WORKFORCE: Nurses at some trusts are being offered shifts paid a grade higher than the job they are doing to get around the agency cap, HSJ has learnt.

A report to the Royal Surrey County Hospital Foundation Trust’s board says Monitor has been informed “other trusts are paying specialist nurses at band six (for band five roles)” and are therefore underreporting the number of times they are breaching the agency caps.

Royal Surrey is one of the highest users of agency staff in England and has been struggling to comply with the agency caps. It has reported each shift where it has had to pay more than the cap to get staff – but the report suggests some other trusts are effectively “upgrading” roles to get staff within the cap. These would not have to be reported to Monitor in the trusts’ weekly returns.

The report also outlines the problems Royal Surrey has had:

  • Of four nursing agencies it had procured under a framework arrangement, one has withdrawn since the caps were introduced and two others will not supply nurses for day shifts and specialist work at the maximum capped rates.
  • The trust is having to pay above cap for a specialist nurse shifts – 121 in one week – because no agencies will supply these staff within the cap.
  • Some junior doctor vacancies are being covered by over-cap doctors. The trust is allocated numbers of juniors for each specialty by the deanery but sometimes juniors fall ill, do not turn up or not enough can be found – this is largely outside the trust’s control. Current contracts expire in March and the trust says it may not be possible to replace them with doctors paid at or under the cap.
  • Eight agency administration and clerical staff are working out their notice, as Monitor has “zero tolerance” for above-cap payments in these areas. The trust is concerned that losing three other staff paid above cap will impact on the running of the areas they work in.
  • The trust is spending “a significant amount of time policing agencies”, which is taking staff away from their day job.

The trust’s board papers for February reveal it spent £1.6m on agency staff in December. It has only 85 per cent of the nurses it needs, despite extensive recruiting from the Philippines.