Trusts warned on temp staff schemes

In a letter, NHS England and NHS Improvement said they were aware that temporary staffing agencies have approached trusts with ‘insourcing’ solutions to staffing needs, including waiting list work. The proposals are for the supply of individual clinicians or teams that are paid at rates above the agency price caps through off-framework agencies.

Under rules set in 2016, breaches of payment caps for locum staff or use of off-framework agencies must be reported to NHS England and NHS Improvement.

The letter goes on to explain that such solutions are not classed as insourcing – the term covers medical and clinical services deployed to use spare, out-of-hours capacity, typically at weekends. They should be in addition to existing provision and bolster outputs and improve efficiency. The contracts are usually offered by specialist providers that deliver an end-to-end service including clinical governance and oversight. Contracts are based on outputs and paid at or below national tariffs.

The national bodies insist insourcing is not about using temporary staff or agencies to help with capacity and demand planning. They added: ‘NHS England and NHS Improvement strongly discourage the use of insourcing solutions where temporary workers are paid escalated rates and where approved frameworks are not used.’

Deploying temporary staff in this way did not increase capacity. The schemes cost more, escalated pay expectations for temporary staff, and attracted workers from other parts of the health system, shifting pressure to other providers. Trusts should consider block booking with on-framework agencies for guaranteed shifts with longer lead times, the letter added.

Before agreeing insourcing deals that involve the provision of temporary staff, the national bodies requested trusts undertake due diligence. This should include checking whether the supplier: can deliver an end-to-end service and is not primarily a temporary staffing agency; is registered with the Care Quality Commission; is not relying on a sub-contractor to provide temporary workers; and will not transfer temporary staff it currently supplies to the trust into the insourcing service.

The letter added that the due diligence should check the proposed pay rates are at or below the price caps and payment is in line with IR35 regulations. There could be tax and VAT implications for the trust if the contract could be defined as the provision of temporary staffing, it said.

Additional staff are required not just to address waiting lists – which in England have reached a record six million – but also to fill shortfalls due to vacancies and illness, including Covid-related absences. All patient-facing staff are due to be fully vaccinated by 1 April (first dose by 3 February). If not, they could be moved away from working directly with patients or even lose their job. NHS Providers said it is believed that 6% of health service staff are unvaccinated.

Following the publication of phase two guidance on vaccination as a condition of deployment, NHS Providers said trusts would continue to try to persuade staff to receive the vaccine, but they were worried about the potential impact on services.

‘We need to be clear in advance about how we will resolve the hopefully small number of instances where service viability and safety could be at risk and the guidance provides additional steps in helping to manage potential disruption,’ said deputy chief executive Saffron Cordery (pictured).

Delaying implementation of the vaccination rules was not the answer, she added. Most trust leaders were in favour of mandatory vaccinations to protect patients, visitors, and colleagues, she said, but they would continue to try to persuade and support vaccine-hesitant staff in the coming weeks.