Barts Health NHS Trust: restoring financial governance and workforce efficiency
Book a demoannualised saving, inclusive of Patchwork costs
hours of shifts filled via the platform to date
approved workers, 76% of whom have worked at least one shift
Overview
Barts Health NHS Trust is one of the largest trusts in the UK, employing over 17,000 staff across four main hospital sites. Managing an NHS service at this scale requires robust mechanisms to ensure the safe and financially sustainable deployment of medical professionals.
To address rising costs and streamline operational management, Patchwork Health partnered with the Trust in 2024. Working alongside their managed service provider, Bank Partners, Patchwork implemented a solution designed to provide a "governance reset" — moving the Trust towards a model of strict financial control and standardised processes.
Hear from Liam Slattery, Director of People Services at Barts Health NHS Trust
The challenge
While the Trust had a centralised system in place, local variations in process had created significant challenges.
High costs and process inconsistencies
Departments often relied on pre-existing, select pools of workers and negotiated pay rates outside of standard Trust-wide governance. This ad-hoc approach was not only inefficient but had become financially unsustainable as it scaled.
The "escalation culture"
Because the previous system allowed for manual overrides, a culture developed where financial controls could be bypassed. This inadvertently incentivised some clinicians to wait for rates to be escalated before booking shifts, making it difficult for the Trust to meet its cost-reduction targets.
The solution: technology as a guardian of Trust policy
Barts Health NHS Trust partnered with Patchwork Health with a clear strategic aim: to drive shift fulfilment through the London Local Rate (LLR) bank and reduce reliance on escalated pay.
Turning policy into technology
Rather than relying on manual adherence to policy, Patchwork configured the system to replicate the Trust's operational procedures. The rate card and escalation protocols were built into the booking flow, ensuring the operational reality matched the financial policy.
A single, transparent route
By channelling all bookings through a single digital route, the Trust eliminated the "grey market" of offline negotiations. Rate escalations could only occur within strict, pre-authorised parameters, restoring consistency across all four hospital sites.
Expanding the pool
Real-time visibility of standard-rate shifts across the entire Trust was vital in expanding the pool of workers working at LLR, reducing dependency on smaller, higher-cost groups and helping stabilise spend without compromising on safe staffing levels.
The clinicians' experience
All available shifts and their correct, approved rates are now visible in a single app. This transparency has removed the uncertainty around pay that previously necessitated offline discussions.
Instant booking for approved workers and clear digital timesheet tracking have helped rebuild trust between clinicians and staffing teams, ensuring that accurate payments are processed without administrative friction.
"Patchwork Health has transformed how I manage my locum shifts. No more lost shifts or delayed payments. It offers clear tracking and lets me adjust hours before signing off on timesheets, ensuring accurate and fair pay. I've had no issues since using it and highly recommend it to all my colleagues."
Dr Amir Fard — Resident Doctor
The results
The partnership has successfully shifted behaviour away from escalated rates, maintaining safe staffing levels while delivering significant cost reductions.
Financial control
£1,111,545 annualised saving, inclusive of Patchwork costs. A successful increase in bookings at London Local Rates drove down average shift cost.
Operational efficiency and engagement
A massive improvement in process adherence, alongside sustained engagement from the Trust's approved worker pool.
Retrospective bookings fell from Oct 2024 to Jan 2025
Median request-to-shift lead time, improved post-Dec 2024
Of shifts filled via the platform to date
Of 2,690 approved workers have worked at least one shift
A strategic shift in behaviour
Bookings moved decisively towards London Local Rates, maintaining safe staffing levels while bringing average shift cost down across all four hospital sites.
"The Patchwork app has been very beneficial... We have met some excellent doctors who have been working with us regularly since the launch."
"Some of the best features are the 'Worker notes' so the doctors can know their roles before applying and 'Admin notes' which are useful for staff... Overall, I think it was a good decision for the Trust to work with Patchwork."
Mercy Grace Jawino — Rota Coordinator, Barts Health NHS Trust
The partnership
The relationship between Barts Health and Patchwork has been defined by adaptability. Patchwork's implementation team worked to ensure the technology moulded to the Trust's specific challenges rather than imposing a rigid, one-size-fits-all model.
Actionable insights
A key element of the partnership has been embedding the Patchwork Insights platform into the Trust's weekly executive meetings. By scrutinising live workforce data, leadership can now make evidence-based decisions, maintaining a tighter grip on pay escalations and identifying trends before they become costly issues.
Continuous improvement
This project was not a one-off installation but an ongoing collaboration. The team continues to refine the system based on user feedback, tweaking escalation controls and reporting structures to ensure the bank operates at maximum efficiency.
Could a governance reset bring your temporary staffing spend back under control?
Tell us how shifts are booked and escalated today and we'll show you what tighter control looks like inside your trust.