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The Benefits for Emergency Medicine of an Annual Approach to Rostering – HealthRota

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This case study demonstrates how the move to an annualised approached to doctors’ rotas brought a range of benefits to the University Hospitals Sussex NHS Trust

Introduction

University Hospitals Sussex (UHSussex) is a leading NHS Foundation Trust serving West Sussex, Brighton & Hove, and parts of East Sussex.

With six hospitals and a major trauma centre, the Trust faces complex staffing challenges in its Emergency Departments. To address issues of rota flexibility, staff retention, and wellbeing, UHSussex adopted HealthRota, an innovative electronic rostering system that annualises hours and enables self rostering.

Since its implementation in 2017, HealthRota has improved work life balance, reduced locum costs, and enhanced patient care, with all Emergency Department posts filled and wellbeing significantly improved. Its success has inspired adoption in over 50 UK emergency departments, demonstrating its scalability and impact.

This case study draws on a comprehensive review of research into the development and impact of the HealthRota electronic rostering system at UHSussex. It explores how annualised rotas, supported by the Royal College of Emergency Medicine, have transformed workforce management in the Emergency Department.

The findings are based on academic studies, NHS England data, and practical insights from an in-depth interview with an Emergency Medicine Consultant and Professor at UHSussex. This individual played a pivotal role in creating and implementing the system, working closely with a small team of developers and the hospital Trust. Their perspective offers a unique look at the journey from initial concept to successful roll-out across multiple departments and hospitals nationwide.

Doctor filling in form

The intervention has been successful in achieving its aims, with studies showing improved wellbeing among doctors and all vacant posts in the Emergency Department of the Trust being filled after five years

Challenges

  1. Designation as ‘major trauma centre’ puts pressure on rotas

    The Trust’s Emergency Department became a major trauma centre in 2013 which required 24/7 Accident & Emergency consultant cover. This put significant strain on the existing rota system which in turn led to lower staff morale and retention.

  2. Reliance on expensive locum staff for day-to-day cover

    At one stage, with just seven consultants and seven registrars available, the need to provide 24/7 Emergency Department coverage meant the Trust was spending £1.3 million per year on temporary locum staff. With locum pay rates almost twice as high as a full-time consultant this marked a significant additional expenditure for the Trust.

  3. Compliance with Regulations

    Balancing contractual rules and regulations, such as the European Working Time Directive (EWTD) and the Working Time Regulations (WTR) in the UK, poses a significant challenge for rota coordinators. The absence of an automated system makes it challenging to monitor the regulations and ensure compliance for a sizable team of resident doctors.

  4. Doctors needed support to adapt to planning leave far in advance.

    Many existing e-rostering solutions lack the functionality to support the complexities of modern medical rotas and are inflexible when it comes to integration with other applications. This limitation hampers innovation, efficiency and the ability to fairly compensate doctors for the hours they have worked.

Solution

When UHSussex became a major trauma centre in 2013, the pressure on Emergency Department doctors soared, making traditional rota systems unsustainable. To tackle this, Professor Rob Galloway partnered with the Trust and IT developers to design a smarter solution: HealthRota, a bespoke electronic rostering system built around annualised hours and self-rostering.

HealthRota introduced a collective rota approach, pooling all clinical hours and matching them against 24/7 coverage needs. This allowed doctors to plan ahead, with leave requests respected and gaps filled through recruitment or locums.

The journey began with a pilot in 2017 for consultants in the Emergency Department. After proving successful, the system expanded to acute medicine, care of the elderly, and later to resident doctors across the Trust.

Flexibility was further enhanced through self-rostering, enabling doctors to choose shifts that fit their lifestyle and swap shifts easily. Real-time tracking ensured compliance with working time rules. Practical tools included an online platform, mobile app with notifications, and calendar sync features. Staff could manage leave, swap shifts without admin intervention, and monitor remaining hours – all in one system.

Strong management backing and collaboration with developers were key, especially during COVID-19, when the system proved vital for resilience. While initial training and admin effort were significant, the payoff has been huge: reduced workload, improved staff wellbeing, and a foundation for future optimisation with AI.

  1. Annualised Hours for the whole team

    The system replaces monthly individual rotas with a collective rota for the whole team that aggregates all clinical hours over the year – excluding annual leave requests, study leave and bank holidays.

    This allows the rota to assign everyone’s hours well in advance so that doctors were better able to work the hours and days they preferred – as well as being more likely to get leave requests accepted up to a year in advance.

  2. The flexibility of self-rostering

    Moving to annualised hours also allows doctors more choice to pick their preferred shifts – for instance electing to focus on early mornings and weekends – to suit their lifestyle.

    The system tracks hours worked in real time so doctors always know how many clinical hours they have worked and how many remain. The HealthRota platform also allow doctors to swap shifts without involving rota administrators – while making sure all contractual and regulatory obligations are met.

  3. Mobile and online tools

    HealthRota brings with it the latest technology, including Android and iOS apps, calendar syncing and real-time notifications and alerts.

    It means doctors have access to their rota information wherever they are – complete with tools that give immediate access to upcoming work schedules, holidays booked and the ability to swap shifts without going through rota coordinators.

  4. More part-time options

    The move to an annualised system means that part-time staff have much more flexibility to plan out their working hours.

