Roll out of MSS to Jr Doctor Host Trusts

Roll out of ESR Manager Self Service to Junior Doctor Host Trusts - A Case Study by St Helens & Knowsley Teaching Hospitals NHS Trust

Background to St Helens & Knowsley Teaching Hospitals

St Helens & Knowsley Teaching Hospitals NHS Trust (STHK) is an acute Trust based in Merseyside employing circa 4,500 staff. The Trust covers two sites one at Whiston Hospital and one in St Helens. Both sites have undergone major re-building in the last few years with new Hospitals on existing sites at St Helens in 2008 and Whiston following in 2010.

STHK went live with ESR in April 2007. The Trust achieved RA5 status in February 2008, becoming the first acute Trust in the North West to do so. At the time this was required before the organisation could implement Manager Self Service (MSS). Following the completion of RA5 status the Trust decided to implement MSS with the backing of the Executive Team and the Director of Human Resources and ESR Executive Sponsor, Anne-Marie Stretch. Manager Self Service was introduced to the Trust in August 2008 with full roll-out completed in 2009. The Trust also fully implemented Oracle Learning Management (OLM) in 2008 which complemented the roll out of MSS. The Trust utilises ESR interfaces with NHS Jobs, COHORT, GMC and Intrepid (the Mersey Deanery System).

The Trust plays a leading role in the North West Special Interest Groups. Mike Winstanley, Senior Development Analyst at STHK, Chairs the North West and the National Self Service Special Interest Group.

The Trust continues to promote and utilise the ESR functionality. On becoming the Single Lead Employer for circa 2,300 Junior Doctors on the Cheshire & Merseyside Deanery programme, they took the opportunity to utilise their skills and expertise in this field to implement Manager Self Service to the Organisations that would be hosting the Doctors whilst on the programme.


The Mersey Deanery runs the training programme for all Junior Doctors in the Cheshire & Merseyside (C&M) area. Prior to the establishment of a single lead employer a number of organisations employed the Junior Doctors by Specialty and then they would be on location at specific host Trusts. However, in 2010 STHK took over the role of Lead Employer for the Deanery and now employs all Junior Doctors from one central point. This not only helps to improve communication it also reduces the amount of administration required.

After becoming the Mersey Deanery’s Lead Employer it became apparent to STHK that it would be necessary to improve the way that sickness absence was recorded and managed

due to the number of Doctors who were employed across 28 organisations plus GP Practices. Before Self Service was implemented each organisation completed a spread sheet with details of each Junior Doctor’s monthly absences and then sent this electronically to STHK. This information would then be input by the Payroll Team into ESR. The recording of sickness absence for Doctors was sporadic at best with some Trusts recording sickness accurately and other Trusts not at all. Records over the last 12 months have provided sickness absence figures at 28 host organisations ranging from 0% to 1.31% (national average being 1.13%). Failure to monitor sickness accurately impacts on the service in many ways:

(1) Patient Safety Compromised;

(2) Additional Costs in Locum Use;

(3) Trainees not completing core training.

The Solution

A method of capturing sickness absence at source and recording this on the employees ESR record directly enables the trainee’s sickness history to transfer with them when rotating around the various host Trusts. This provides an on-going account of the amount of sickness a trainee has taken and also highlights any underlying reasons for sickness.

Recording of annual leave and special leave is another area which is problematic. With trainees rotating from Trust to Trust and also rotating within Trusts the accurate recording of annual Leave is often not undertaken. Trainees frequently arrive at host Trusts without accurate leave histories or incomplete records. This could lead to too much annual leave being taken. This also applies to special leave such as episodes of bereavement and carers leave. Recording this on the record allows host Trusts to see this and provides a more robust and consistent approach being taken.

The Introduction of ESR Manager Self Service to all host organisations provides a platform for the recording of all absences. This not only addresses the issues of Absence recording but for the first time host Trusts are able to produce reports centrally from our ESR system on the doctors in training that are currently working within their Trust.

