Most roster systems force you to choose a start date, an end date and then hope nothing changes. Some take that a step further and lock you into clean 4-week boxes. Neat on paper, but impossible in practice.

At Patchwork we built our rostering system differently: rolling, agile and human-centric. That means managers publish what they can when they can, keep future blocks in draft, and make targeted edits without rebuilding the whole year.

This results in predictability where it matters, and flexibility where reality bites.

The problem with inflexible scheduling

Traditional rostering systems often create more problems than they solve:

Fragmented records

A single, real-life roster gets scattered across multiple digital versions, making it difficult to review past activity or conduct audits.

Messy reporting

Data has to be manually pieced together from various rosters, which complicates analysis and compromises accuracy (and takes ages).

Un-productivity

Managers find themselves spending more time on roster maintenance than on managing their teams and services.

Some organisations try to work around these limitations by creating long-term rosters that span 12 or even 24 months. While this might seem like a solution, it isn’t sustainable.

Different teams and roles operate on vastly different cycles. For instance, resident doctors might rotate every few months, while annual job plans are set for the year. A one-size-fits-all approach simply doesn’t work and clinician and non-clinical staff bear the brunt of this.

Introducing rolling rosters: The Patchwork solution

Here’s how we’re making rostering smarter and more intuitive:

No need to recreate

Instead of starting from scratch every few months, you can simply extend your existing roster. This creates a continuous, unbroken record of all scheduling activity. We’ve even attached a short walkthrough, so you can see this in action for yourself.

Publish in increments for clearer planning

Managers can release the roster in blocks. This gives staff the predictability they need, while managers retain the flexibility to adapt to future changes.

Seamlessly manage staff patterns and rotations

Whether it’s accommodating rotations, promotions, or new team members, patterns can be easily extended, edited, or ended within the same roster. Crucially, managers can also swap workers safely in and out of schedules when rotations happen, without breaking continuity or creating a new roster. That means less repetitive work, fewer errors, and a smoother process for everyone. Take a look here at how this works on Patchwork Rota.

Align service and job plans

Managing rosters will soon allow shifts and activities from service and job plans to be added at any time, even after a roster has been extended. There’s no need to overhaul your workflow, just extend, adjust, and keep rolling.

Why a flexible approach matters

By moving away from rigid, start-and-end-date rosters, we empower healthcare organisations to:

• Reduce the administrative burden on managers.
• Crucially, improve the accuracy of reports and forecasts.
• Provide staff with clarity while maintaining operational flexibility.
• Strengthen retention by creating a more efficient work environment that is more considerate to the clinicians’ work.

With Patchwork, rosters move with you, they are agile and fluid, supporting continuous service delivery.

 

The NHS 10-Year Health Plan arrives as the latest in a series of ambitious blueprints, once again positioning itself as a catalyst for meaningful change, aiming to improve care delivery while reshaping the working environment for its dedicated workforce.

Packed with forward-thinking initiatives, it sets out a future where staff wellbeing, operational efficiency, and the thoughtful use of technology are brought to the forefront. But while the vision is welcome and much-needed, the true test will be in the application. If delivered, this plan represents more than just intention; it offers a real opportunity to build flexible, motivated, and empowered healthcare teams.

Here, we explore how the plan addresses key aspects of workforce management and why, if realised, these changes could help build a brighter, more sustainable future for everyone in the system.

Redefining staff numbers and quality by 2035 

By 2035, the NHS staffing landscape is set to look very different. Compared to the projections laid out in the 2023 Long Term Workforce Plan, there will be fewer healthcare professionals in post. However, those who remain will work within an improved environment, one that prioritises how staff are treated, trained and supported throughout their careers.

The focus is clearly shifting from workforce quantity to workforce quality. This means more meaningful career development, stronger day-to-day support, and better recognition of each individual’s contribution. These changes are designed to improve performance and morale, while also ensuring care remains consistent and high quality.

Central to this approach will be the systems that underpin how staff grow, feel valued, and are deployed in ways that match demand. From job planning and appraisals to regular feedback and structured progression, the plan signals a move towards a more intentional, supportive employment experience across the NHS.

Technology has a crucial role to play in this. Digital tools can bring greater transparency to how staff are allocated, ensure rotas reflect individual preferences and capacity, and support continuous development through easier access to appraisals, learning, and feedback. When deployed well, these systems don’t just manage the workforce, they help teams feel seen, supported, and better aligned to service needs.

