Reducing expenditure on NHS agency staff: rules and price caps


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.

Coronavirus (COVID-19)

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.


Rules and price caps

Agency rules — updated June 2019 PDF, 257.8 KB

An update to the agency rules due to come into effect from 16 September 2019.

Admin and Estates special projects form DOCX, 79.1 KB

This form is for trusts requiring resource and specialist admin and estates skills. It should be completed and submitted to NHS Improvement for all short-to-medium-term projects.

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 Improvement.

List of approved framework agreements PDF, 81.9 KB

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.

How to apply for framework agreements to be approved PDF, 276.2 KB

Guidance for framework operators to secure approval for their framework agreements. It is the responsibility of framework operators, not trusts, to apply to have their agreements approved.

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.

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

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:

Who the rules apply to


  • 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

In addition to the agency rules, we've also implemented an approval process for the procurement of interim agency very senior managers (VSMs) earning above £750 a day by trusts.

From 31 October these rules will apply to:

  • all NHS trusts
  • NHS foundation trusts receiving interim support from the Department of Health (DH)
  • NHS foundation trusts in breach of their licence for financial reasons

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

Interim agency very senior manager approval process PDF, 159.2 KB

Sets out the approval process for procuring interim agency very senior managers

Interim very senior manager remuneration approval form DOCX, 88.4 KB

Submit this form to seek approval of VSM spend.

Interim very senior manager remuneration approval form for a turnaround director DOCX, 88.9 KB

Submit this form to seek approval for a VSM turnaround director.

Contact us

If you have any queries or concerns, please email

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

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