1. MARKET
1.1 Market definition and scope
1.2 The overall UK recruitment industry
1.2.1 Market size and growth
1.2.2 The temporary labor force
1.3 The UK Healthcare Flexible Staffing Market
1.3.1 Market size
1.3.2 Spend areas excluded from healthcare staffing market size
1.3.3 NHS England
1.3.4 NHS in the rest of the UK (Scotland, Wales, and Northern Ireland)
1.3.5 Independent sector hospitals
1.3.6 General practitioners
1.3.7 Bank or pool staff
1.3.8 Insourcing
1.4 Demand and Supply in 2023
1.4.1 Long-term factors impacting demand and supply of flexible healthcare staffing
1.4.2 Demand for Healthcare
1.4.3 External shocks
1.4.3.1 The UK’s exit from the European Union (Brexit)
1.4.3.2 The Covid-19 pandemic
1.4.3.3 A cost-of-living crisis
1.4.3.4 Industrial action
1.5 The healthcare workforce
1.5.1 Overview
1.5.2 Composition and growth of the NHS workforce
1.5.3 Recruitment in the wider healthcare system and reliance on international workers
1.5.4 Vacancies
1.5.5 Absences
1.5.6 Retention and Satisfaction Levels
1.6 Rising demand pressures
1.6.1 Ageing population
1.6.2 Changing burden of diseases
1.6.3 Preventative healthcare
2. POLICY
2.1 Overview
2.2 Key announcements and policy documents
2.2.1 NHS Long Term Workforce Plan (2023)
2.2.1.1 The Long Term Workforce Plan: Modelling
2.2.1.2 The Long Term Workforce Plan: Potential impact on agency staffing
2.2.2 Agency Rules (2015)
2.2.3 NHS People Plan (2020)
2.2.4 Francis Inquiry Report (2013)
2.2.5 2023 Spring Budget (Pension tax relief)
2.3 Impact of a Labour Government
3. REGULATION
3.1 Overview of regulatory framework
3.2 NHS England ‘Agency Rules’
3.2.1 Overview
3.2.2 Expenditure limits
3.2.3 Price caps
3.2.4 Mandatory use of approved framework agreements
3.3 IR35
3.3.1 Overview
3.3.2 IR35 extension to the public sector
3.3.3 Extension to the private sector
3.4 Conduct of Employment Agencies and Employment Business Regulations 2003
3.4.1 Purpose and Benefits of the Conduct Regulations
3.4.2 Overview of Specific Conduct Regulations
3.4.3 Work-seekers
3.4.4 End users/hirers
3.4.5 Key Information Document
3.5 Agency Workers Regulations 2010
3.6 Health and social care specific regulations
3.7 Independent regulators for professionals within healthcare
3.7.1 General Medical Council (GMC)
3.7.2 Nursing and Midwifery Council (NMC)
3.7.3 Health and Care Professions Council (HCPC)
4. MAJOR PROVIDERS
4.1 Overview
4.2 Key players in healthcare recruitment
4.2.1 Specialist Healthcare Staffing Agencies
4.2.1.1 Provider commentaries
4.2.2 Generalist agencies offering healthcare staffing
4.2.3 NHS Professionals
4.4 Specialisms with the recruitment sector
4.3 Profitability and revenue growth in healthcare recruitment
4.5 Independent providers: Developing capacity in the healthcare workforce
4.6 Harnessing technology for improved recruitment processes
4.7 Insourcing for the NHS
4.7.1 Insourcing vs. recruitment staffing
4.7.2 Contracts awarded to healthcare recruitment companies
5. INVESTORS
5.1 Investor activity: UK healthcare recruitment sector
5.1.1 Overview
5.1.2 Significant private equity-backed transactions
5.1.3 Sector interest by investor type
5.1.4 UK healthcare recruitment transactions: Historic deal flow (2008-2023)
5.1.5 Selected UK healthcare recruitment transactions, 2018-2023
5.2 Private equity interest in the UK healthcare recruitment sector
5.3 Valuation and deal structures in the UK healthcare recruitment sector
5.3.1 Factors impacting valuation
5.3.1.1 UK healthcare recruitment sector-specific factors
5.3.1.2 General factors
5.4 Investor activity: International healthcare recruitment highlights
5.4.1 International environment
5.4.2 International deals in healthcare recruitment
5.5 Private Equity Investor Profiles
5.5.1 Agathos Management LLP
5.5.2 Albion Capital
5.5.3 Aliter Capital
5.5.4 BGF
5.5.5 DBAY Advisors
5.5.6 Dedicare AB
5.5.7 Graphite Capital
5.5.8 IPE Ventures