A shift towards reform and value-based care

The NHS is moving away from a model that prioritises short-term financial goals without addressing the structural challenges that underpin them. In its place comes a value-based approach, one that seeks to maximise outcomes for every pound spent. This marks a significant shift in how decisions are made, with resource allocation and performance measured not by input alone, but by the impact on patient care and staff wellbeing.

To make this shift meaningful, access to accurate, real-time workforce data will be essential. Understanding patterns of staffing, demand, and capacity at both local and system levels can unlock more efficient deployment, reduce gaps in care, and support the shift from reactive to proactive planning. Without this level of insight, efforts to improve outcomes risk falling short.

Technology that enables this, through smarter scheduling, better communication, and agile workforce reporting, will be crucial. These solutions don’t just optimise staffing in the moment; they create a more responsive, transparent foundation for long-term transformation, helping workforce leaders align resources with clinical need and strategic goals.

Flexible work as the new standard 

Flexible working is fast becoming a non-negotiable across the NHS, and the plan reinforces this shift. It sets out an approach to reduce reliance on costly extra-contractual work and to eliminate agency staffing altogether by the end of this parliamentary term. The proposed transition of agency workers into staff bank roles promises greater flexibility for clinicians, stronger familiarity for teams, and improved cost efficiency for organisations.

There is real potential in this change, with projected savings of up to £1 billion over the next five years. Crucially, this is money that could be channelled back into frontline services and workforce support.

For clinicians, flexibility has long been tied to better work-life balance, greater autonomy, and a sense of control over schedules. The benefits for patients are just as clear, with more consistent care and stronger staff engagement. It is encouraging to see this direction backed at a national level, and for those of us who have championed flexible working for years, it feels like a long-overdue alignment between policy and practice.

The transition away from agency will require the right infrastructure to make it work in reality. Technology that is built around flexibility, visibility, and ease of use will be essential to making this vision stick and to truly embed new ways of working for the long term.

Staff given smart technology

Technology sits at the heart of the NHS’s latest vision. There is a strong emphasis on workforce management technology, with commitments to reducing administrative burdens so that staff can spend more time with patients. The benefits here are twofold: improving outcomes while helping to ease burnout and stress, promising to reshape both how care is delivered and how teams work behind the scenes. It’s a familiar idea, and one that’s been explored before, but it is refreshing to see it clearly backed by national bodies.

Crucially, this plan recognises that empowering healthcare professionals also means giving them the right tools, not just digitising for the sake of it. We have seen the difference that effective, fit-for-purpose systems can make to staff morale, retention and performance. When technology supports rather than hinders, the impact across an organisation is significant.

Alongside this, the plan places a welcome focus on staff wellbeing and development, from smoother onboarding processes to tackling non-clinical workload. There is a clear shift towards creating a working environment where people feel supported and valued. It is a recognition that long-term sustainability does not just depend on budgets or technology adoption, but on how well the NHS supports the people powering it. 

A future of possibility 

The NHS 10-Year Health Plan paints a hopeful picture of the future. By harnessing flexible working models, leveraging technology, and investing in its greatest asset, its people, the NHS is positioning itself as a modern employer and a global leader in healthcare innovation. 

Achieving these goals will require partnership, collaboration, and a willingness to embrace change. The foundations laid by this plan should pave the way for a sustainable, efficient, and patient-centred NHS. 

Whether you’re a workforce leader, manager, or frontline clinician, the time to engage with this transformation is now. Together, we can build an NHS that not only meets the needs of patients but empowers its staff to thrive. 

 

Comments from our CEO and Co-Founder, Dr Anas Nader: 

“While ‘doctors in pockets’ and AI diagnostics will grab the headlines, the behind-the-scenes transformation this plan promises to deliver is just as important.

If we are serious about building an NHS ‘fit for the future,’ we urgently need to find ways to maximise operational efficiency and implement new solutions to address age-old problems like staffing and service planning.

That’s why I’m especially pleased to see leaders commit to harnessing digital tools that free up staff time and streamline laborious admin, as well as the focus on offering greater flexibility for clinicians. The test now will be how the government goes about delivering on these pledges.

Goals such as eliminating all external agency spend by the end of this parliament are ambitious, but without a concrete strategy to replace this essential labour, we risk adding to the pressure on overstretched teams and exacerbating the strain on our chronically overburdened health service.”

 

The recent joint letter from the Secretary of State for Health and Social Care and the Chief Executive of NHS England set a clear and ambitious direction. The NHS have been asked to reduce agency spend by 30% in the next financial year.

