NHS trust cuts agency bill by £28m after banning off-framework shifts

An NHS trust in the south of England has cut its spending on agency staff by £28m in 18 months, from £41m to £13m, after it stopped using agencies that charge above nationally agreed rates and built an in-house bank of 3,800 nurses, doctors and support staff who pick up shifts through an app.

Wessex Downs NHS foundation trust, which runs three hospitals and had one of the highest agency bills in the country in 2024, said its bank now covered 94% of unfilled shifts, up from 61%. It has also cut the number of shifts that went unfilled altogether from 14% to 4%. NHS England will from January require 20 trusts with the highest agency costs to adopt the same model.

“The agencies were charging us £1,900 for a single night shift from a locum consultant, and the consultant was seeing £900 of it,” said Dr Helen Marchbank, the trust’s chief executive. “We were paying £1,000 a night for a middleman. Once we offered the same doctors £1,100 directly, through a system that paid them within 48 hours, most of them came across in a month.”

The trust’s bank pays nurses about 15% above their substantive rate for extra shifts and allows them to choose shifts up to six weeks ahead. Crucially, it also pays within two days rather than at the end of the month, which Marchbank said had been “the single most important change”. Agency staff had typically been paid weekly.

Lydia Okafor, a staff nurse on the trust’s acute medical unit who takes two or three bank shifts a month, said the system had changed how colleagues felt about overtime. “Before, you would do an agency shift at a hospital down the road and feel like a mercenary. Now you are doing an extra shift on your own ward with people you know, and the money is in your account by Thursday,” she said.

The Royal College of Nursing welcomed the figures but cautioned that banks were “not a substitute for a workforce”. “If a trust needs 3,800 people to pick up extra shifts, it is 300 nurses short,” a spokesperson said. “Banks make the shortage cheaper. They do not make it go away.”

Agency spending across the NHS in England fell to £2.3bn last year, from a peak of £3.5bn in 2023, but remains highest in mental health and in rural trusts that struggle to recruit. The trade body representing staffing agencies said that trusts banning off-framework suppliers risked “unfilled shifts and closed beds” in specialities where the bank model could not supply enough people.

Marchbank said that had not happened. “We closed one ward for three weeks in February 2025, and that was it. It cost us less than one month of the old agency bill.”