Managed Service for Nursing

Lancashire Teaching Hospitals NHS Foundation Trust

statistics for managed services case study
Managed services case study overview


Medacs Healthcare has worked in partnership with Lancashire Teaching Hospitals for over 20 years, delivering onsite Managed Service and Staff Bank programmes for their medical staffing teams and providing a MasterVend service for nursing and allied health professionals. 

In late 2019, with a need for more control over their temporary nursing staffing operation, Lancashire Teaching Hospitals upgraded to a full Managed Service for nursing, with a dedicated onsite team and a sustainable gainshare cost model to incentivise the rapid delivery of savings. 


Even prior to the start of the pandemic, nursing shift requests had reached unsustainable levels, exceeding the current number of equivalent nursing vacancies. The Trust urgently needed more nurses, along with better rota control and planning, and new more stringent processes for scrutinizing bookings and rates. 

As the COVID-19 pandemic hit, this became especially important, with demand, rates and costs for critical care and ICU nurses rising exponentially. To increase fill to meet demand, while keeping costs at sustainable levels, the Trust needed much more visibility over what was happening, so they could rapidly build in more efficient and resilient booking methods. 

nurses walking through ward
healthcare professional holding tablet with digital graphics


Despite the pressures of the ongoing pandemic, fill was effectively doubled and savings targets were exceeded by 38%. 

Key steps to achieve the required change included: 

  • Conducting a detailed review of candidate records on Health Roster, which revealed multiple duplicate records and dual registration issues, with the same nurses working through multiple agencies for different rates. Rota planning was significantly improved with an extensive record clean-up.
  • Introducing enhanced authorisation processes to ensure all bookings were fully justified and properly scrutinised at the appropriate level.
  • Working closely with the Trust’s own nursing staffing teams to develop an accurate picture of exactly how many nurses were needed on which wards and improve internal communication processes. With support, staff have embraced new working methods and incorporated more advance planning into rota management. When a regular shift can’t be filled, alternative options are considered before rates are escalated or off-framework agencies approached, inline with ‘reduce or replace’ protocols. Developing a more ‘joined-up’ approach to nursing staffing as a whole, with better integration with bank booking processes and active identification of newly required permanent vacancies.
  • Producing granular monthly MI reports to provide a clear and accurate understanding of fill levels and rates across all departments and assess the percentage of temporary staffing costs driven by COVID-19 in comparison to vacant posts and sick leave.
  • Improving the supply chain management, with the addition of 26 new suppliers and more active engagement to ensure adherence to rate protocols and foster a healthy level of competition.  


The result is a significant reduction in rates and over all temporary nursing staffing costs, averaging over £70,000 in savings per month. Over the last 12 months fill has also effectively doubled. The total up lift in fill is the equivalent of employing 30 fulltime nurses. 

managed services cumulative savings graph

Upgrading to a Managed Service has almost doubled our nursing fill and delivered impressive cost savings in less than 12 months. Medacs Healthcare’s onsite team are like a seamless extension of our own teams and have really improved the communication between different divisions, giving us the rota control we needed and a much more accurate understanding of our true nursing staffing needs.

Lancashire Teaching Hospitals NHS Foundation Trust, Workforce, Education and Strategy Director

The onsite team have worked really closely with us and the results have been very positive. Integration with bank processes is now seamless and I’m seeing a proactive, problem-solving approach to filling shifts instead of an immediate knee-jerk reaction to deal with a perceived need.

Lancashire Teaching Hospitals NHS Foundation Trust, Temporary Staffing Manager

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