This is a significant objective. For workforce leaders already navigating complex pressures, it may feel like a steep hill to climb. But with the right tools, infrastructure and insights, meaningful progress is not only possible but achievable.

At Patchwork Health, we’ve been working with NHS organisations across the country to make this shift a reality. In this short piece, we unpack what the latest guidance means for those on the ground and show how technology can help organisations move forward with confidence.

Turning policy into practice

The letter urges every NHS organisation to play its part in delivering better value for money and reducing unnecessary spend. Agency margins are described as, in most cases,  avoidable costs that could be redirected into patient care.

This isn’t just a budgeting challenge. It’s a system-wide objective to deliver flexible work more effectively. It means empowering clinicians to choose bank over agency as their preferred route of flexible work and ensuring the right internal processes and systems are in place to support that choice.

Building a better bank experience

One of the clearest messages from the letter is that staff banks should be the first port of call for temporary staffing. To make this work, the bank experience has to be easy, transparent and rewarding. 

Patchwork Bank is designed to do exactly that. Clinicians can browse, book and manage shifts in real time. Notifications, digital timesheets and simplified workflows help reduce friction. We have also recently improved our onboarding flow, making it far easier for organisations’ temporary staffing teams to view and assess applicants to the bank. Booking shifts and getting paid on time is paramount, and when clinicians feel supported, your bank becomes stronger and a far more reliable resource. 

 

Making smarter use of your data

The letter also calls on trusts to review and manage their bank pay rates carefully. Organisations are expected to evaluate their rates against the local market and ensure they are not exceeding the average agency equivalent.

Patchwork’s rate comparison dashboard gives you the visibility to do this with confidence. You can compare real-time rate data across your region, and understand where your spend sits in relation to anonymised data sets. For organisations, it is about maintaining financial grip and control while remaining competitive enough to attract staff to their bank.

Supporting you to plan ahead

 

With increased government intervention and closer attention paid to spend, it will be more important than ever to demonstrate clear progress and have robust plans in place. That includes tracking where reliance on agency persists, understanding why, and having the tools to make more effective use of internal and collaborative staff banks.

 

Patchwork’s reporting suite offers full visibility of temporary staffing activites. You can monitor trends, flag risks, such as, oversight across last minute vacancies and the risk of unfilled shifts that could end up going to agency. For many of our NHS partners, these insights are already helping to shape strategy and reduce agency demand through informed decision-making. 

We also support trusts with worker onboarding, communication tools and features to help surface bank options before agency routes are considered. It’s a system designed to put your internal workforce first.

 

You’re not starting from scratch

This is a complex challenge, but it’s one we’ve seen many organisations overcome. Whether you are just starting to reduce agency usage or looking to reach the next stage of your temporary staffing strategy, Patchwork is here to support workforce transformation.

By working in partnership with NHS teams, we’ve supported tangible savings, increased bank fill rates and helped ensure that flexibility doesn’t come at the expense of sustainability.

For all NHS organisations, ensuring compliance, maintaining fairness, and productively meeting the dynamic needs of patient care all hinge on having the right tools in place. Traditional rostering approaches often lack the visibility and efficiency required, leaving teams grappling with fragmented processes and outdated information.

This is where data-driven rostering solutions, like Patchwork Rota, step in. With data surfaced via Patchwork Insights, the solution doesn’t just simplify rostering, it transforms the process into a strategic asset. By enhancing visibility and transparency, the system enables informed staffing decisions that support compliance, fairness, and ultimately, safer workforce utilisation.

The central role of visibility

Compliance isn’t just about ticking boxes, it’s the backbone of safe and effective care delivery. Failing to comply with regulations, such as maintaining minimum staffing levels or honouring agreed working hours, risks service disruptions and puts undue stress on employees. Ensuring compliance begins with visibility knowing where your resources are, identifying gaps, and seeing who’s available, before making decisions.

Yet, many organisations lack real-time access to this data, forcing managers to make staffing decisions without the necessary information. This often leads to over or understaffing, increasing reliance on costly temporary staff and creating inefficiencies throughout the workforce deployment process. With data-driven rostering, these issues become far more preventable and give teams comfort around their workforce decisions.

How Patchwork Rota drives compliance and fairness

Patchwork Rota, powered by data from Patchwork Insights, offers a holistic approach to workforce management, addressing multiple challenges with an emphasis on compliance and fairness.

