Date published: 8 July, 2024
Date last updated: 20 November, 2025
Elective care, Finance, Workforce

Guidance for trusts on the use of insourcing

Introduction

This guidance outlines how trusts should approach insourcing, and sets out the requirements for trusts to ensure such arrangements are compliant and distinct from temporary staffing solutions.

When used appropriately, insourcing is an opportunity to maximise productivity and efficiency, for example, supporting the achievement of the 18-week referral to treatment target. Compliant insourcing can utilise spare or new, out-of-hours capacity to ensure that more patients can be treated.

When sourcing providers for insourcing, it is mandatory to use compliant suppliers, on an insourcing framework agreement. 

Insourcing suppliers should offer services to trusts at or below the unit prices published as part of the NHS Payment. This ensures cost-effective care delivery, helping reduce waiting lists while maintaining financial sustainability.

What is insourcing?

Insourcing refers to the delivery of medical specialty, consultant-led surgical or clinical services, which are deployed to a participating authority within existing structures to use spare, out-of-hours capacity, typically at weekends and evenings, within a trust.

The lead consultant listed on the GMC Specialist Register for the relevant specialty will lead the multidisciplinary team and manage the patient pathway, including clinical governance and oversight. They will accept clinical responsibility for the care of all patients referred under the insourcing arrangement and hold their own indemnity.

These services are typically contracted based on the required service outputs and are charged at or below the NHS Payment Scheme rates with relevant medical service VAT exemptions applied as appropriate.

Insourcing is not the deployment of temporary workers or the use of temporary staffing agencies to support with capacity and demand planning, It is also not the supply or management of temporary workers into a trust. All deployment of temporary agency staffing must be procured through an approved framework agency. 

Essential checks by trusts

All trusts must undertake the appropriate due diligence before contracting any insourcing solutions, including the following essential checks:

  • Only use compliant suppliers procured through a framework insourcing agreement.
  • The supplier must have the specialist capabilities required to deliver an end-to-end service, including clinical oversight and governance, and is not primarily a temporary staffing agency.
  • The supplier must be Care Quality Commission-registered for the duration of the call-off contract.
  • The supplier must not provide temporary staff to the trust through an insourcing contract and will not transfer existing agency supply into the insourcing contract.
  • The supplier must not be used to deploy temporary workers or manage the supply of temporary staffing agencies into the trust as part of an insourcing package.
  • Proposed pay rates for insourcing arrangements must be at or below the NHS England agency price caps and align with IR35 legislation.
  • The contract must clearly fall outside the scope of what could be defined as temporary staffing provision to avoid potential tax and VAT implications, and trusts must test this as part of due diligence.
  • The supplier is providing the service and seeing patients within the trust premises, typically evenings and weekends, to use additional capacity outside of core hours and business as usual. 

Insourcing and temporary staffing

As outlined above, insourcing should not be inappropriately used to supply temporary agency staff.

Improper use of insourcing to supply temporary staff can inflate pay rates, reduce workforce availability elsewhere, and breach the Agency Rules, including price caps. This in turn drives up costs across the system.

If approved frameworks are not used, there is also a risk of non-compliant staff being supplied to a trust which carries clinical, staff and patient safety risks.

Instead, to supply temporary agency staffing in a cost-effective way, trusts should consider block bookings through approved framework agencies, ensuring guaranteed shifts with longer lead times. 

Contact details  

For further support with insourcing, please contact your framework operators via the contact details below. 

HealthTrust Europe

NHS Workforce Alliance

If you have any general questions or concerns about temporary staffing, please contact the NHS England Temporary Staffing team at england.agencyrules@nhs.net.

Publication reference: PRN01349

Date published: 8 July, 2024
Date last updated: 20 November, 2025