Commenting on how important this project was for STHK, Anne-Marie Stretch (pictured right), Human Resources Director said “The current, on-going and planned NHS reforms require all NHS Organisations to focus on the Quality, Improvement, Prevention and Productivity (QIPP) Agenda which aims to make £20 billion efficiency savings by 2015 without adversely impacting on patient care. It is believed that the amount of sick leave taken in a year costs the NHS £1.7 billion and one of the QIPP targets is to reduce these costs and the Audit Commission estimate that a saving of £290 million could be made in the NHS by improved management of sickness absence. It is therefore critical that there are effective attendance management systems in place in all NHS organisations. The roll out of ESR Self Service to our Junior Doctor Host Trusts will play a fundamental part in monitoring, managing and supporting sickness absence for the Junior Doctors and it will enable us, the Lead Employer to capture ‘real time’ absence information and thus critically provide early intervention. This will help reduce highly expensive locum costs and improve patient care, governance and the working conditions for the Junior Doctors and their colleagues.”

Key Stage Set Up

Pilot Phase for Rollout of Manager Self Service

In November 2011 a three month Self Service pilot was rolled out with Aintree University Hospitals NHS Foundation Trust and Warrington and Halton Hospitals NHS Foundation Trust. Initially the project lead, Mike Winstanley, met with medical staffing managers at both Trusts to build an understanding of how each captured sickness absence and annual leave for Junior Doctors, and who was responsible for feeding this information back to STHK.

Mike (pictured left) explains: “Both reporting structures were evaluated to determine how effective they were in terms of each Trust’s overall hierarchy and whether information was collected robustly. We then worked around these structures to ensure that the Self Service system fitted within the hierarchy, whilst remaining as flexible as possible. This was particularly important as we wanted to ensure that each organisation was comfortable with recording the information and that it mirrored their local arrangements where possible”.

Full Implementation

In March 2012 the decision was taken to roll out Manager Self Service to all of the other Trusts within the C&M area. A project timetable was drawn up to allow a phased approach and the following Trusts listed below are now all using Self Service. 

  • Aintree University Hospitals NHS Foundation Trust
  • Warrington and Halton Hospitals NHS Foundation Trust
  • Liverpool Heart and Chest Hospital NHS Foundation Trust
  • Mid Cheshire Hospitals NHS Foundation Trust
  • Clatterbridge Cancer Centre NHS Foundation Trust
  • Wirral University Teaching Hospital NHS Foundation Trust (Arrowe park)
  • Countess of Chester
  • East Cheshire Trust (Macclesfield)
  • Liverpool Women’s
  • St Helens & Knowsley Hospitals NHS Teaching Hospitals Trust
  • 5 Boroughs
  • Alder Hey Children’s NHS Trust
  • Cheshire & Wirral Partnership
  • Walton Centre for Neurology
  • Liverpool Dental Hospital
  • Mersey Care
  • Royal Liverpool Hospital
  • Southport & Ormskirk

Operating Principles

Operating Principles

Mike continues: “When each Trust joins the system we visit the medical staffing team to determine how reporting currently works, who needs log-in details and how the ESR Manager Self Service can be made to fit around existing hierarchies. For example at Aintree, Junior Doctors were required to report their absence to the head of their department, who was responsible for sending departmental reports to STHK’s payroll. Therefore when Aintree joined the Manager Self Service system it became the role of those specialty managers to input ESR data for all the Junior Doctors in their department. However, at

Warrington and Halton, Manager Self Service was set up for staff in just one central medical staffing department, as Junior Doctors were used to reporting absence to this single location. However, Warrington & Halton have now reviewed their methods and they plan to devolve the responsibility for this to the Divisions.

Once users are live on the system, a group training session is held to educate managers on how to input data correctly. This training is conducted in-house using a training database which allows users to see how the ESR system works without potentially causing any errors on the live system”.