Here’s how it works:

1. Real-time data visibility

With central, easily accessible dashboards, workforce managers can monitor every aspect of rostering, from shift assignments to leave balances. This ensures that key compliance metrics, such as minimum staffing numbers or mandatory coverage are met without manual guesswork.

For example, instead of relying on generic rota patterns or outdated lists, managers can see live data about who has been rostered, who is available, and where resource surpluses or shortages exist, informing workforce decisions, minimising errors and reducing manual admin. 

2. Automated decision-making 

Patchwork Rota’s solution balances complex factors, including regulatory requirements, skill mixes, and staff availability – to create compliant and fair rosters.

Imagine a situation where staff preferences clash with organisational needs. Automated systems review the data, assign shifts that meet compliance standards, and clearly communicate the rationale behind decision-making. This minimises bias, retains transparency, and boosts trust between clinicians and management.

By doing the heavy lifting, Patchwork Rota allows rota coordinators to focus their attention on higher-priority tasks, reducing admin time from hours to minutes.

3. Foster fairness with preference-based rostering

Fairness doesn’t have to come at the cost of efficiency. Patchwork Rota enables preference-based rostering, allowing clinicians to submit their availability for upcoming shifts. This ensures their work-life balance is considered while still adhering to compliance needs for coverage and operational safety.

Staff preferences are intelligently balanced with other priorities, aligning schedules in ways that foster morale and fairness. With fewer surprises and more transparent processes, engagement improves and so does compliance with working hour agreements.

4. Integrated data and staffing insights

Organisations often struggle to match staffing numbers to service demand, leading to overstaffing in some areas and understaffing in others. Patchwork Rota solves this by incorporating real-time demand data into scheduling decisions.

For example, with data from different departments, rota coordinators gain clarity on patient volume, service demand, and resource requirements. This equips teams to redistribute staff dynamically, ensuring compliance and safety without resorting to more costly temporary staffing options as a first port of call.

Building a safer, smarter workforce

The NHS staff survey has shown that staff engagement and well-being are linked to the tools and systems they interact with daily. 

By adopting Patchwork, organisations create a support structure that promotes fairness, reduces manual rostering stress, and ensures compliance.

Ultimately, compliance and productivity are two sides of the same coin, one cannot work without the other. With data-driven tools, the gap between staff satisfaction, operational efficiency, and patient safety closes further, supporting a safer, more reliable healthcare system for everyone.

Want to discuss how you could boost workforce productivity at your organisation with Patchwork? Get in touch here. 

We summarise how poor visibility of clinical activity can throw a department off balance – and what we can do about it.

Job planning shouldn’t have to be as complex as it often is for workforce teams. Put simply, job planning involves matching clinicians with activities that need completing. But in practice, it’s rarely this straightforward.

For any departments juggling priority emergency duty cover, year-round service requirements, and the other everyday realities of annual and professional/study leave, it gets complicated – fast. Without accurate, up-to-date data, it’s not just scheduling that suffers – it’s:

• Patient care
• Staff workload
• Health and wellbeing
• Recruitment and retention
• Organisational finances

Losing sight of the full picture

Accurate rota patterns are essential for planning and meeting true service capacity. Many clinicians, particularly consultants, work rosters that span the full year, even though they’re only contracted for around 42 of the 52 weeks when allowing for holiday and professional/study leave. If this isn’t properly reflected in job plans, organisations risk underestimating clinical hours available, leading to a shortfall. These are subsequently filled as last-minute gaps – often at premium rates.

In one worked example, misaligned planning for 8 surgeons on a 1-in-8 rota would lead to a shortfall of 230 clinical hours. That’s the equivalent of 420 fewer patients seen annually across clinics and theatres. If the Trust had tried to cover this at late notice, the cost would exceed £40,000 – for just one roster. The true cost to the organisation should be calculated by taking this figure and multiplying across the number of similar working arrangements. Beyond the financial hit, the knock-on effects include less planned care, more cancellations, and growing waiting lists.

Unfortunately, this isn’t a one-off. Across the system, rotas are being built using spreadsheets, outdated systems, and incomplete staffing data – leading to mismatched supply and demand, overworked teams, and missed opportunities to deliver care more efficiently.

Patchwork Health’s Job Planning product,  powered by the original L2P technology and co-designed with both clinicians and managers, addresses this head-on. Unlike other job planning systems, its handling of priority activities simplifies accurate rota planning, making it easier to flag capacity risks early and fill gaps at standard rates. The system reflects the realities of NHS working life – where wellbeing, working hours, and professional development are vital to protecting both workforce capacity and patient care.

