The Gera NHS Agency Reliance Index

Gera NHS Agency Reliance Index: FAQs

What is the Gera NHS Agency Reliance Index?

The Gera NHS Agency Reliance Index (NARI) is a base-100 index that tracks how heavily the NHS in England still relies on premium agency staffing, measured by national agency-staff spend, with 2023/24 set to 100. It stands at 66.7 for 2024/25 — because agency spend fell from around £3.0bn in 2023/24 to about £2.0bn in 2024/25, a reduction of nearly £1 billion. Source: DHSC / NHS England.

How is the index calculated?

NARI(year) = agency spend that year ÷ agency spend in the base year (2023/24) × 100, rounded to one decimal place. It is a standard base-100 level index. Every spend figure is a real published DHSC / NHS England number; the 2024/25 figure is the stated 2023/24 total (around £3 billion) less DHSC's reported reduction of nearly £1 billion. The only Gera choices are the base year and the rounding, both disclosed on the methodology page.

How much does the NHS spend on agency staff?

DHSC states the NHS in England spent around £3.0bn on agency staff in 2023/24, and cut that by nearly £1 billion over 2024/25 to roughly £2.0bn — a reduction of about 33%. Even after the cut, the NHS still spends billions of pounds a year filling shifts with temporary agency workers, with recruitment agencies charging up to £2,000 for a single nursing shift.

What does agency spending tell us about NHS staffing shortages?

Agency spend is money the NHS pays, at a premium, to fill shifts it cannot cover with its own permanent staff — so it is a direct measure of the workforce gap. DHSC reports around 113,000 vacancies across NHS services, and recruitment agencies charging up to £2,000 per nursing shift. Reducing agency spend sustainably depends on filling those posts with substantive and bank staff, which is why NHS workforce plans emphasise both retention and recruitment.

What is the difference between agency and bank staff?

Agency staff are supplied by external recruitment agencies, which charge the NHS a premium fee on top of the worker's pay. Bank staff are clinicians on the NHS's own internal staff bank who pick up extra shifts directly, without an agency margin. NHS policy is to shift work from agency to bank and substantive posts: DHSC reports that NHS Professionals, the national NHS staff bank, displaced over £680 million of external agency fees and provided more than 40 million patient-care hours in a single year.

Is a higher or lower index better?

A lower index is generally better for NHS finances: it means less money spent at a premium on external agency staff. But a falling agency index only reflects a genuinely healthier workforce if the shifts are being covered by the NHS's own permanent and bank staff rather than simply going unfilled. The index tracks agency reliance; it is not, on its own, a measure of whether the NHS has enough staff.

Why is the NHS cutting agency spending?

The Health Secretary ordered NHS trusts to reduce agency spending, and NHS Planning Guidance requires a cut of at least 30% in the next financial year. NHS England estimates up to £1 billion could be released over five years by moving from agency to substantive and bank staffing and reinvested in patient care, and reports that off-framework agency use is at an all-time low.

How often is the index updated?

The index currently covers the two financial years for which DHSC published comparable national agency-spend totals in its 2 June 2025 announcement (2023/24 and 2024/25). Gera extends the series when NHS England or DHSC publishes each subsequent year's agency-spend total. This release was compiled on 3 July 2026.

What does the index NOT show?

It covers England only and measures AGENCY spend, not total temporary staffing (it does not add in the separate NHS bank pay bill). It is a national figure, not a per-trust or per-region breakdown, and it is not a clinical-quality or safety measure. It is information about NHS finances and workforce, not medical advice. GeraClinic is a private telemedicine service and is not part of, or affiliated with, the NHS.