Generic Attendance Management Policy

A single consistent attendance management policy was introduced across all Trusts that host Junior Doctors to coincide with roll-out of Manager Self Service. “This is helping managers to use the new system more effectively and consistently across C&M, as they are given clear responsibility for managing absence and holding Return to Work (RTW) interviews. They are also able to see real time information, so when Junior Doctors hit triggers they are able to respond immediately”.

Key Challenges

  • There is a need to train people on how to use Manager Self Service but this can be difficult due to the geographical size of the region. Therefore one group training session is held at each Trust rather than offering training to individuals. The size of this session is limited only by how many PCs are available at a time at each Trust.
  • IT systems across Trusts can also differ, so the training database is used to deliver training. This is externally accessible via an internet link from any Trust.
  • Each user needs to be issued with a smart card via their Trust to access ESR. However, due to lack of resources individuals sometimes face delays in receiving these cards. The solution to this problem was to give users enough notice so that they could inform their respective RA Teams in advance so that the cards could be prepared and issued in advance of the Go Live Date.
  • Some organisations are yet to implement Manager Self Service in-house, so line managers from those Trusts often need more support as they are not familiar with the system. This requires training to be tailored to their needs.

Key Learning

  • Make sure that you have enough users to cover unexpected absences. It is advisable that a line manager’s senior manager and someone at an administrative level can act on their behalf if they are on leave.
  • Manager Self Service systems should be set up so that information which is input locally can be viewed and amended centrally. This makes it possible to correct any errors and gives the system a degree of flexibility.

Key Outcomes

  • The number of Junior Doctors currently live using ESR Manager Self Service totals 1642 which equates to 95% of the 1735 Junior Doctors who are employed via STHK. The other 275 Junior Doctors are located in GP Practices.
  • Sickness absence recording has shown a significant increase which provides a fuller picture of the scale of the challenge. In the short-term this has caused an increase in the reported level of absence; however in the long-term it is expected that a uniform sickness absence policy will help reduce this figure and conversely will reduce costs.

ESR & Learning (OLM)

The ESR Manager Self-Service system is linked to the Oracle Learning Management (OLM) database, which allows Self Service users access to record information about Junior Doctors’ training including Mandatory Training. This enables each Trust to tailor training to each Doctor, thus helping to avoid duplication which often causes frustration and an unnecessary waste of resources.

The Future

Finance staff will also be given access to the Manager Self Service system. This will reduce the amount of queries that need to come through to the payroll department/individual line managers, thus making the system more efficient.

Plans are currently being developed to introduce Employee Self Service to the Lead Employer Doctors. This will allow them to view and update certain aspects of their information including personal information. This will also give them access to their on- line payslip and allow them to see their salary information before the payslip arrives in the post.

The Trust is piloting the streamlined ESR and Deanery Interface. This will lead to a number of benefits including reducing the administrative burden on NHS Trust and Deanery Personnel. It uses the position number and ID to link the applicant in the Deanery system to the correct Deanery position in ESR, thus removing the need for Vacancy & Requisitions to be created. NHS Trusts are made aware of the incoming and outgoing Junior Doctor much quicker (both for rotations and for recruitment). This will mean that the Host Organisations will be able to see the Doctors on the first day of their rotation or start date. It will also improve data consistency and potential improvements on data quality within both ESR and Deanery systems.


The implementation of Manager Self Service across the Deanery has been widely welcomed and has been a positive experience.

Commenting on the success of the project Claire Scrafton, Deputy Director of HR said “The implementation of Manager Self Service to the Host Trusts involved in the Lead Employer Programme has transformed the way that sickness absence data is recorded and monitored. For the first time we are able to access live and real time data giving the Lead Employer team the ability to monitor more closely sickness absence information and make early interventions. These interventions are in the best interests of the Employer but most importantly the employees. We are looking forward to working closely with our colleagues across the Merseyside and Cheshire area in utilising and developing ESR to its full potential including Employee Self Service.”

For More Information

Please contact Mike Winstanley at for more information.