Making space for what matters most

Matching capacity with demand isn’t just about filling shifts – it’s about making space for the work that matters most. In surgical departments, that might mean reducing usual activity during priority emergency duty cover. But to do that well, you need visibility over who’s available and when.

Good job planning means taking those full 52 weeks into account – even if you’re only working 42. It means forecasting leave, mapping cover, and giving teams a shared, trusted source of truth to build around.

The takeaway? Don’t let your data let you down

If you want job plans that actually work in practice (and don’t crumble under pressure), you need systems that can handle the complexity – and surface the most accurate information at the right time.

Good data isn’t a ‘nice-to-have’, it should be the foundation of all decisions an organisation makes.

The NHS Staff Survey continues to act as a vital barometer for the sentiment and experiences of NHS staff across the country. This year, for bank-only workers, the insights reveal both enduring challenges and opportunities for improvement within the workforce. With over 24,000 responses collected, this specialised report sheds light on the experiences of those who work within the NHS bank system.

From flexibility demands to workforce well-being, the findings make it clear that change remains essential. Here, we break down some of the topical themes and explore the steps organisations can take to better support bank-only staff.

Staffing pressures and uneven workloads

Bank-only workers surveyed this year highlighted continuing concerns about staffing levels. Only 42.22% of respondents said there are enough staff available for them to do their job properly. Furthermore, only 34.69% of survey participants stated they “never” or “rarely” feel unrealistic time pressures. These figures show that while progress has been made since 2023, the majority of bank staff continue to operate in challenging environments.  

The often temporary nature of bank work means these employees regularly fill staffing gaps in pressured settings, leaving them less able to reliably anticipate the demands of their shifts. Building more robust, coordinated scheduling systems that integrate bank and substantive workers could be a key step toward alleviating discrepancies in workload.  

Flexibility is NOT a luxury

Flexibility stood out as one of the most critical themes in this year’s survey. While 74.19% of respondents reported being able to decide their own hours, this represents a near 3% drop compared to the previous survey. While this relatively high percentage suggests that bank workers continue to benefit from flexible scheduling, this sentiment is not shared to the same extent by their substantive colleagues.

For the NHS, retaining experienced workers and ensuring high engagement requires listening to the growing demand for adaptable scheduling. The survey shows workers prioritise the ability to control their hours for reasons ranging from pursuing additional income to maintaining a better work-life balance.

Patchwork Bank supports this need directly, as bank workers can instantly view available shifts, book directly through the app 24/7, and track both shift history and upcoming payments – all from their phone. This streamlines the process, reduces admin, and provides much-needed visibility and reassurance, allowing clinicians to work flexibly, with fewer calls, fewer emails, and no unnecessary delays.

To make improvements to flexible working for both bank and substantive workers, organisations must look at rostering and scheduling tools that promote autonomy and control for all staff. Solutions like self-rostering, shift swaps, and transparent rota systems can help drive satisfaction, retention, and workforce sustainability.

Burnout still remains prevalent

Bank-only workers are not immune to the broader workforce struggles surrounding burnout and emotional fatigue. The survey highlighted that 30.17% of respondents feel emotionally exhausted, while 22.49% have reported work-related stress.

These statistics illustrate the crucial need for interventions that support the well-being of temporary staff. Without access to consistent managerial support or peer networks often afforded to permanent team members, this group can feel particularly isolated from mental health resources and workplace support systems.  

Implementing tools that streamline workflows, reduce administrative burdens, and foster community between bank and permanent workers will be key. For example, Patchwork Health’s product suite includes centralised communication tools that make it easier to access real-time support and additional system training when needed.

Tech and collaboration – a positive step

With only 50.08% of bank workers agreeing that their organisations help them balance work and home life, and just 45.96% feeling supported by their bank teams, technology could provide a pivotal advantage in driving engagement and ease of access to resources.

Bank-only workers often operate across multiple departments and locations, making consistent access to operational tools essential. Digitised systems that support flexible scheduling and real-time communication can play a major role in building a more connected and sustainable workforce.

Patchwork Health’s platform enables bank clinicians to instantly view, book, and manage shifts – while tracking when and where they’ve worked and how much they’re owed. By consolidating everything into one streamlined system, bank workers are given greater autonomy, and organisations can reduce the administrative burden and oversight challenges often associated with temporary staff.