    For instance, they can do their jobs over the entire year or have extended periods off, making up the hours by working more intensely for the rest of the year.

Results

73%
Doctors said system ‘very beneficial’ to quality of life & career
+213%
Increase in full-time consultants and registrars over 5 years
-68%
Decrease in medical emergencies at nights & weekends

The introduction of annualised rotas and HealthRota at UHSussex has transformed working conditions for doctors. By giving staff greater control over their schedules, the system has improved work life balance and reduced stress, leading to better mental health and wellbeing. Surveys show that 67% of doctors found the rota very beneficial to their professional life, and 73% said it greatly improved their overall quality of life.

With the ability to plan personal time up to a year in advance, consultants and resident doctors can prioritise family and personal commitments. The department now has more female consultants, including mothers, and male consultants report spending more time with family. Shift patterns are structured to prevent fatigue, such as limiting night shifts to three in a row.

These changes have boosted staff retention and recruitment. In five years, consultant numbers grew from 7 to nearly 24 full-time equivalents, and registrars increased from 7 to 20. Locum costs dropped dramatically, from £1.3 million annually to only covering sickness absences, saving the Trust significant funds that can be reinvested in permanent staff.

The system also enabled new training opportunities, including clinical fellow posts with dedicated non-clinical time, improving education and patient care. Flexible working options, such as part-time contracts with extended breaks, have further enhanced job satisfaction.

Patient outcomes have improved too. With 24/7 consultant cover, medical emergencies at nights and weekends have fallen by 68%, and wards now have four times as many doctors on duty during peak times.

The success of HealthRota has led to its roll-out across the Trust, adoption in over 50 UK emergency departments, and expansion to other specialties. It has earned national recognition, including awards from the Royal College of Emergency Medicine, the British Medical Journal, and the Health Service Journal.

Key Takeaways

  • Improved working conditions: Changing the way the rota was organised removed key psychosocial risks (PSRs) and improved working conditions for doctors across the board and allowed for increased staffing levels.
  • Improved staff retention: Improved working conditions and quality of life has boosted staff satisfaction levels and attracted new recruits and allowed all long-standing vacancies to be filled.
  • Better training opportunities: Annualised hours and rota management means that proper, scheduled training can now be realistically incorporated into doctors’ work schedules. This allowed the creation of new clinical fellow posts for resident doctors with 25% of time set aside for training.
  • Reduced need for locum staff : Annualised hours and more efficient rota management means less reliance on expensive locums to plug gaps.
  • Better patient care: With measurable improvements in staff quality of life and staffing levels, patient care benefits. For instance, medical emergencies at night or on weekends fell 68% in the wake of the changes.
  • Mandate for change: Recognising unsustainable workloads sparked decisive action that delivered improved staff wellbeing and retention, reduced costs, and enhanced patient care. HealthRota proves workforce flexibility and organisational efficiency are not incompatible.

Conclusion

The key takeaway of this intervention is that changing the way the work is organised removed the identified PSRs and therefore improved the working conditions of doctors at all levels working in emergency medicine and allowed for increased staffing levels. This in turn improved patient care and is saving the NHS resources by reducing the need for expensive locum staff.

As shown in this case study, the changes that were introduced gave doctors more control over their working hours and flexibility to work part time if desired. In turn, this has had a very positive effect on their mental health and day-to-day lives. Indeed, allowing doctors to better reconcile work and their personal life using annualised hours and self-rostering reduces stress and allows them to provide the best patient care. This is therefore clearly an example of how the way in which work is organised can impact workers’ safety and health.

In addition, given the links between working conditions and staff levels, the improvement in the mental health and work–life balance of workers at UHSussex has also resulted in retaining workers and, over time, attracting new staff to the hospital with all vacant posts now filled. This is a self-reinforcing phenomenon, as with higher staff levels, there are fewer last-minute call outs to cover unexpected shifts, higher staff satisfaction and sense of control over the working conditions in the department.

Annualising hours has allowed doctors to opt for part-time working arrangements under which they may work intensely for several months and then have a break of several months, as the self-rostering feature of the HealthRota system can account for such preferences as long as clinical cover is provided 24/7.

Therefore, the annualisation of hours has multiple benefits for the doctors by improving their working conditions and control over their work, which in turn reduces PSRs related to lack of control over working patterns. The hospital has also benefited as patient care has improved thanks to safer levels of staffing in the A&E department.

Finally, the increase in staff retention and happiness means that UHSussex has a reduced need for locum cover, which saves the hospital money, enabling more investment in the careers and development of its staff. This means that doctors can focus more on their core tasks and spend more time in training and taking up development opportunities while ensuring that patient care continues to be of a high quality.

The transferability of this intervention is also clear, given that the system has been rolled out in other hospitals and departments and has the flexibility to be adapted to suit their specific needs. The HealthRota system could be used for any shift-based work in any industry by annualising hours, as the core concept of providing the cover an organisation needs to function while giving staff more control over the days they actually are needed to work remains the same.

About European Agency for Safety and Health at Work

The European Agency for Safety and Health at Work (EU-OSHA) is the European Union’s leading authority on occupational safety and health. Established to make European workplaces safer, healthier, and more productive, EU-OSHA provides research, analysis, and practical resources to support employers, workers, and policymakers across Europe.

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