The Department of Health has launched a new framework to control spending on temporary medical and dental staff, introducing price caps for locum doctors and dentists for the first time in Northern Ireland. The initiative, announced on 2 March 2026, represents the latest phase in a four-year campaign to reduce reliance on expensive agency workers across the Health and Social Care (HSC) system.
Health Minister Mike Nesbitt welcomed the framework as a “very significant step” in efforts to stabilise the workforce, building on previous successes that have seen agency spending on nursing staff drop by more than a fifth and social work agency usage eliminated entirely. However, the announcement comes amid rising vacancy rates across the health service and ongoing uncertainty over pay awards for 2026/27.
Price Caps and Framework Controls
The new Medical and Dental Agency Framework establishes approved suppliers committed to quality standards and agreed rates, replacing the previous system where off-contract agencies could charge premium rates without restriction. For the first time, a “price cap” will apply to medical and dental locums, similar to the mechanism introduced for nursing and midwifery staff in 2023.
Health Minister Mike Nesbitt said: “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.”
The Minister added: “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.”
Building on Previous Reductions
The framework follows measures implemented since 2020 to curb agency expenditure, which reached £320 million across all staff groups by 2021/22. According to the Department, these earlier initiatives have achieved substantial savings:
- Nursing and midwifery agency spend fell by 22.3% between 2022/23 and 2024/25, with off-contract agency usage “near totally eliminated”
- Social work agency usage ceased completely in June 2023, with 160 former agency staff transferred to permanent contracts and more than 700 newly-qualified social workers recruited directly by Trusts since mid-2023
- Admin and clerical agency spend reduced by 9% between 2022/23 and 2024/25
- Support services agency spend reduced by 7% over the same period
Nesbitt noted: “Tackling the high levels of use and the associated costs of Agency staffing is a complex and challenging piece of work. 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.”
Sixteen Workstreams to Address Workforce Gaps
The Department has acknowledged that the framework alone will not deliver workforce stabilisation. A Medical and Dental Agency Reduction Group, co-chaired by Neil Guckian, Chief Executive of the Western Health and Social Care Trust, 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.
These include establishing new rates for “E-locums” (additional shifts worked by existing HSC medical staff), reviewing vulnerable specialties to consider telemedicine and regional working arrangements, and examining medical training allocations to reduce reliance on resident doctor locums.
Rising Vacancies and Unanswered Questions
While the framework aims to reduce costs, the Department’s own statistics reveal persistent workforce pressures. As of 31 December 2025, there were 6,078 vacancies actively being recruited across HSC Northern Ireland, representing a 7.0% vacancy rate. This marks a 9.7% increase in vacancies since December 2020, despite the overall workforce growing by 9.0% over the same period to 67,866 whole-time equivalent staff.
Nursing and midwifery vacancies account for nearly one-third of all unfilled posts, with 1,981 positions actively being recruited. The Belfast HSC Trust carries the highest vacancy burden with 1,776 posts unfilled, though the South Eastern Trust has managed to reduce its vacancies by 8.3% over the past year.
The announcement also comes as the Minister has yet to confirm whether a recommended 3.3% pay award for Agenda for Change staff will be implemented for 2026/27, citing uncertainty over the departmental budget. The NHS Pay Review Body recommended the increase, which has already been confirmed for England and Wales, but Nesbitt has stated he can only deliver commitments “when clear about my budgetary position.”
Questions for Stakeholders
- Will the new price caps be set sufficiently low to encourage doctors to accept substantive posts rather than locum work, or will they simply reduce the pool of available temporary staff without addressing retention?
- Given that vacancies have risen by nearly 10% since 2020 despite workforce growth, how will the 16 workstreams address the underlying retention crisis rather than focusing primarily on recruitment mechanisms?
- With the Minister unable to confirm the 3.3% pay award recommended for 2026/27 due to budget constraints, how will the framework compete with private agency rates that may become relatively more attractive if HSC pay falls further behind inflation?
- Will the “E-locum” system genuinely reduce overall expenditure, or will it simply redirect costs from external agencies to internal premium payments without addressing the root causes of staffing shortfalls?
What Happens Next
The success of the framework will depend on its ability to balance cost control with workforce supply. While the nursing and midwifery framework has achieved significant savings, medical and dental locums represent a distinct challenge, with highly specialised roles that may prove difficult to fill through standardised rates.
The Department will need to demonstrate progress against the 16 workstreams over the coming year, particularly in addressing vulnerable specialties where recruitment remains challenging. Meanwhile, the resolution of the 2026/27 budget and pay award negotiations will likely determine whether the framework can attract sufficient substantive staff to reduce reliance on temporary workers, or whether vacancy rates will continue to climb despite the new controls.