How would clinicians use time freed up by technology?
How would clinicians use time freed up by technology?
9 May 2024
Key points
- The idea that technology can free up ‘time to care’ for NHS staff, allowing the health service to increase volumes of clinical activity, has become a major focus of health policy, informing the NHS Long Term Workforce Plan and the NHS productivity plan announced in the 2024 Spring Budget. This analysis from the Health Foundation explores how freed-up time might be used, drawing on a survey of clinical staff, expert interviews and a rapid evidence review.
- If potentially time-saving technologies are to generate productivity benefits, then the time freed up has to be used effectively. This is often assumed but by no means guaranteed. The evidence review estimated that less than 1% of the literature on the impact of technology on staff time in health care actually considers how freed-up time is repurposed. Given this significant evidence gap, more research is needed.
- Our analysis cautions against the assumption that time freed up by technology will automatically translate into the equivalent amount of time being used for patient care. When we asked clinical staff how they would likely use freed-up time, survey respondents allocated only 27% of that time to patient care or direct clinical activity. It is important that policymakers, system leaders and those involved in workforce planning use realistic assumptions when it comes to modelling how freed-up time may be used.
- This figure, however, should not be taken as a general rule or upper limit on the use of freed-up time for patient care. Explicit planning is required to ensure the effective repurposing of time, and this should be done with staff and wider stakeholders. So good change management is critical to deriving the benefits from time-saving technologies.
- Our survey respondents and expert interviewees suggested that, in addition to potentially increasing care volumes, freed-up time could be used in a range of ways, from enhancing the quality of patient consultations to having more time to think and undertake wider professional activities like training, research and quality improvement. These activities can also benefit productivity – for example, through boosting care quality, enhancing knowledge and skills, streamlining service delivery and supporting staff wellbeing and retention. A broad view of how freed-up time can contribute to improved NHS productivity is therefore crucial.
- There is an important opportunity here for NHS leaders and employers to create a compelling ‘offer’ for staff, one making it clear that – in addition to increasing care volumes – a proportion of freed-up time could be used for activities, such as training or research, that would not only benefit productivity but make a crucial contribution to improving job quality.
Our research draws on an anonymous online survey of clinical staff across the UK and semi-structured qualitative interviews with experts on the use of technology and AI in clinical practice.
We targeted eight professional groups in which there are workforce shortages and thus particular hopes for technology to save time and support staff capacity. To reach and represent each group, we worked directly with the relevant professional body:
- anaesthetists (via the Royal College of Anaesthetists)
- GPs (via the Royal College of General Practitioners)
- intensive care doctors (via the Faculty of Intensive Care Medicine)
- nurses (via the Royal College of Nursing)
- obstetricians and gynaecologists (via the Royal College of Obstetricians and Gynaecologists)
- physiotherapists (via the Chartered Society of Physiotherapy)
- psychiatrists (via the Royal College of Psychiatrists)
- radiologists and oncologists (via the Royal College of Radiologists).
The survey and interviews were conducted by the Health Foundation with support from these partners, who collaborated with us on the survey text and interview script.
Partner organisations promoted the survey to their members across their communications channels. It was also shared with practitioners from relevant specialties via the Health Foundation’s own networks. The survey was open between 24 November 2023 and 31 January 2024 across the survey platform Qualtrics. We received 614 completed responses. 54 of these were removed from the final dataset because they did not meet our eligibility criteria, which excluded those not working within one of our specific staff groups, not currently practising (for example, those who had fully retired) or working fewer than 4 hours per week. As the survey asked about current uses of technology and the potential for saving time, we wanted to focus on staff whose practice exceeded a minimum number of hours. These criteria left 560 eligible responses, which we used for our analysis and reporting.
For the qualitative interviews, partner organisations connected us with experts on the use of technology and AI in their respective specialties or staff groups. We conducted 17 video interviews between January and April 2024. The details of our interviewees appear in the acknowledgements.
We also commissioned the Evidence Centre to carry out a rapid review of the evidence base on the impact of digital and telephone technology on staff time in health care to help us understand the scope of literature. The review drew on published and unpublished studies available in English from any country between January 2010 and September 2023. The review was designed to provide an indication of the body of literature on this topic rather than to undertake a systematic review or a critique of the evidence base, and we deliberately set broad parameters. It sampled 500 studies most relevant to our search parameters on the impact of digital and telephone technology on health care staff time and workload.
Our survey respondents included greater representation of those at a later or more advanced stage of their career. The answers shifted slightly for those at an earlier stage. Among specialty trainees, for instance, 1 hour was still most likely to be spent on ‘direct clinical activity/patient care’ and ‘reduction of my overtime’, but the third choice was ‘receiving education, training and CPD’. With 3 hours, ‘direct clinical activity/patient care’ was the top option for this group, followed by ‘receiving education, training and CPD’ and then ‘delivering education, training and CPD’. Those at different stages of their careers or with different levels of seniority may have different priorities and/or levels of autonomy when it comes to repurposing their time, and are likely to have different work patterns. For example, the rotational nature of medical training could affect the likelihood of trainees using freed-up time for improvement activities that may outlast their placement at a particular site. (As only 40 respondents were specialty trainees, it is difficult to draw robust conclusions about this group, and more research is needed to explore this issue.)
Our findings suggest that how clinicians would use freed-up time is contingent on a range of factors, from the setting in which they work and their career stage to how much time is released.
We asked those respondents who suggested they would spend some of their freed-up 3 hours on patient care or direct clinical activity to estimate – to the nearest half hour – how much of the 3 hours they would spend on this. 28% said 1 hour, followed by 24% who said 2 hours. On average, respondents who said they would use some of the 3 hours on patient care (46% of the total sample) allocated around 106 minutes each to this (59% of the total possible 3 hours). If 46% of respondents would use 59% of their freed-up time on patient care, this means that 27% of the time freed up across all respondents would be used in this way. While this calculation extrapolates from a relatively small sample of clinicians presented with a speculative scenario, it nevertheless points to the importance of exercising caution when assuming that any time freed up by technology will necessarily create the equivalent amount of additional time for patient care. Our findings suggest only a minority of freed-up time may be repurposed for this.
Further reading
Work with us
We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.
View current vacanciesThe Q community
Q is an initiative connecting people with improvement expertise across the UK.
Find out more