5.5.9 Maven Capital Partners
5.5.10 Montreux Capital Management
5.5.11 NorthEdge Capital LLP
5.5.12 Onex Corporation
5.5.13 Praetura Ventures
5.5.14 Sovereign Capital Partners
5.5.15 Sullivan Street Partners
5.5.16 Twenty20 Capital
6. MARKET POTENTIAL
6.1 Temporary recruitment staffing market value projected to grow against a backdrop of uncertainty
6.2 Short-term outlook
6.3 Medium-term outlook
6.4 Long-term outlook
6.5 Drivers of change in the temporary healthcare recruitment market
6.5.1 Competing for the supply of bank staff to the NHS
6.5.2 The emergence of insourcing as an alternative service delivery model
6.5.3 Utilising technology to reduce complexity in e-rostering, while improving efficiency
6.5.3 M&A opportunities continue to exist in a fragmented sector with low barriers to entry, but the ability to meet NHS compliance checks will be critical for success
APPENDIX
APPENDIX 1. GLOSSARY
APPENDIX 2. REGULATORS
APPENDIX 3. TRADE BODIES AND ASSOCIATIONS
APPENDIX 4. MAJOR HEALTHCARE RECRUITMENT AGENCIES
APPENDIX 5. FINANCIAL APPENDIX
LIST OF TABLES
Table 1.1 Spending on flexible health staffing services 1 by user, £m, UK, 2021/22 and 2022/23
Table 1.2 NHS England agency expenditure compared to UK NHS total, 2012/13-2022/23
Table 1.3 Regional shares of NHS Trusts’ spending on agency (non-NHS) staff, and proportion of total staff costs, by region, England, 2020/21 and 2021/22
Table 1.4 Average number of whole time equivalent (WTE) temporary workers employed by NHS Trusts in England, 2013/14-2021/22
Table 1.5 General practice workforce, England, September 2015-September 2023
Table 1.6 NHS bank expenditure by sector, England, 2018/19-2022/23
Table 1.7 Number of registered nurses and midwives by region of registration origin, 2014/15-2022/23
Table 1.8 NHS vacancy rate by Trust sector and occupation group, FTE terms, England, June 2023
Table 1.9 NHS vacancy rate by region and occupation group, FTE terms, England, June 2023
Table 1.10 Sickness absence rates by full time equivalent days available and lost in the NHS, England, June 2019-June 2023
Table 1.11 Annual leavers from the NHS, and percentage rate, headcount, England, 2010/11-2022/23
Table 2.1 NHS Long Term Workforce Plan: Commitments to train
Table 2.2 NHS Long Term Workforce Plan: Commitments to reform
Table 2.3 NHS agency and bank staff expenditure and proportion to total (agency + bank) temporary staff spending, England, 2015/16-2022/23
Table 3.1 Seven pillars of the Agency Rules price cap
Table 3.2 NHS England maximum agency price cap: Medical and dental, 2023/24
Table 3.3 NHS England maximum agency price cap: Non-medical/dental staff, 2023/24
Table 3.4 Agency recruitment: Approved framework operators, 2023/24
Table 4.1 Selected healthcare staffing recruitment companies, financial growth for last three years, 2020-2022
Table 5.1 Selected UK healthcare recruitment transactions, 2018-2023
Table 5.2 Selected international deals in healthcare recruitment
LIST OF FIGURES
Figure ES1 Spending on flexible healthcare agency staffing services by user, £m and percentage of total, UK, 2022/23
Figure ES2 NHS agency spending in the UK, £m, 2012/13-2022/23
Figure ES3 Annual leavers and joiners from the NHS, and percentage leaver and joiner rate, England, 2010/11 to 2022/23
Figure ES4 NHS England’s bank staff expenditure and proportion to total (agency + bank) temporary staff expenditure, England, 2015/16 to 2022/23
Figure ES5 UK healthcare recruitment M&A transactions, 2008-2023
Figure 1.1 Value of the recruitment industry,all sectors, UK, 1988-2021
Figure 1.2 Number of temporary employees (seasonally adjusted), unemployment rate, and annual real GDP growth, 1992-2023
Figure 1.3 Spending on flexible agency healthcare staffing services by user, £m, UK, 2022/23
Figure 1.4 NHS agency expenditure in the UK, £m, 2012/13-2022/23
Figure 1.5 NHS bank staff expenditure and proportion to total (agency + bank) temporary staff expenditure, £m, England, 2015/16-2022/23
