Patchwork Insights: 5 tactics to improve your shift fill rates

Data from NHS England shows a total of 4.7million people were waiting to start treatment at the end of February 2021 — the highest figure since records began in August 2007. The NHS faces a huge challenge in recovering services and a significant determinant in meeting that challenge will be optimising the use of your temporary workforce to fill as many shifts as possible.

Using Patchwork’s live data analytics platform, we have collected data from over 32 of our NHS partner organisations across a 6-month period to identify 5 best-practice tactics you can introduce to optimise shift fill rates across your organisation.

#1 Request shifts as early as possible


  • Shift fill rates were increased by 10%
  • The number of shifts at Base Rate (i.e. that did not require escalation) increased by 20%

The NHSE&I target for requesting shifts is at least 6-weeks in advance. Whilst there may be a range of barriers to achieving this, requesting shifts as far in advance as possible is proven to increase your shift fill rate and increase the number of shifts filled at Base Rate. Set aside time to premeditate any upcoming gaps in your rota, such as upcoming parental leave, long-term staff absence and planned training courses, to enable you to request shifts as early as possible.

Our data shows that:

  • On average, shifts requested at least 6-weeks in advance have a 10% higher fill rate than shifts that are requested up to 1-week in advance.
  • 71% of shifts requested at least 6-weeks in advance were filled at Base Rate, which was 14% higher than the shifts requested up to 1 week in advance (only 57% of these shifts were filled at Base Rate).
  • In one Trust where we have seen consistently high fill rates, 91% of shifts requested at least 6 weeks in advance were filled at Base Rate. This was 21% higher than shifts that were requested up to 1 week in advance, where only 70% were filled at Base Rate.

Figure 1: Snapshot of Unfilled:Filled Escalated:Filled Base Rate shifts across 32 partner trusts

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#2 Look at the effectiveness of your existing bank workers

Outcome: Improved engagement from trust’s existing bank of workers

Across our partner trusts’ digital staff banks, we have identified the following worker trends:

  • Career locums who tend to book 15+ shifts per month
  • Bank workers who pick up a few shifts per month on an ad-hoc basis
  • Bank workers who book shifts for several consecutive months and then reduce booking activity
  • Bank workers who have been onboarded, but are yet to book a shift

It is important to begin by investigating engagement patterns and exploring why workers behave in certain ways. Has something changed which is causing them to stop booking shifts? Do any of their credentials need updating? Are they still available to work?

Many bank workers can feel secondary to substantive staff. To avoid this, we recommend regularly engaging with workers on your bank to create a sense of belonging and thus encourage an uptake in shift booking. It is also beneficial to identify any bank workers who are no longer available to work; this will provide insight into how large your active pool of workers really is.

By utilising and engaging with the bank you currently have, you will optimise the effectiveness of your existing pool of staff and form a better understanding of how many additional bank workers you should aim to recruit.


#3 Onboard newly recruited staff promptly

Outcome: Quickly onboarded bank workers had a higher engagement and retention rate

Encouraging more staff to join your bank is of course always beneficial, helping to spread the load across a wider pool of staff to minimise burnout and improve your fill rates. However, to ensure the success of your recruitment programme, onboarding is key. The data is clear: bank workers who have been onboarded quickly tend to book more shifts. We have found that workers who experienced a longer gap between registration and approval not only take longer to book their first shift, but are more likely to remain inactive and never book a first shift.

Review your list of doctors who need to complete the onboarding process and see what steps need to be taken. We recommend setting a target to approve registered workers in less than 7 days wherever possible. This positive experience from the offset will encourage workers to become active members of your staff bank.

Figure 2: Each circle in the graph below represents an individual

2nd image Shifts vs Registration to Approval - excluding 3+ months.png

#4 Ensure prompt sign-off, approval and payment for worked shifts


  • The number of shifts worked by individuals increased
  • Bank workers booked more shifts in advance 

As highlighted in Figure 3 below, the highest number of shifts are undertaken by staff who regularly have their shifts approved for payment within 7 days of the shift being worked. Where payment has taken several months to approve, the number of shifts worked by an individual falls significantly. To support our partner trusts to bring flexible pay to healthcare and improve the financial wellbeing of their workers, Patchwork has partnered with leading financial wellness company Wagestream. Wagestream is funded by social impact charities in order to help bring financial security and stability to the lives of working people by challenging the negative effects of the monthly pay cycle.

Figure 3: Each circle in the graph below represents an individual

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On a more granular level, we discovered prompt payment also resulted in bank workers pre-booking a higher number of shifts further in advance (Figure 4). Comparatively, individuals who experienced long wait times between working a shift and approval for payment were unlikely to book shifts for future dates (Figure 4). Review your shift:payment lead times to check whether any members of staff are waiting long periods of time to be paid. By improving your payment process, you will increase the number of shifts booked by doctors in the future and grow their confidence in working with your organisation.

In Figure 4, we can see how bank workers whose shifts are approved for payment within 1-3 weeks (the green circles) are more likely to book shifts regularly and well into the future, confident that they will be paid promptly after they’ve worked their shift. Bank workers who’ve experienced a long wait for payment approval (the yellow/orange/red circles) are less likely to book shifts for dates in future. They may be hesitant to book any further shifts until they’ve been paid, or may stop booking shifts altogether.

Figure 4: Each circle represents a shift and the colours are how long it took for that shift to be approved for payment. The vertical dotted line represents when the snapshot was taken, delineating between past and future dates.

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#5 Escalate rates appropriately for hard-to-fill shifts

Outcome: Ensure hard-to-fill shifts are covered in advance

While escalated rates come with an increased cost, some shifts need escalating to ensure they are filled and this should be done early and appropriately with the right financial controls in place. During a 6-month period across all of Patchwork’s partner Trusts, 89% of escalated shifts were filled. By selecting a fully interoperable solution, shifts can be automatically escalated between your rostering solution, your temporary staffing bank and your vendor management system (VMS), ensuring no time is wasted on admin and all shifts are filled. Our rate escalation tool automatically ensures that only appropriate shifts are escalated with the right level of approval.

In conclusion

These five key tactics drawn from country-wide hospital staffing data have a common theme: a forward-oriented, proactive approach is essential to the delivery of successful staffing outcomes.

Patchwork Health is working hard to support our NHS partners in building strong internal and collaborative staff banks, enabling successful advance shift advertisement and capacity building. For further information on how you can increase the shift fill rate at your bank, please email and one of the Patchwork team will be happy to advise.