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Monitor caps; introducing the break glass clause


by Stephanie Tasker | 7 June 2016

According to the BBC, the newly implemented NHS Caps are breached more than 50,000 times a week.

Introduced in November 2015 the monitor caps were brought in to overcome the increasing agency spend within the NHS across both medical and non-medical staffing. The caps set a limit on hourly rates for agency doctors, nurses and other clinical and non-clinical staff. Originally the caps were set at 150 per cent additional on normal pay for junior doctors and 100 per cent for all other staff, before gradually being reduced to 55 per cent across the board from 1 April 2016.

As an agency we have been working closely with the trusts to manage client expectations whilst also attempting to match required skill sets and none negotiables with the budgets given.

Throughout the first few months following the implementation, Sellick Partnership did not see a huge decrease in the number of interim appointments across the trusts – seemingly candidates were a lot more open to reducing their rates than we first thought and understood that it was either this or face the possibility of missing out on a role. Nevertheless, we have now started seeing a number of candidates revert back to pre-cap daily rates and the market has in turn become very saturated; a free for all and clients are all chasing those same candidates who remained true to the caps.

Latest reports claim that the caps have saved trusts £300k, so regardless of our opinions, it would appear that they are working in reducing costs to agency workers. That being said, reports have been released and not all is as it seems...

Queue ‘The Break-Glass Clause’ allowing trusts to exceed the limits for interim fees in response to significant risks to the clinical safety of patient services. This loophole essentially allows a trust to operate outside of the caps providing they can prove that it would be a risk to patient safety if they did not. Now I’m no expert in NHS patient safety but I’m fairly sure it would be relatively impossible to create a situation whereby patient safety is not effected. 

This is certainly demonstrated in the figures released last week confirming that in the first week that the rules first took effect, beginning 23rd November 2015, the clause was used 35,662 times between 228 hospital trusts. This fell to 21,277 times in the week beginning 28th December 2015 but since then the use has risen, reaching 54,419 uses in the week beginning 4th April 2016 and 53,644 in the week beginning 11th April 2016 which were the last figures released. It’s clear from these statistics that tusts are utilising this clause to avoid losing out on the best but in most cases some would argue, overly expensive.

Maybe this is a happy outcome for all, the NHS are making savings, candidates are able to work at the rate they want and the Trusts are able to secure people at the right skill set for each post as opposed to settling for candidates that match their budget rather than their requirements. It will be interesting to see how much longer the caps last and furthermore how long the market can continue before it runs out of Interim Candidates within the specific bandings of high demand.

Without CCS approved agencies such as ourselves working constantly to meet demands of the NHS Trust,  they would be in a far worse state they are in – they might well be up in money but more importantly would lack any of the varied skills required to serve our nation a nation who would undoubtedly be exposed these significant risks to the clinical safety of patient services outlined in the clause!

I'd love to hear your thoughts on the matter of NHS agency caps below. Do you think the caps have been effective or have they been detrimental in the provision of talent in the Public Sector and Procurement market?