Figure 1.6 NHS agency expenditure, cash and real terms (2022/23 prices), £m, England, 1988/89-2022/23
Figure 1.7 NHS England Trusts agency (non-NHS) staff spending, by type of Trust, £m, 2021/22
Figure 1.8 Agency (non-NHS) staff spending as a proportion of total staff spending by NHS England Trusts, 2000/01-2021/22
Figure 1.9 NHS agency expenditure by country, UK excluding England, £m, 2012/13-2022/23
Figure 1.10 NHS agency expenditure by occupation group, UK excluding England, £m, 2013/14-2021/22
Figure 1.11 GP locums in the general practice workforce, FTE terms, England, September 2015- September 2023
Figure 1.12 NHS waiting list and waiting times for patients waiting to start treatment at the end of the month (incomplete pathways), and average (median) time waited, England, August 2007-August 2023
Figure 1.13 Practising doctors and nurses per 100,000 inhabitants in OECD countries, 2022 (or latest data)
Figure 1.14 Number of NHS staff, FTE terms, England, March 2023
Figure 1.15 Full-time equivalent NHS staff by staffing group, England, 2010-2023
Figure 1.16 Annual leavers and joiners from the NHS, and percentage leaver and joiner rate, headcount terms, England, 2010/11-2022/23
Figure 1.17 Cumulative percentage growth in NHS hospital and community health service staff, FTE terms, by staffing group, England, 2010-2023
Figure 1.18 FTE NHS professionally qualified clinical staff, England, 2010-2023
Figure 1.19 Cumulative percentage growth in NHS professionally qualified clinical staff, FTE terms, England, 2010-2023
Figure 1.20 Cumulative net change in number of doctors registered by GMC since 2006 by primary medical qualification (PMQ) region, UK, 2007-2022
Figure 1.21 Cumulative net change since March 2015 in the number of registered nurses and midwives by region of registration origin, 2014/15-2022/23
Figure 1.22 Proportion of leavers in the first five years of registration by region of training, March 2018-March 2023
Figure 1.23 NHS vacancy rate by staffing group, England, June 2017-June 2023
Figure 1.24 Monthly sickness absence rate of NHS employees, England, January 2010-June 2023
Figure 1.25 Reasons for NHS staff resigning voluntarily, growth of proportion of each reason to total, index (2011/12 = 100), England, 2011/12-2022/23
Figure 1.26 NHS Staff Survey, percentage that disagreed or strongly disagreed across a selection of questions, England, 2018 and 2022
Figure 1.27 NHS Staff Survey, satisfaction with level of pay, by occupation group, England, 2022
Figure 1.28 NHS Staff Survey, percentage of staff that will probably look for a job in the next 12 months, by length of stay, England, 2018 and 2022
Figure 1.29 Primary care GPs that report being extremely or very stressful in ten high-income countries, 2022
Figure 1.30 Estimated number of people living with major illness, England, 2010-2040
Figure 2.1 Government-financed healthcare expenditure, nominal and real (2022 terms), £bn, UK, 1997-2022
Figure 2.2 Projected increase in demand for NHS England staff, FTE terms, 2021/22 and 2036/37 projection
Figure 2.3 Projected increase in supply of NHS England staff, FTE terms, 2021/22 and 2036/37 projection
Figure 2.4 Cumulative percentage growth in total NHS agency and bank spend, England, 2015/16-2022/23
Figure 4.1 Top ten specialist healthcare staffing agencies’ revenue, £m, for latest financial year
Figure 4.2 Top ten staffing agencies providing healthcare staffing by revenue, £m, for latest financial year
Figure 4.3 Healthcare recruitment agencies by specialisms, 2020-2022
Figure 4.4 Healthcare recruitment agencies revenue growth for last three years, by CAGR ratio, 2020-2022
Figure 5.1 Major UK transactions by investor type, 2018-2023
Figure 5.2 UK healthcare recruitment M&A transactions, 2008-2023
Figure 6.1 NHS agency spend, UK, 2021/22-2022/23, and 2023/24-2024/25 (projections)
