Article

Stop, shift, supercharge: How to create capacity for the work that matters in the NHS

Work has changed across all sectors, but nowhere more than the NHS. With pressures rising, leaders can rethink work to free capacity and improve care.

Work in the NHS has changed dramatically. As pressures continue to stretch both the system and the people working within it, rethinking how work is organised is now a leadership imperative. With the right approach, this can release capacity, improve staff wellbeing and deliver better patient care.

The latest NHS Staff Survey highlights the stark reality facing its workforce: fewer than half of employees (46%) can meet conflicting demands on their time; 32% feel burnout because of workload; and more than a third (34%) have witnessed an error or near-miss in the previous month that could have harmed colleagues or patients.

The question now is not whether change is needed, but where it should begin. And that was the focus of our roundtable discussion with leaders at this year's NHS Confed Expo: how can work be organised differently to ensure effort goes towards the moments that matter, for both patient care and for staff?

Putting work in the right place

Over time, many NHS roles have expanded beyond their original purpose. More and more non-clinical tasks have found a ‘home’ within clinicians’ roles, leaving them with less time for the work that is most aligned with their skills, training and passion. In nursing, for example, there is a growing gap between the reason people entered the profession and how they spend their day - with admin regularly taking them away from direct patient care.

Although nursing vacancy rates have fallen, recruitment alone is not enough to solve the capacity challenge. The NHS Long Term Workforce Plan also assumes productivity increases of around 1.5-2% a year, but achieving this is unlikely to come from asking people just to work harder; it requires work to be organised differently.

This is where work redesign comes in. This involves understanding the activities and tasks that make up a role, asking whether they are still needed and adding value, whether they are happening in the right place, and whether they are being undertaken by the people (or technology) best placed to do them.

In an NHS context, this means looking at how work can be redistributed so that tasks sit with the right people, in the right place, at the right time. Doing this effectively can of course drive productivity and efficiency, but more importantly, it ensures that quality of care is driven by the correct expertise and nurses can spend more time doing what drew them to the profession in the first place. Ultimately, it means they can apply their clinical proficiency, human judgement and skilled expertise where they make the greatest difference to patients.

Stop, shift, supercharge

Attendees explored what work redistribution might look like for nursing using the stop, shift, supercharge framework.

Stop: What no longer needs to happen?
Shift: Who, or what, is best placed to do the work?
Supercharge: Where should the capacity created be reinvested?

Beginning with what’s not working, they asked: Which activities no longer add value? What could stop altogether or be reallocated to another role, team or technology? These discussions gave permission for participants to acknowledge some of the frustrations and constraints of the current system.

Focus then moved from releasing capacity to reinvesting it. The capacity created through stopping unnecessary work and shifting appropriate tasks should be reinvested in the moments that matter most. Reframing in this way expanded the conversation beyond efficiency towards improving patient outcomes and making better use of nurses’ expertise.

Although nursing provided the starting point, participants quickly identified other opportunities across other clinical services. Any service experiencing pressure could ask the same questions: what could stop, what could shift, and where could skilled professionals spend more time?

For NHS leaders, the crux of all of this is being able to protect and amplify the high impact human moments where experienced clinicians make the biggest difference and ultimately improve patient experience. In high-stakes settings, these are often the interactions that rely on experience, intuition and professional judgement, such as recognising signs of deterioration, responding to changing patient needs and building trust with patients and families. These capabilities cannot necessarily be reduced to a list of tasks on a job description, but this is precisely the kind of work that should be protected and strengthened through redistribution. So, where can you start?

Where to start

It’s important to note that work redistribution does not have to begin with a whole organisation. Start where the need is already visible: a pathway where staff repeatedly raise frustrations, patient feedback highlights recurring issues, or external assessments identify opportunities for improvement. Those ‘hot spots’ provide a natural place to explore how work could be organised differently.

Begin with one pathway or team. Identify a service where there is both a clear need and a leader who is open to trying something different. Establish a baseline, test ideas, learn what works and build from there. Understand how work is actually lived, rather than what is solely in the job description. Which activities genuinely add value? Which have accumulated over time? Which could be stopped, be shifted elsewhere or be supported by tech? And what moments absolutely need a person because that’s where they have the greatest impact on patients?

Just as importantly, be clear about the ‘why’. For nurses in particular, the message cannot be about reducing headcount or indeed filling the spare capacity with more work. It’s about creating capacity to spend more time on patient care, make workloads more sustainable and give clinicians more time to do the work where their expertise matters most.

For some organisations, their immediate priority may not be work redistribution at all. Fragmented pathways, data sources or operating models may well need to be strengthened first to provide a solid foundation before optimising how work is organised. There is little value in optimising what’s already broken.

The role of technology

One way of redistributing work is through technology, for example by automating routine administrative tasks or using AI-driven tools to provide evidence and data to support decision-making. This helps nurses to spend less time on activities that are lower value and more time applying their uniquely human capabilities like judgement and compassion. Of course, this must be underpinned by safe and appropriate governance, with human oversight and safeguards around how AI-generated information is used.

Participants were optimistic about AI's potential here, sharing examples of new approaches already happening across individual trusts, such as AI-powered note-taking during ward rounds. However, many felt innovation is happening in pockets: different trusts, hospitals and even departments are experimenting with their own solutions, often with little visibility or sharing of what’s working. Without a way of sharing this learning, organisations risk solving the same problems repeatedly rather than building on each other's experience.

An opportunity to rethink

Against the ambitious backdrop of the NHS 10 Year Plan, with services moving from hospital to community settings, greater use of technology and a stronger emphasis on prevention, many job roles are already changing and evolving in a new context. But rather than viewing this as another transformation attempt, there could be an opportunity now to rethink how the very essence of work is organised as new models of care take shape.

There is no doubt that we are operating in a period of unprecedented change, but perhaps this is a catalyst to give NHS leaders permission to ask a different question: if we were designing these services today, would we organise the work in the same way?

If you’d like to explore how your organisation can create capacity for the work that matters, our workforce specialists would be pleased to speak with you.

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Article

Stop, shift, supercharge: How to create capacity for the work that matters in the NHS

Putting work in the right place

Stop, shift, supercharge

Where to start

The role of technology

An opportunity to rethink

Our people

Maura Jarvis

Lydia Coleby

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