Health Minister unveils new locum doctors and dentists price cap in agency crackdown

Northern Ireland’s Health Minister has launched a new framework aimed squarely at reducing reliance on costly agency doctors and dentists — introducing a price cap for the first time and signalling a fresh push to stabilise the medical workforce.

The new Medical and Dental Agency Framework follows the introduction of a Nursing, Midwifery and Support Workers Framework in May 2023, and forms part of a broader strategy to curb escalating agency spend across Health and Social Care (HSC).

Welcoming the development, Health Minister Mike Nesbitt said the move marks “another very significant step” in ongoing efforts to reduce agency and locum staffing.

“My predecessor, Robin Swann established the HSC Regional Agency Reduction Implementation Group (ARIG) in March 2020 and today represents another very significant step in our continuing efforts to reduce the use of agency/locum staffing,” he said.

“We expect that this new Medical and Dental Agency Framework will very significantly reduce the number of doctors supplied by off framework suppliers and paid at off framework rates.

“Similar to the approach for the registered Nursing, Midwifery and Support Workers Framework, a ‘price cap’ has been introduced for the first time into the Medical and Dental framework. This should enable Trusts to secure better value and reduce locum spend. It is anticipated that it will also support stabilisation of the medical workforce through some doctors taking up substantive posts with Trusts.”

Workforce stability at the core

Stabilising the workforce sits at the heart of the reforms. Reducing expenditure on medical and dental locums is intended not only to ease financial pressures, but also to deliver wider benefits — including improved governance, enhanced quality of care, greater team morale and better operational performance.

The first focus of ARIG was nursing and midwifery, historically the largest area of agency expenditure. Measures introduced included a new agency framework, the cessation of off-contract agency use, investment in recruitment to the core HSC workforce and reform of the HSC Nursing bank.

Between 2022/23 and 2024/25, total spend for registered nurses and midwives reduced by 22.3%, alongside the near total elimination of off-contract agency use.

Progress has also been recorded across other professions. In Spring 2023, social work leaders agreed to end the use of agency social workers within HSC organisations. Off framework agency utilisation ceased on 31 March 2023, with all remaining agency use ending on 30 June 2023.

During the same period, agency spend reduced by 9% in admin and clerical roles and by 7% in support services.

“Tackling the high levels of use and the associated costs of Agency staffing is a complex and challenging piece of work,” Mr Nesbitt said.

“I am encouraged by the fact that Trusts have worked collaboratively across HSC to address this problem and welcome the progress made to date in reducing our agency spend on Nursing and other staff groups and completely eliminating our use of agency staffing in Social Work.”

16-point action plan to follow

The Department has made clear that the new framework alone will not deliver the full financial savings or workforce stabilisation sought.

A Medical and Dental Agency Reduction Group, co-chaired by Neil Guckian and Professor Lourda Geoghegan, Deputy Chief Medical Officer, has developed a comprehensive action plan comprising 16 individual workstreams to be progressed over the next 12 months.

Key elements include:

• Establishing new rates for E-locums — additional locum shifts filled by core HSC staff — with competitive rates designed to reduce reliance on external agencies.

• Reviewing vulnerable specialties and considering measures to stabilise services, including telemedicine, digital innovation to support regional working and the development of regional cover for particular advisory specialties.

• Reviewing the medical workforce pipeline to identify future risks, assess training numbers across specialist programmes and re-examine historic allocations of doctors in training, with the aim of reducing reliance on resident doctor locums.

The direction of travel is clear: reduce agency dependency, retain more staff within substantive posts, and bring greater financial control to a system under sustained pressure.

With price caps now extended into the medical and dental sphere, the coming year will test whether the strategy can replicate the reductions already achieved in nursing and social work — and whether the savings can translate into longer-term workforce stability across Northern Ireland’s health service.