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

Guidance for trusts on the use of insourcing

Introduction

NHS England have become aware of temporary staffing agencies approaching trusts and offering ‘insourcing’ solutions to meet their routine temporary staffing demands and to support with additional pressures such as, reducing their elective waiting lists.

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 enables trusts to continue providing care to patients, reducing patient waiting lists whilst also saving trust money in the long term.

What is insourcing?

Insourcing is a term used to describe the provision of medical specialty, consultant-led surgical or clinical services, which are deployed to a participating authority within existing structures to utilise spare, out-of-hours capacity, typically at weekends and evenings, within a trust.

This is in addition to the trusts existing provisions, with the intention to bolster service outputs and improve efficiency.

Such services are typically provided by specialist medical or clinical providers who can provide the specialist capabilities required to deliver an end-to-end service, including clinical governance and oversight.

The lead consultant, who is listed on the General Medical Council specialist register for the agreed specialty they are insourced to deliver, will lead the multidisciplinary team relevant to the requirements to manage the patient pathway. They will accept clinical responsibility for the care of the patients referred to them as part of the insourcing arrangement and hold their own indemnity.

These services are typically contracted for based on the required service outputs and are charged at or below the unit prices published as part of the NHS Payment Scheme 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, and the supply or management of temporary workers into a trust. All deployment of temporary agency staffing must be procured via an approved framework agency. 

Insourcing and temporary staffing

NHS England prohibits the use of insourcing solutions where rates are not in line with or below the prices in the NHS Payment Scheme and where compliant approved frameworks are not used. Insourcing should not be inappropriately used to supply temporary agency staff.

The reason for this is because it often does not provide access to additional workforce, rather, escalated pay rates attract workers from elsewhere. There are no controls on spend, agency commission, and it is not aligned to the Agency rules including Agency price caps.

This can reduce the supply of agency workers available to fill shifts elsewhere in a trust and wider health system, and has a ripple effect on general agency rates, as may raise the pay expectations of agency workers, and force other departments and trusts to increase their rates to attract workers back.

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

Instead, in order to supply temporary agency staffing in a cost-effective way, we recommend that trusts consider block bookings with on framework agencies for guaranteed shifts with longer lead times. 

Due diligence regarding insourcing and temporary staffing

We request that all trusts ensure that appropriate due diligence is undertaken before contracting for any insourcing solutions:

  • the supplier is compliant, and procured via a framework insourcing agreement
  • the supplier has 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 is Care Quality Commission (CQC) registered or prepared to utilise the trusts CQC registration throughout the duration of the call-off contract should the trust require, and the insourcing agreement has been reviewed and rated. If trusts do not use a CQC registered provider, they will hold the risk of the insourcing provider operating under their registration, which would need to be risk rated by the trust board
  • the supplier is not providing temporary staff to the trust through an insourcing contract and will not transfer existing agency supply into the insourcing contract
  • the insourcing supplier is not being used to deploy temporary workers or manage the supply of temporary staffing agencies into the trust as part of an insourcing package
  • the proposed pay rates for temporary workers provided as part of the service are at or below the NHS England agency price caps, and the payment of temporary workers aligns with the requirements of IR35 legislation
  • the contract is not within the scope of what could be defined as the provision of temporary staffing, which may have tax and VAT implications for the trust. In addition, trusts have tested the tax and VAT implications
  • the supplier is providing the service on trust premises to utilise additional capacity outside of core hours and business as usual, typically evenings and weekends
  • the patients are seen on trust premises and not at another location

Contact details  

For further support with this, 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 Temporary Staffing team at NHS England (england.agencyrules@nhs.net). 

Publication reference: PRN01349

Date published: 8 July, 2024
Date last updated: 8 July, 2024