We’re taking steps to support NHS providers to reduce their agency staff bills and encourage workers back into substantive and bank roles. This will help ease the financial pressure facing the NHS.

• Guidance
• Consultation
• Rules and price caps
• Approved frameworks
• How to reduce use of agency staff: a diagnostic tool
• Toolkits for making effective use of temporary staff
• Who the rules apply to
• Interim very senior manager pay
• Contact us
• Related content

Guidance

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 2020, 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.

• Guidance for trusts on the use of insourcing – This document provides guidance for Trusts on the use of Insourcing Solutions to support the reduction of elective waiting lists.
• Guidance on EU Settlement after UK-EU Withdrawal on 1 January 2021 – The purpose of the this publication is to provide guidance on EU settlement to the temporary staffing sector.
• Guidance on vaccinations for temporary workers (bank and agency workers) during COVID-19: 27 January 2021
• Guidance for trusts on agency use during COVID-19: update July 2020-19
• Guidance for trusts on agency use during COVID-19 pandemic
• Letter from Helen Whately MP, Minister of State for Care: March 2020
• Letter from Helen Whately MP, Minister of State for Care: December 2020

Consultation

• Reducing reliance on agency staff: proposals on administration and estates and off-framework agency staff — for consultation
• Consultation response
• Impact of changes to the agency rules for admin and estates departments

Rules and price caps

• Agency rules – updated February 2024 – An update to the agency rules that came into effect in April 2023
• Admin and Estates special projects form – This form is for trusts requiring resource and specialist admin and estates skills. It should be completed and submitted to NHS England for all short-to-medium-term projects.
• Price Card 2024-2025
• Working through intermediaries: IR35 update (2021) – An update on the application of the IR35 legislation which came into force on 06 April 2017.
• Submit your monthly temporary staffing return online.

Approved frameworks

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 England.

• List of approved framework agreements – Trusts are required to use these agreements when procuring agency staff. We’ll continue to review applications for approval on an ongoing basis and keep trusts updated of any changes to the list of approved agreements.

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How to reduce use of agency staff: a diagnostic tool

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

• Diagnostic tool – PDF version
• Diagnostic tool – Excel version

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

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Toolkits for making effective use of temporary staff

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

The agency expenditure ceiling has been re-introduced to the NHS System Oversight from September 2022. To support the implementation, NHS England have published an Agency Rules Toolkit and Bank Development Toolkit on the FutureNHS temporary staffing hub (this platform requires a log-in). The toolkits have been developed to support providers and systems to embed the new requirements and provide practical support in steps, that can be undertaken to reduce agency expenditure.

• Bank development toolkit
• Agency rules toolkit

Who the rules apply to

Organisations

• 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

Staff groups

• 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

Interim very senior manager pay

Following the introduction of the Agency Rules in 2019, NHS England also implemented an approval process for the procurement of interim agency very senior managers (VSMs) earning above £750 a day by trusts.

These rules apply to:

• all NHS trusts
• NHS foundation trusts receiving interim support from the Department of Health and Social Care (DHSC)
• NHS foundation trusts in breach of their license for financial reasons.

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

• Interim agency very senior manager approval process – sets out the approval process for procuring interim agency very senior managers.
• Interim very senior manager remuneration approval form – submit this form to seek approval of VSM spend.
• Interim very senior manager remuneration approval form for a turnaround director – submit this form to seek approval for a VSM turnaround director

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Contact us

If you have any queries or concerns, please contact the Temporary Staffing team on england.agencyrules@nhs.net.

Related content

We’ve produced a series of webinars to help you reduce your trust’s agency spend:

• Identifying issues in your trust: explains the rules and demonstrates how to use our diagnostic tool
• Effective rostering: highlights the principles of efficient rostering, including e-rostering
• Case study in improving A&E staffing: hear how one trust increased recruitment and retention of medical staff in A&E
• Agency rules update: find out about using approved frameworks for the procurement of all agency staff, and the price caps reduction
• A&E delays: learn how performance against the 4-hour A&E standard reached its lowest level for more than 10 years
• Reducing reliance on medical agency staff: provides practical steps for trusts to take to reduce reliance on medical agency staff.