Last month, Ian Dalton, Chief Executive of NHS Improvement, outlined changes to its current rules aimed to further reduce the spending on agency staff across the NHS.

These changes include a reduction in the "sign off limit" for high cost agency staff. Currently, sign off from an NHS Trust's Chief Executive is required for agency staff engaged at or over £120 per hour. This limit is to be reduced to £100 per hour. Mr Dalton's letter to Trusts can be found here: It will mean more staff fall within the cap and potentially more administrative work for NHS bodies that are bound by NHS Improvement’s Agency Rules (NHS Trusts and certain NHS Foundation Trusts).

The NHS has made significant changes to the way in which they engage agency staff since the introduction of NHS Improvement's Agency Rules. ( These changes include the requirement that NHS Trusts use framework agreements approved by NHS Improvement to procure all agency staff (nurses, doctors, other clinical and non-clinical staff). NHS Improvement states that it has worked with framework operators to ensure that all approved framework agreements contractually embed the price caps for agency staff.

Contracts with current agency providers should be carefully considered by NHS Trusts before steps are taken to implement changes in the way agency staff are commissioned. A key consideration is whether changing agencies could lead to current agencies seeking "transfer fees" against NHS Trusts. NHS Improvement are aiming to reduce the cost of NHS staff but “transfer fee” claims can be sizeable.