savings, they are also able to provider better continuity of care via directly employed doctors.

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