Rules for all agency staff working in the NHS

Caps on the total amount NHS providers can pay per hour for an agency worker and rules on nursing agency spend.

Applies to England

From 1 April 2016, Monitor is part of NHS Improvement. This guidance has been superseded by an updated guide on NHS Improvement’s website.

Agency rules

We have introduced a set of rules to support NHS trusts and foundation trusts to reduce their agency expenditure.

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.

The agency rules cover all staff groups, including: nursing, medical, all other clinical and other non-clinical agency staff.

The agency rules do not apply to substantive/permanent staff or bank staff.

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.

The rules

Submit your mandatory weekly data return using this online template

Framework agreement approvals process

As set out in the agency rules documents above, 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.

We’ve published a list of approved framework agreements that trusts are required to use 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.

It is the responsibility of framework operators, not trusts, to apply to have their agreements approved. Trusts are requested to notify the framework operators they use of these arrangements.

We’ve published guidance for framework operators, which sets out the requirements for them to secure approval for their framework agreements.

Why the rules have been brought in

NHS provider spending on agency staff has been rising year-on-year and is a significant driver behind the deterioration in NHS providers’ finances.

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.

The rules on price caps have been introduced following our consultation with the sector.

Use our diagnostic tool

We’ve created a diagnostic tool to help NHS providers move to best practice and reduce the use of agency staff. The tool, which has been developed with pilot sites, will allow you to diagnose issues, decide ways forward and implement improvements quickly.

We also hosted a webinar that outlines the rules and explains how to use our new diagnostic tool, which is still available to watch online.

Download the tool

The tool is available to download in different formats:

Contact us

If you have any queries or concerns, please email

Published 20 November 2015
Last updated 23 March 2016 + show all updates
  1. We've published 'Agency rules for trusts' and 'Price caps and maximum wage rates reference tables'.

  2. Published the 'List of approved framework agreements'

  3. Added note clarifying plan to introduce price caps for ambulance staff from 1 July 2016.

  4. We've updated the section 'Agency price caps update: new framework arrangements'.

  5. We've published an update on agency price caps

  6. We've updated the FAQ document.

  7. We've added a new document to the page: Agency price caps: trusts’ questions answered.

  8. Added a new diagnostic tool to help trusts move towards best practice and reduce the use of agency staff. Also added a link to our support webinar taking place on 14 December.

  9. Published new guidance on price caps for agency staff working in the NHS and consolidated a separate guidance on nursing agency spend into this page.

  10. First published.