Comparing NHS framework rates: what agencies need to know in 2026

For UK healthcare staffing agencies, NHS framework rates are both a ceiling and a floor. They define the maximum hourly rates that NHS trusts can pay for agency staff under approved frameworks — and understanding them is essential to operating profitably and competitively in 2026.

This article covers the key frameworks in operation, how rates are structured, the bands that matter most, and what changes agencies should be planning for.

The NHS framework landscape

There are two primary frameworks through which NHS trusts procure agency staff in England:

NHS Workforce Alliance (NHSWA)

The NHS Workforce Alliance framework covers the majority of nursing, allied health professional (AHP), and healthcare science (HCS) placements. It is managed jointly by NHS London Procurement Partnership, NHS Commercial Solutions, NHS North of England Commercial Procurement Collaborative, and East of England NHS Collaborative Procurement Hub.

The NHSWA framework sets rate ceilings by staff group and pay band. Trusts that procure outside these frameworks without a waiver are subject to NHS Improvement scrutiny.

Crown Commercial Service (CCS) — RM6278

The CCS Medical Staffing framework (RM6278) covers medical and dental temporary staffing — locum doctors, consultants, and dental practitioners. This framework operates differently from nursing frameworks, with rates often quoted as percentage uplifts over NHS standard pay rather than fixed hourly amounts.

How NHS pay bands translate to agency rates

NHS staff are paid on the Agenda for Change (AfC) pay scale, which runs from Band 1 to Band 9. In practice, most agency nursing and AHP placements fall within Bands 5 to 8.

The framework rate for any given shift is a function of:

• The AfC band of the role
• The shift type: standard (Mon–Fri, day), unsocial (evenings, nights, weekends), or bank holiday
• The uplift cap: frameworks set a maximum percentage uplift over the standard AfC rate that agencies can charge

As of 2026, the framework cap for nursing placements (Band 5–7) sits at approximately:

Band

Standard hourly rate (AfC)

Max agency charge rate (incl. uplift)

Indicative agency margin

Band 5 (Staff Nurse)	£14.09	~£28–£32/hr	£4–£8/hr
Band 6 (Senior Nurse)	£16.37	~£33–£38/hr	£4–£9/hr
Band 7 (Advanced Nurse)	£19.74	~£40–£46/hr	£5–£10/hr
Band 8a (Specialist)	£23.36	~£48–£55/hr	£5–£12/hr

Note: These are illustrative figures. Actual framework rates vary by region, trust-specific contracts, and the specific NHSWA lot. Always refer to your framework agreement for the authoritative figures.

The off-framework problem

A persistent challenge for agencies is that NHS trusts — particularly those with acute staffing shortages — sometimes procure outside framework rates when they cannot fill shifts through approved channels. This is technically a breach of NHS procurement rules, but it does happen.

Agencies operating off-framework face two risks:

1. Non-payment disputes: Trusts can refuse to pay invoices for off-framework placements, citing procurement policy.

2. Framework suspension: Repeated off-framework activity can result in an agency being removed from the framework.

The practical solution is robust rate card management in your ATS: the system should flag any proposed charge rate that exceeds the framework ceiling for the relevant band and shift type, before the booking is confirmed.

Integrated Care System (ICS) variation

Since the creation of Integrated Care Systems in 2022, there is increasing variation in how NHS bodies manage temporary staffing at a local level. Some ICSs have established regional "banks" (internal staff banks) that take priority over agency placements, with agency staff only engaged after the bank is exhausted.

This has two implications for agencies:

1. Volume reduction in some regions: Agencies operating heavily in ICS areas with strong internal banks (typically large urban ICSs like North West London or Greater Manchester) may see reduced volume.

2. Compliance bar raising: ICSs are increasingly requiring agencies to demonstrate higher compliance standards as a condition of preferred supplier status.

Allied Health Professional (AHP) rates

AHP rates under the NHSWA framework cover a broad range of professions including physiotherapy, occupational therapy, speech and language therapy, radiography, and sonography.

AHP placements tend to command higher margins than nursing in some specialties — particularly sonography and specialist radiography — due to lower candidate supply. However, the framework rate caps apply equally.

For Band 7 AHP specialists (e.g. advanced physiotherapists, specialist radiographers), charge rates of £45–£60/hr are achievable on framework in high-demand specialties.

Medical locum rates under CCS RM6278

Medical locum rates operate on a different model. Rather than fixed hourly ceilings, the CCS framework uses a reference cost based on the standard NHS pay for the grade, with an agreed percentage uplift cap.

For junior doctors (FY1–ST3 equivalent), the framework typically allows uplifts of 20–55% over standard NHS pay, depending on the grade and whether the placement is within or outside core hours.

For consultants and specialty doctors, the picture is more varied. High-demand specialties — emergency medicine, anaesthetics, psychiatry — routinely see off-framework rates paid by trusts under hardship waivers, as supply constraints mean the standard framework cap cannot attract sufficient candidates.

What this means for your rate card management

Operating profitably on NHS frameworks requires precise rate card management. The key disciplines are:

1. Band-specific rate cards

Maintain a rate card for every combination of staff group, AfC band, and shift type. Rates for unsocial hours and bank holidays should be pre-calculated so consultants can quote accurately without manual calculation.

2. Framework ceiling alerts

Your staffing system should automatically flag any charge rate that approaches or exceeds the framework ceiling. This prevents inadvertent off-framework placements and the associated risks.

3. Margin floor enforcement

Set a minimum acceptable margin (in £/hr, not just %) below which a placement should not proceed without senior approval. For most agencies, a margin below £3/hr is unsustainable once you factor in payroll costs, compliance costs, and overhead.

4. IR35 and umbrella company considerations

Most NHS agency placements are inside IR35. This means candidates must be paid through a PAYE umbrella company or directly through PAYE. The employer's NIC (currently 13.8%) and Apprenticeship Levy (0.5%) are costs to your agency or passed to the umbrella — factor these into your rate modelling.

5. Annual rate uplifts

AfC pay rates are reviewed annually. The 2025 NHS Pay Review Body recommendation resulted in a 5.5% uplift for most bands. Your rate cards must be updated immediately following any AfC uplift to ensure you are billing at the correct framework rate and maintaining margins.

Planning for 2026/27

Several developments are likely to shape NHS framework rates and procurement over the coming year:

• Framework renewal: NHSWA frameworks are subject to periodic renewal. Agencies should monitor tender notices on Find a Tender and NHS Supply Chain portals.
• AI-driven rate benchmarking: NHS trusts are beginning to use benchmarking tools to identify agencies charging above the median for equivalent placements. Agencies that can demonstrate value — higher fill rates, lower cancellations, stronger compliance — will be better positioned to defend their rates. See how AI is transforming shift management to understand how technology drives fill rates.
• Bank-first mandates: Expect more ICSs to mandate bank-first usage before agency engagement, particularly for elective care specialties.

For agencies that manage their rate cards carefully, maintain impeccable compliance standards, and leverage technology to fill shifts faster than competitors, NHS frameworks remain a viable and profitable route to market. The margins are thinner than the private sector, but the volume and predictability of NHS demand compensates.

The agencies that thrive in this environment are those that treat rate management as a core operational competency — not an afterthought.