Background:
NHS Shetland’s Health and Social Care Partnership (HSCP) faced mounting concerns about inconsistent workload distribution across its Community Nursing Services, which included rural island care and Board-managed GP practice nurses. Disparities in resource utilisation between urban and remote bases created inefficiencies, with some clinicians experiencing high daily caseloads while others had minimal activity.
The Executive Team invited Meridian Productivity to assess capacity, review allocation practices, and help improve operational consistency across the service, all within existing budgets.
Analysis:
Meridian carried out a comprehensive 25-day evaluation across the Shetland Islands, conducting observational studies, team leader shadowing, and stakeholder interviews. Key findings included:
Large variations in daily visits between urban and rural teams, highlighting imbalance in service demand and resource use.
No consistent work allocation or patient tracking system in place.
A lack of clinical recording tools to support productivity measurement and workload forecasting.
Practice nurses across GP surgeries displayed significant variation in slot lengths, skill mix usage, and appointment volume—resulting in inconsistent patient access and service expectations.
This lack of structured management controls hindered the ability to deliver equitable care and constrained the service’s ability to optimise staffing.
Implementation:
Meridian launched a 12-week improvement programme focused on building fair and transparent systems to plan, allocate, and measure community nursing activity. Core interventions included:
Co-designed work allocation controls that enabled team leaders to assign daily visits based on real-time need and staff availability.
A bespoke clinical activity recording system, allowing visibility of care provided and supporting service benchmarking.
Introduction of productivity norms across all sites, including the non-doctor islands and Board-managed practices.
Tailored workshops and 1:1 coaching to develop local leadership skills, embed new processes, and encourage collaborative problem-solving.
A custom management dashboard to monitor performance against agreed targets and inform decisions on staffing levels and resource use.
Meridian also worked with island-based nurses to distinguish between health and social care activities, enabling clearer planning and better workforce deployment.
Results:
he project delivered significant operational gains:
5.6–10.9 WTE in potential staffing capacity released, identified through better workload distribution and data-driven allocation.
Embedded allocation processes, giving managers real-time visibility of capacity and ensuring more consistent, equitable care across all sites.
Improved workload balancing enabled underutilised staff to absorb demand spikes—reducing reliance on recruitment and mitigating pressures in overstretched teams.
A new clinical data system gave NHS Shetland, for the first time, a clear view of demand, capacity, and activity—critical for future workforce planning and budget control.
Based on just five months of recorded data, the Board identified 4.6 WTE in surplus capacity, while 5.2 WTE vacancies were already being reviewed—suggesting the opportunity to avoid unnecessary recruitment costs.
