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.
High costs and process inconsistencies
While the Trust had a centralised system in place, local variations in process had created significant challenges. 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"
A significant driver of cost was the inconsistent application of pay rate policies. 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.
This dynamic meant that the Trust’s agreed escalation processes, designed to maintain financial health, were frequently circumvented, making it difficult for the Trust to meet its cost-reduction targets or control temporary staffing spend effectively.
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.
Patchwork collaborated closely with the Trust’s medical staffing teams and executive stakeholders to deploy a solution that did more than just advertise shifts - it acted as a guardian of Trust policy.
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. This ensured that the operational reality matched the financial policy, preventing bookings that did not align with the Trust's budget controls.
A single, transparent route
The solution consolidated all activity into one transparent marketplace. By channelling all bookings through a single digital route, the Trust eliminated the "grey market" of offline negotiations. This ensured that rate escalations could only occur within strict, pre-authorised parameters, restoring consistency across all four hospital sites.
Expanding the pool
By providing real-time visibility of standard-rate shifts across the entire Trust, the solution was vital in expanding the pool of workers working at LLR through intuitive and easily accessible technology. This reduced dependency on smaller, higher-cost groups and helped stabilise spend without compromising on safe staffing levels.
While the project focused on financial control, ensuring a positive experience for clinicians was vital for adoption.
Clarity and trust
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.
Streamlined administration
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 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.
The partnership has successfully shifted behaviour away from escalated rates, maintaining safe staffing levels while delivering significant cost reductions.
Financial control
● £1,111,545: estimated annualised saving (inclusive of Patchwork costs).
● Strategic shift: Successful increase in bookings at London Local Rates (LLR), driving down average shift cost.
Operational efficiency
● Reduction in retrospective bookings: A massive improvement in process adherence saw retrospective bookings fall from 548 in Oct 2024 to just 92 in Jan 2025, improving financial forecasting and control.
● 20 days: Median request-to-shift lead time (improved post-Dec 2024).
Engagement
● 431,142 hours of shifts filled via the platform to date.
● 76% of 2,690 approved workers have worked at least one shift, with 42% active in the last 90 days.
“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