Guidance For NHS Trusts

The NHS faces increasing pressure to manage growing elective care backlogs, particularly following the COVID-19 pandemic. NHS Trusts must now find innovative solutions to meet key targets such as the 18-week referral to treatment (RTT) time. While temporary staffing has long been a tool for managing staff shortages, NHS insourcing is emerging as a strategic approach to add capacity specifically for elective services. Understanding the differences between insourcing and temporary staffing, alongside compliance and governance requirements, is crucial for NHS Trust administrators and decision-makers to implement the most effective solutions.

What Is Insourcing?

NHS insourcing refers to the use of specialist medical teams who operate within NHS Trust premises, typically during off-hours such as evenings or weekends, to increase the availability of elective services. Unlike temporary staffing, which fills staffing vacancies, insourcing brings in entire clinical teams to perform services such as elective surgeries, diagnostic tests, or other treatments that help reduce elective care backlogs.

The core aim of insourcing is to assist NHS Trusts in meeting treatment targets by providing additional capacity without the need for external facilities. This approach allows trusts to make better use of their existing resources when demand for operating rooms or diagnostic facilities is lower, thereby boosting productivity. By working during off-hours, insourcing specialists focus on elective procedures, which supports Trusts in achieving RTT targets without burdening regular staff with extra duties.

Key Differences Between Insourcing and Temporary Staffing

It is critical to distinguish between insourcing and temporary staffing, as they serve distinct purposes within the NHS.

• Insourcing involves bringing in specialist medical teams to perform elective procedures within NHS facilities, often during weekends or evenings when these resources are underutilized. The insourcing provider works under the Trust's clinical governance framework, ensuring consistency with NHS standards and compliance with local protocols.
• Temporary staffing, on the other hand, is used to fill short-term gaps in the workforce. Agencies provide temporary doctors, nurses, or other healthcare professionals to cover staff absences or shortages. This approach is more focused on maintaining day-to-day operations rather than addressing specific service backlogs.

Unlike temporary staffing, insourcing does not focus on covering staffing gaps but on expanding capacity for specific services. Moreover, insourcing is governed by NHS framework agreements, which ensure that services are provided at or below NHS Payment Scheme prices. These frameworks help Trusts secure cost-effective and compliant solutions for tackling elective care backlogs, while avoiding the challenges of fluctuating agency pay rates.

Compliance and Governance Requirements for Insourcing

To ensure quality and safety, Trusts must comply with several regulatory and governance requirements when opting for insourcing. Failure to do so can expose Trusts to financial penalties, reputational damage, and, more critically, risks to patient safety.

1. Framework Compliance NHS Trusts should use suppliers listed under approved NHS framework agreements to ensure that they are working with providers who meet all regulatory standards. These frameworks offer a pre-approved list of insourcing providers who meet quality, pricing, and compliance criteria, making it easier for Trusts to select reliable partners.
2. Care Quality Commission (CQC) Registration Insourcing services must either be covered under the provider's CQC registration or conducted under the NHS Trust's CQC registration. This ensures that clinical care is governed by established standards of safety, quality, and governance. In either case, the appropriate clinical oversight must be in place to protect patient safety and ensure compliance with legal and regulatory requirements.
3. Tax and VAT Considerations Trusts need to carefully review the tax and VAT implications when engaging insourcing providers. Misclassification of insourcing services or overlooking VAT rules can lead to significant financial burdens. Compliance with tax regulations is essential to avoid unexpected costs that could erode the financial benefits of insourcing.

Potential Risks of Misusing Insourcing

While insourcing offers numerous benefits, improper use can lead to several risks:

1. Non-Compliant Staffing If insourcing is used to fill temporary staffing gaps rather than expanding capacity for elective services, it can result in increased costs. Using insourcing in this way can inflate pay rates, reduce the availability of agency workers, and lead to higher overall expenses for the NHS Trust. Additionally, if insourcing providers are not vetted according to NHS framework agreements, this may lead to non-compliant staffing arrangements, which could put the Trust at risk of legal and financial repercussions.
2. Quality and Safety Risks Failure to use approved insourcing providers or a lack of proper clinical governance oversight can compromise patient safety. Non-compliance with CQC regulations and NHS standards may lead to poor clinical outcomes, legal liabilities, and reputational damage to the Trust.

Best Practices for Implementing insourcing in NHS Trusts

To maximise the benefits of insourcing while mitigating risks, NHS Trusts should adhere to several best practices:

1. Due Diligence NHS Trusts must ensure that all insourcing providers meet stringent regulatory standards. This includes verifying CQC registration, working with providers under NHS framework agreements, and ensuring that the necessary clinical governance structures are in place. Trusts should conduct thorough vetting processes to confirm that insourcing providers align with NHS safety and quality standards.
2. Cost-Effective Planning Careful planning is required to ensure that insourcing is the most cost-effective solution for increasing capacity. Trusts should assess facility availability during off-hours, the specific services that are in demand, and the potential cost savings compared to other approaches. Insourcing can often be more financially viable than outsourcing to private providers if managed correctly.
3. Avoiding Misuse as Temporary Staffing Insourcing should strictly be used to expand capacity for elective procedures and not as a tool for covering staffing shortages. NHS Trusts must reinforce this distinction to avoid inflating costs and misusing resources. By focusing on elective care, Trusts can keep insourcing aligned with its intended purpose—boosting service capacity to reduce backlogs.

Conclusion

NHS insourcing offers a strategic solution for addressing elective care backlogs by leveraging specialist teams to provide clinical services during off-hours. When used appropriately, insourcing can help NHS Trusts meet RTT targets, improve patient outcomes, and optimise facility use. However, Trusts must adhere to strict compliance and clinical governance requirements, particularly around CQC registration, NHS framework agreements, and tax considerations. By following best practices and ensuring that insourcing is not used as a temporary staffing fix, NHS Trusts can enhance service delivery in a safe, cost-effective, and compliant manner.