Bank workers play a crucial role in the NHS

The 2024 survey makes it clear that bank-only workers remain vital to the NHS’s ability to function, but they require specific support mechanisms that go beyond traditional structures. Whether improving communication with bank teams or introducing robust safety nets for emotional and physical well-being, these changes can strengthen the NHS’s agile, temporary workforce model.  

The insights from this year’s survey underline one resounding truth: meeting the needs of bank staff creates a more resilient and sustainable NHS.

The way we discuss our NHS workforce is evolving. Staff are not just a number or a target on a balance sheet; people are rightly recognised as critical enablers of sustainable care delivery. This pivotal shift was the focus of our recent webinar, where we brought together influential voices from across the system. Together, we unpacked the 2025/26 priorities and operational planning guidance through the lens of workforce transformation.

Sue Hodkinson, Director of Client Partnerships at Patchwork and former NHS Executive Director of People, opened the discussion with a remark that set the tone for the session:

“We need to move away from thinking about workforce as a cost, and instead think of it as an enabler of good care.”

With workforce expenditure comprising around 65% of total NHS budgets, this perspective shift couldn’t be more urgent. While the guidance remains largely financially focused, the group emphasised that achieving a sustainable future for the NHS calls for more than just reducing costs. Instead, the need is for smarter, more human-centred ways of working.

Flexibility and sustainability

Amanda Grantham, Turnaround Director and Transformation Director, at East London Foundation Trust, echoed this sentiment, emphasising the inherent connection between financial and workforce sustainability. She explained, “The only way you’re going to get financial sustainability is by having a sustainable workforce model. You need the right people, in the right place, working in a way that works for them.”

This demands systems that place flexibility at their core, eliminating unnecessary barriers while fostering long-term resilience. A promising step in this direction has been the changes to statutory and mandatory training requirements. By simplifying processes and enabling staff to move more easily between roles, the system is laying the foundations for greater workforce agility to meet the needs of both individuals and services.

It’s also worth noting that flexibility delivers benefits not only for staff but for budgets as well. Amanda highlighted this dual advantage, stating, “If you can improve well-being and flexibility, often your cost savings will drop out at the bottom of that as well.”

Retention is always a critical focus

Beyond flexibility, retention emerged as a clear priority. The economic argument is compelling; research consistently shows it is far more expensive to backfill a role than to retain an existing staff member. Yet, many systems continue to struggle with addressing the underlying causes of turnover.

The consensus was clear: investing in retention is not optional. Whether through improving flexibility, ensuring access to professional development opportunities, or enabling clear career progression, the NHS must place greater focus on understanding and meeting staff needs to encourage long-term engagement and loyalty.

The multiple roles of data

Richard Lucas, Head of Data at Patchwork, highlighted another vital component of workforce transformation – the power of data. He emphasised, “One of the biggest blockers to workforce transformation is the lack of integrated data. Trusts often don’t know exactly where their people are or how they’re being utilised.”

Without clear visibility, any effort to plan effectively will inevitably fall short. By adopting platforms like Patchwork to integrate and streamline workforce data, Trusts gain the clarity needed to move from a reactive approach to proactive, strategic planning. However, technology alone isn’t the answer. “It’s about aligning the technology to your workforce vision – then using it to join up all the moving parts”.

Building the future

At the heart of this conversation lies a simple truth: behind every budget line is a person. The future of the NHS depends on how well it values, supports, and enables its people. To build a more sustainable and effective system, we must abandon the idea of workforce as a problem to be managed. Instead, we need to foster collaboration, utilise data effectively, and ensure technology is designed to serve the workforce it supports.

By working together, 2025/26 can be a turning point – a moment when the NHS becomes not only financially sustainable but also rooted in resilience, humanity, and care. Beyond the numbers, this is the opportunity to build a system that truly reflects the incredible people at its core.

From 12th September 2025, significant changes to exception reporting will take effect across England, reshaping the process for resident doctors. These reforms aim to enhance transparency, fairness and oversight, creating a framework that supports clinicians and organisations as they navigate the process of exception reporting.

For NHS managers, understanding these updates is essential for ensuring compliance and supporting your teams effectively. This blog explores the key reforms, what they mean for your organisation, and how technology from Patchwork Health is already aligned to help you adapt.

What’s Changing in September 2025?

The new framework introduces three key updates designed to improve how additional work hours are recorded, verified, and resolved.

