Team Based Rostering
Summary
London North West University Healthcare NHS Trust’s Team Based Rostering initiative aligns with the NHS People Promise to improve flexibility, inclusion and sustainability. By giving staff greater input into working patterns and introducing the approach across 71 inpatient wards, it supports wellbeing, work-life balance and retention. The initiative is contributing to improved staff satisfaction and is designed to strengthen safe, consistent patient care. The programme recognises ongoing challenges in aligning rosters with financial and establishment structures and in addressing cultural change, and continues to refine a fair, transparent model.
The Challenge
The Trust recognised it was not meeting the NHS People Promise commitment of “We work flexibly.” Shift workers, especially those on nights and irregular hours, were not experiencing fair and predictable rotas, genuine flexibility, or consistent consideration of their work-life balance. Policies on rostering and flexible working existed but were applied unevenly, with evidence of unsafe and inequitable practices, including breaches of the Working Time Directive that impacted both patient safety and staff wellbeing.
Many wards still relied on outdated request books and there was no central record of agreed flexible working. Some staff had followed the same patterns for decades without review, creating unfairness, financial overspend, inconsistent skill mix, and frustration among colleagues. Reliance on permanent night shifts, unchallenged occupational health restrictions, and ad-hoc agreements added further strain.
The Solution
Engagement was central to success, including:
- Hybrid webinars and workshops for every ward
- Weekly forums with matrons and ward managers
- Staff surveys before implementation and three months after
To scale up, a business case secured a Band 7 nurse and Band 6 administrator. An embedding phase now supports nursing teams for three months post-implementation to review KPIs, identify improvements, and receive targeted guidance. Each ward then presents progress to the Deputy Chief Nurse and Divisional Heads of Nursing, ensuring accountability and sustained change.
Results & Next Steps
The programme has delivered measurable benefits:
The initiative was led by the Deputy Chief Nurse and a core project team, supported by Finance, HR, clinical staff, and learning from other NHS Trusts. A collaborative pilot was launched across six inpatient units, involving around 400 staff. Resources included webinar training, intranet materials, establishment and crewing data, and bespoke data tools. Senior nurses co-developed rostering principles that balanced fairness, equity, and safe skill mix.
- The pilot delivered savings of £11,000 per unit each month, contributing to £1.5m in savings in the last fiscal year through reduced sickness absence, turnover, and agency reliance.
- A survey of 1,086 staff, with a 47% response rate, reported 75% satisfaction three months after implementation.
- Historical flexible working agreements are being aligned to crewing requirements, and rostering guidelines now limit night shifts to support the goal of eradicating permanent night working.
- Progress on complex issues such as legacy occupational health recommendations is being taken forward with the Chief People Officer, Employee Relations, and Occupational Health.
- The project has been shared with more than 20 NHS Trusts, endorsed by NHSE’s “We Work Flexibly” campaign, and designated an exemplar site with a case study in development.
Momentum is now extending beyond nursing, with Radiology being scoped and Allied Health Professionals and administrative teams next. The project has already contributed to a 1.5% reduction in nursing turnover and a decrease in short-term sickness, supporting the Trust’s cost improvement programme. Ongoing priorities focus on embedding improvements, listening to staff, and maintaining strong governance and assurance.
