Locum’s Nest is a digital health solution that connects clinicians to temporary work in healthcare organisations. Founded by two doctors in 2016, the company has already saved the NHS £50 m by placing doctors directly into vacant shifts and avoiding agency fees.

Locum’s Nest seeks to solve a problem that is ubiquitous throughout the NHS: the inevitable gaps that appear in hospital and GP practice staffing rotas, often at the busiest times of the year. Filling these gaps can require a lot of effort and often relies on the use of locum agencies, which brings a financial cost. As trained NHS doctors, Locum’s Nest co-founders Dr Nick Andreou and Dr Ahmed Shahrabani have directly experienced these staffing issues , as well as the sensation of guilt when they couldn’t help out. It was this that motivated them to build a digital solution to reduce the reliance of the NHS on staffing agencies.

“Doctors are highly regulated,” says Ahmed. “But we value autonomy and know what we want, so we need a tool that allows us to choose when, how and where we want to work. Our idea was simple: we wanted to build a free app for doctors and a web platform for hospitals so they could bypass the middleman and post 100s of shifts that need filling. We wanted to create the digital ecosystem for doctors to work flexibly.”

Nick and Ahmed launched Locum’s Nest in late October 2016 at Royal Surrey NHS Foundation Trust. At the time Ahmed was working there and in contact with Nikki Hill, the Associate HR Director, who was keen to trial the technology. After raising some initial money to get the app off the ground, they launched the technology in the ENT department. Two months later they launched in the neighbouring Ashford and St Peter’s NHS Foundation Trust and two months after that they started the first NHS collaborative staff bank for doctors across both these Trusts.

“Overnight the two Trusts doubled their effective workforce of doctors,” says Ahmed. “And the doctors loved it because they had access to twice as many shifts. The resulting workforce climate is exactly what we wanted to create, enabling absolute NHS workforce mobility and improving patient continuity of care. Crucially the technology has empowered and retained the workforce and, as a result, improves patient safety and quality of care. In addition it potentially saves billions of pounds in agency spend.”

Luck, timing and evidence

Locum’s Nest now has 25,000 doctors on the app and works with well over 20 trusts and 100 GP practices. This includes a consortium of seven trusts in the south of England that allows doctors to pick up shifts in neighbouring trusts, benefiting both the individuals and the organisations.

The co-founders believe that timing was important in the company’s success: they founded Locum’s Nest just before NHS Improvement (now merged with NHS England) estimated that the NHS spend on staffing agency fees was £3.7 billion pounds and identified the need to address this.

“We had the platform up and running when this was announced,” said Ahmed. “Even then we were very clear about its fundamental purpose and the bigger picture of collaboration. We’ve always stuck to our vision for transparency, even when it seemed easier to change to encourage more clients. Now more NHS Trusts are joining because they share this vision and can see we have the evidence that it works. As more Trusts come on board, the better data we have and the greater proof there is behind our technology.”

Growth and learning

During the early stages of their development, the co-founders met with MedCity. At this point Locum’s Nest was still a skeleton app and they needed advice on how to develop the technology. “MedCity was hugely helpful,” says Ahmed. “The team there are very knowledgeable about the sector and have the ability to absorb a founder’s energy and passion and help turn it into something that works on the ground. We have a lot of respect for the work they do.”

In June 2017 Albion Capital put £1.1. million into Locum’s Nest. Their belief in the company was further confirmed the following year in October when, together with IDO investments, they provided another £3 million of backing.

It was also during 2018 that the company joined the Digital Health.London Accelerator. “When we joined we were still in the scale-up stage of development and DigitalHealth.London was fantastic at helping with brand awareness and enabling discussions with industry.”

Earlier this year, Locum’s Nest won the ‘Company that has Delivered the Greatest Benefit to the NHS’ award in the DigitalHealth.London awards. “It was a great recognition for our work and how much we’ve evolved since our time on the programme,” says Ahmed.

The team at Locum’s Nest now consists of over 40 people, with many from an NHS background. Their headquarters are based in Hammersmith, London and they have a number of regional hubs connecting with NHS Trusts all over the country.

Adoption across the NHS

Based on the data they have collected, Locum’s Nest estimate that they could save the NHS £500 million in the first year by reducing the need to use expensive agencies. And this is just counting those doctors working in secondary care. Having established relationships with a number of Trusts, they have learnt that each organisation needs a slightly different approach.

“It’s about finding those leaders who share your vision,” says Ahmed. “Which in our case is a belief in flexible working, doctor and healthcare worker empowerment and new technology. Once you find those leaders, you then need to contact them at the right time when they’re not inundated with other priorities. The NHS is fifth largest employer in the world so workforce will always be one of the most important drivers for those leaders. So it’s about timing, people and perseverance.”

Customer feedback is central to development at Locum’s Nest and they have built and iterated the technology through continuous data collection from users. They are determined to provide a consumer-focussed app for doctors whilst incorporating solutions to overcome any questions or concerns from the Trusts.

“Every Trust is different,” says Ahmed. “But they all share very similar high-level problems so you have to adapt your offering and ensure your vision remains the same. Some Trusts are concerned about losing doctors to their neighbours but at Locum’s Nest we have built in safety measures to prevent this from happening. In fact what we’re seeing is that transparency grows the staff bank and increases the fill rate. We have 1000s of shifts worth of data across dozens of trusts that proves transparency and honesty are only positive for the NHS.”

Recognition and the future

In addition to the DigitalHealth.London award, Locum’s Nest have been runners-up in the Pitch GovTech startup competition, and were ranked in The Daily Telegraph top 5 ideas to save the NHS. In October 2019 they were awarded a place on the new GP IT future Suppliers Framework. The framework is part of the Digital Buying Catalogue which will act as a digital marketplace allowing buyers to search for and compare supplier solutions that will meet their needs.

“An emphasis on the primary care market is very important for us,” says Ahmed. “And the GP IT Suppliers Framework is very influential in terms of awareness so that people can see these solutions are out there. Already we’ve had a number of requests for meetings and discussions on partnerships.”

“Our aim is to solve the UK’s healthcare workforce challenge through total workforce mobility via more innovations,” says Ahmed. “Our ultimate goal would be one NHS, one staff bank but we’ll have to wait and see exactly how we get there.”