Reducing expenditure on NHS agency staff: rules and price caps

On 16 September 2019 new agency rules were enacted that required trusts to use only substantive or bank workers to fill admin and estates shifts, with trusts allowed to request an exemption under certain conditions.

However, we know that more estates and facilities staff, particularly cleaners, porters and security staff, are required to help the NHS respond to COVID-19. As set out in our letter of 17 March 2020opens in a new window, we will remove burdens that could hamper your efforts.  Therefore, for the rest of the COVID-19 response, trusts will no longer need to request an exemption for any estates and facilities agency workers.

We ask that trusts simply inform us (retrospectively if needed) of their plans and we will record this information. Please ensure your temporary staffing managers work with the agency framework operators who can advise on the appropriate agencies to approach for supply.

From 1 April 2016,  trusts in scope of the rules are required to procure all agency staff via the framework agreements or arrangements approved by NHS Improvement.

This tool, which has been developed with pilot sites, will allow you to diagnose issues, decide ways forward and implement improvements quickly.

We recently hosted a webinar that outlines the rules and explains how to use our new diagnostic tool. It’s available to watch online

The following toolkits will help trusts maximise the use of staff banks, medical locums and reduce overall agency spend:

• Making effective use of staff banks
• Reducing reliance on medical locums: a practical guide for medical directors

• All NHS trusts, NHS foundation trusts receiving interim support from the Department of Health and NHS foundation trusts in breach of their licence for financial reasons
• All other foundation trusts are strongly encouraged to comply
• Ambulance trusts and ambulance foundation trusts are covered by the ceiling and framework rules from 1 April 2016 and the price cap and maximum wage rate rules from 1 July 2016

• The agency rules cover all staff groups: nursing, medical, all other clinical and other non-clinical agency staff
• The agency rules do not apply to substantive/permanent staff or bank staff

In addition to the agency rules, we’ve also implemented an approval process for the procurement of interim agency very senior managers (VSMs) earning above £750 a day by trusts.

From 31 October these rules will apply to:

• all NHS trusts
• NHS foundation trusts receiving interim support from the Department of Health (DH)
• NHS foundation trusts in breach of their licence for financial reasons

All other foundation trusts are strongly encouraged to comply with this process.