1. New Approval Routes for Reports

• Educational exception reports will now go directly to Directors of Medical Education (DMEs). All other reports will be routed to HR or Medical Workforce HR.
• Working hours reports for under two hours go straight to HR. Reports over two hours will involve the educational supervisor, with a greater focus on safe staffing, rather than contesting clinical judgement.
• The Guardian of Safe Working Hours (GoSWH) retains overall oversight, ensuring compliance and surfacing unsafe working patterns.

2. A New Three-Stage Review Process

A structured, standardised process now applies across all trusts:

Level 0 – Standard: HR reviews evidence and approves payment or TOIL if everything aligns.

Level 1 – Clarification: HR contacts the doctor if discrepancies are found.

Level 2 – Escalation: If the doctor maintains the report is accurate despite rejection, GoSWH makes the final decision.

This consistent approach ensures fairness, reduces disputes, and ultimately improves transparency.

Note: Reports over two hours follow a slightly different route involving educational supervisors, but with an emphasis on safety – not questioning clinical judgement.

3. TOIL or Pay – your choice

Doctors can now choose between Time Off in Lieu (TOIL) or additional pay for extra hours worked. However, if a breach of safe working limits occurs, TOIL becomes mandatory to protect clinician wellbeing.

This empowers doctors to align work compensation with their needs – while keeping rest and safety front and centre.

How Patchwork Health supports the new exception reporting framework

Adapting to these reforms doesn’t have to be a challenge. Patchwork’s existing exception reporting system already reflects these principles – meaning no need for costly overhauls or operational disruption.

Here’s how our platform is ready to support your trust:

✔️ Confidential, role-based access

Reports can be easily funnelled directly to HR and GoSWH – ensuring appropriate access and reducing conflicts of interest. Our system supports configurable review access, meaning, for example, clinical supervisors won’t see exception reports under two hours – removing concerns about raising reports having a negative impact.

✔️ Seamless submission and approval

Clinicians can submit exception reports via our app. Reports are automatically configured to the correct approver – HR, DMEs, or GoSWH – reducing delays and manual admin. The system notifies all parties that reports should be actioned within 7 days, reflecting best practice set out in the reform. Built-in notifications keep everyone updated, and all parties can track the status of their reports in one place.

✔️ TOIL or Pay preferences built-in

Clinicians can clearly state their preference for TOIL or pay at the time of submission. These choices are securely logged – streamlining HR and payroll follow-ups while ensuring compliance with the 2025 framework. 

✔️ Tiered review and in-system disputes

Our review system supports multi-level escalation – perfectly aligned with the new three-stage model. Should any disputes arise, they can be resolved within the platform, minimising admin while preserving consistency and fairness.

✔️ Easy onboarding and visibility

We make onboarding seamless. Clinicians can upload documents quickly, non-clinical staff have visibility into required actions, and automated notifications cut down the back-and-forth, keeping processes flowing smoothly and actively encouraging sign ups.

Why these reforms matter for NHS managers

The 2025 exception reporting reforms are more than policy changes – they are a critical step towards building an NHS workplace culture that prioritises fairness, safety, and sustainability. Here’s why they matter:

• Improved safety for clinicians and patients

By standardising reporting routes and introducing mandatory TOIL for unsafe breaches, these changes protect doctors from burnout and ensure better care quality.

• Enhanced transparency and trust

Clear approval processes and structured verifications help build trust between clinicians and management while ensuring that systems are fair and equitable.

• Reduced administrative burden

Automatic routing, consistent procedures, and other tools reduce workloads for HR teams, DMEs, and GoSWHs, allowing them to focus on strategic priorities.

• The value of fighting for safe working hours, fair compensation, respect for doctors’ time, and restoring the profession.

Resident doctors with the choice between TOIL and pay allows greater flexibility and control over their workloads, creating a more supportive and empowered working environment. The reforms demonstrate a renewed commitment to reviews focusing on safety, rather than questioning clinical judgement, fostering a culture of professional respect. 

NHS managers and HR teams play a vital role in bringing these changes to life and these reforms reflect the NHS’s commitment to fostering not only safer working conditions, but sustainable too, whilst importantly attracting and retaining top talent within the healthcare service.

Each year, the NHS Staff Survey gives us a window into the reality of working in the NHS. With 774,828 staff responding in 2024, the recently published results provide a great insight into the complexities, feelings and mindset of the workforce over the last year.

From staffing shortages to well-being concerns, the latest findings highlight both ongoing challenges and areas of progress. Here are some key takeaways:

1. Staffing pressures

Only 34% of NHS staff feel there are enough people in their organisation to do their job properly. While this is a slight improvement from last year, it still leaves two-thirds of the workforce stretched thin, covering gaps and taking on extra workload. At the same time, just 27% say they rarely or never experience unrealistic time pressures – meaning the majority are working against the clock, shift after shift.

