Zero agency spend by 2029/30, and bank budgets are capped too

NHS trusts in England are working to spending limits designed to end agency staffing altogether. The medium-term planning framework NHS England published on 17 November 2025 gives every trust an agency limit for 2026/27, 2027/28 and 2028/29, and for the first time a bank limit alongside it. If you pick up NHS shifts through an agency or a staff bank, those two numbers are shaping what you will be offered for the next three years.

What the planning framework sets

The agency limits are built from a cut to each trust's current spend: 30% in 2026/27, then 25% in 2027/28 and 25% again in 2028/29. NHS England states the destination without hedging, expecting "no agency spending in 2029/30". The baseline for the first reduction is the Month 6 forecast outturn, which means the position a trust reports this autumn becomes the figure every later cut is measured against.

The bank limit is the new part. Each organisation is given a limit that reduces current bank spend by between 7.5% and 15% in each of those three years, and organisations that lean more heavily on bank are required to cut more. Performance is monitored at individual trust level rather than across a system, so one trust's underspend does not cover another's overspend.

The agency rules that already bite

None of this starts from a blank page. NHS England's agency rules, last updated on 19 November 2025, set price caps as the maximum hourly amount excluding VAT a trust may pay. The caps sit at 55% above 2016 substantive pay rates and are inclusive of holiday pay, employer National Insurance at 13.8%, pension of up to 3% and the agency's own fee. They are not uprated when Agenda for Change is uprated, so every pay award narrows the distance between a capped agency rate and a substantive one.

Trusts must also procure through NHS England-approved frameworks. Going off-framework is permitted only on exceptional patient safety grounds with executive director sign-off, the route the rules call "break glass". The band 2 and 3 story shows how quickly this can move: chief executive approval was required for every band 2 or 3 agency shift from 1 July 2025, and agency use in those roles had to be removed entirely by 31 January 2026.

One protection runs the other way. Under the Agency Workers Regulations 2010, after 12 weeks in the same role you gain equal treatment on pay and annual leave. That clock is worth tracking yourself, because it depends on dated records of where and in what role you worked.

The procurement plumbing is changing too. The Crown Commercial Service framework RM6380, Health Workforce Solutions, is listed as running from 1 March 2026 to 28 February 2034 and consolidating earlier agreements, including the one covering managed staff banks.

Bank work is not automatically the cheaper option

The official position is that banks are the efficient route. NHS England's letter of 2 June 2025 told trusts to cut agency spend by at least 30% in the following financial year, with the stated ambition to "eliminate agency use altogether by the end of this government's term", and urged them to build staff banks, keep bank rates competitive but not above agency equivalents, and consider the national bank run by NHS Professionals. The projected saving given in that letter was around £1bn over five years.

The Recruitment and Employment Confederation disputes the premise. Freedom of information data it published on 11 May 2026 found bank shifts costing more than agency cover at several named trusts. At Nottingham University Hospitals the average top bank shift came to £5,723 in 2024/25 against £4,491 on agency. At Imperial College Healthcare the comparison was £5,509 on bank in 2025/26 against £2,116 on agency. At Newcastle upon Tyne the figures were £1,365 and £372. Bank spend at the Manchester University trust nearly doubled across four years, from £60.2m in 2020/21 to £114.3m in 2024/25. REC chief executive Neil Carberry put it bluntly: "The idea that Bank staff are always cheaper is simply wrong." REC has asked the Health and Social Care Committee to open an inquiry.

So the two sides are on record and they disagree. The Department of Health and Social Care and NHS England treat bank as the saving; REC's shift-level figures show the opposite in specific trusts. Neither position changes the spending limits, but it is useful context if you are told a bank rate is the best a trust can do.

Where the work goes from here

Both routes into NHS temporary work are now capped in the same document, which is the change that matters. The older advice, to move from agency to bank when agency tightens, assumed bank had room to absorb the work. For 2026/27 to 2028/29 it does not. Trusts holding two limits at once tend to reach for rostering, substantive recruitment and international or internal redeployment first, and the residue lands unevenly: some departments still cannot fill a night, while the same clinician finds their usual bank shifts thinned out.

For anyone selling time into that market, the practical consequence is a more mixed month. Direct engagement by practices, hospices, private providers, occupational health and insurers sits outside these limits entirely, and so does work for non-NHS employers. Expect a working month that contains bank shifts taxed at source, agency shifts run through an agency payroll or an umbrella, and self-employed invoices, all at once.

The part the spending limits do not measure

There is a cost to temporary work that no framework counts. The National Guardian's Office published "Temporary Workers, Permanent Voices" on 26 March 2026, a speak-up review of exactly this workforce. It found that 60.4% of the temporary workers surveyed feel they lack a voice in the NHS in England, with fear of losing shifts the main barrier to raising a concern. As more of the temporary workforce moves onto banks, whose shifts are allocated locally, that finding is worth keeping in view.

What to record while the caps take hold

• Record the route for every shift: trust bank, agency, or direct engagement. The route decides whether tax was deducted at source and which figures belong on your self-assessment.
• Track the 12-week clock per hirer and per role, with dates. Equal treatment on pay and annual leave depends on it, and no one else is counting for you.
• Ask what sits inside a quoted agency rate. Because the cap is inclusive of holiday pay, employer National Insurance and pension, a capped hourly figure is not comparable with a bank hourly rate or a self-employed fee until it is unpicked.
• Keep payslips and remittance advice from every employer. With three or four PAYE engagers in a year, tax codes drift, and your accountant can only reconcile what you can produce.
• Note bank rate changes in writing when they arrive. Rate movement is now policy-driven rather than purely local, so the date and the amount are worth having.

If you are a nurse, paramedic or physiotherapist whose month now spans two payrolls and an invoice book, the record-keeping is the part you control. Sessional's shift log keeps agency and PAYE shifts next to self-employed work in one place, and the guide to agency and PAYE shift tracking explains how the figures separate at year end.

Sources

• Medium-term planning framework: revenue finance and contracting guidance (NHS England, 17 November 2025, updated 27 November 2025)
• Agency rules (NHS England, 5 April 2023, updated 19 November 2025)
• Letter: further action to reduce NHS spending on temporary agency staffing (NHS England, 2 June 2025)
• NHS bank shifts often cost more than agency cover in trusts, contrary to DHSC claims, according to new FOI data (Recruitment and Employment Confederation, 11 May 2026)
• Temporary Workers, Permanent Voices: A Speak Up Review (National Guardian's Office, 26 March 2026)
• RM6380 Health Workforce Solutions (Crown Commercial Service, framework running 1 March 2026 to 28 February 2034)