It’s clear that the system is struggling to keep pace with the needs of staff, but there are safety nets available to reduce soaring pressures. 

Organisations may look to the resources of a temporary bank to reduce strain on stretched permanent staff and help meet rising patient demand.

2. Burnout & well-being still a key priority

42% of NHS staff report feeling worn out at the end of their working day, and more than half (55%) have worked while unwell in the past three months.

While these statistics are of course concerning, there is some progress – work-related stress has fallen slightly to 41%. But with nearly half of the workforce still feeling the strain, rostering solutions that protect staff wellbeing are more critical than ever. If a clinician’s schedule is unpredictable, reactive and created without their input, organisations can adopt solutions that empower clinicians with the flexibility they need.. For example, if a clinician has to stay late after a shift, adopting a system that makes submitting exception reports seamless may help in alleviating some  pressure.

3. Flexibility is not a buzzword

Flexibility is no longer a nice-to-have – it’s an expectation. Yet, only 36% of NHS staff feel they have access to good flexible working opportunities, highlighting a growing demand for more adaptable scheduling and greater autonomy over working patterns.

For many, rigid rostering structures make it hard to achieve a sustainable work-life balance, leading staff to seek alternative ways to manage their shifts on their terms. Making it as seamless as possible to pick up bank shifts and empowering staff with easy self-rostering tools will be key to improving retention. If the NHS wants to retain its workforce, embracing greater flexibility within its existing structures will be crucial to ensuring staff feel supported, in control, and able to work in a way that suits them.

4. Systems systems systems

Workforce challenges don’t just come down to numbers. Less than 60% of NHS staff feel they have the right materials, supplies, and tools to do their job properly, and only 50% feel involved in decisions that affect their work.

As demand grows, outdated systems and rigid structures risk slowing down progress. Giving staff more say in workforce planning, alongside smarter, more agile workforce solutions, could help unlock new ways of working to empower clinicians and managers alike.

So what’s next?

The 2024 NHS Staff Survey highlights not only challenges but also new opportunities. Ensuring our NHS staff feel supported, valued, and empowered is more crucial than ever. This calls for improved workforce planning, smarter rostering, and a stronger focus on staff wellbeing.

The UK Government has announced amendments to the Employment Rights Bill, aiming to improve job security, wages, and working conditions. While much of the focus has been on zero-hours contracts and statutory sick pay, these changes could also impact NHS workforce management, particularly in temporary staffing. We’ve broken down a few of the key changes and takeaways for NHS organisations and workforce managers:

More stability for the NHS agency and temporary workforce

The Bill ensures that all workers, including up to 900,000 agency staff, can access contracts that reflect the hours they regularly work. While this improves job security for clinicians, it also means NHS trusts will be required to review how they engage with temporary staff. As a result, organisations relying on flexible workforces must balance maintaining compliance with meeting operational needs. This may require reviewing rostering practices, updating contract terms, and ensuring bank and agency workers have fair access to secure working patterns.

Tighter regulations on agencies

A major change is the crackdown on non-compliance. NHS organisations working with external staffing providers should ensure they only partner with ethical and compliant agencies. The goal is to prevent workers from losing out on rights and protections when employed via third parties. Trusts may need to audit their supply chains, implement stricter due diligence processes, and ensure that all agency staff receive the pay, benefits, and protections they are entitled to under employment law. 

Strengthened Statutory Sick pay

For the first time, Statutory Sick Pay (SSP) will become a legal right for all workers. Employers must provide SSP from day one of illness, rather than the current ‘waiting period’ of three days. This shift could reduce sickness-related disruptions in hospitals, while ensuring staff don’t feel pressured to work while unwell. NHS employers must update their payroll systems, communicate these changes to their workforce, and ensure that temporary and agency workers also benefit from the new protections.

What’s next?

For NHS workforce managers, these changes reinforce the importance of fair and flexible workforce management. While the Bill doesn’t eliminate the need for temporary staffing, it does highlight the need for sustainable and transparent workforce strategies that work for both clinicians and employers. Trusts will need to review their existing policies, contracts, and staffing models to ensure compliance, which may require short-term administrative effort. However, in the long run, these changes can help create a more stable and engaged workforce, reduce last-minute staffing gaps, and improve retention by offering fairer working conditions.