What’s the Difference Between NHS Bank and Locum Agency Work?

You’ve probably been told you have two choices for flexible healthcare work: stick with NHS bank shifts for security, or go to an agency for better pay.

But what if both options are leaving money on the table?

This article breaks down exactly how NHS bank work and agency work actually compare – the real costs, the hidden fees, and what you actually take home. We’ll also look at why collaborative staff banks like Flexzo Ai are changing the game for healthcare professionals who want both flexibility and fair pay.

By the end, you’ll know which option genuinely works best for your situation.

NHS Bank Work: The Traditional Internal Option

NHS bank work means joining the internal staffing pool of a specific Trust. When they need extra cover, they call their bank staff first before looking elsewhere.

How NHS Bank Work Works

You register with one Trust and become part of their internal flexible workforce. When shifts become available, the Trust contacts bank workers to fill gaps. You’re essentially a permanent employee with flexible hours, working only when needed and when you’re available.

The Benefits of NHS Bank Shifts:

• Familiar working environment – you know the systems, colleagues, and procedures
• NHS pay rates with proper enhancements for unsocial hours
• Access to NHS pension scheme
• Paid annual leave (usually calculated as a percentage of earnings)
• Job security and employment protections
• No agency fees cutting into your pay

The Limitations of NHS Bank Shifts

• Limited to one Trust – fewer shift opportunities
• Still subject to the same staffing shortages affecting permanent staff
• May get cancelled if permanent staff can cover
• Often first to be moved around if emergencies arise
• Limited variety in work settings

Locum Agency Work: Maximum Flexibility, Maximum Uncertainty

Locum agencies act as middlemen, connecting healthcare professionals with multiple employers. They handle the administrative side while taking a percentage of what the employer pays.

How Agency Work Functions

You register with one or more agencies who then market your services to various healthcare providers. The agency handles contracts, compliance, and payment, taking a commission (typically 15-25%) for their services.

The Advantages of Locum Agency Work

• Work across multiple sites and Trusts
• Often higher headline hourly rates
• Flexibility to accept or decline any shift
• Exposure to different working environments and practices
• Can work with multiple agencies to maximise opportunities

The Drawbacks of Locum Agency Work

• Agency fees reduce your actual earnings
• Inconsistent work availability
• Complex tax situations (often through umbrella companies)
• No paid holidays unless “rolled up” into hourly rate
• No pension contributions
• Constant paperwork and compliance checks
• Less job security and employment protection

The Hidden Costs That Agencies Don’t Highlight

Many healthcare professionals are surprised by how much agency work actually costs them:

Umbrella Company Deductions

Most agencies use umbrella companies that can deduct £20-40 per week for administration, insurance, and other charges. Over a year, this adds up to £1,000-2,000 in hidden costs.

No Real Holiday Pay

While agencies may claim to offer holiday pay, it’s usually just your normal hourly rate redistributed. You’re not actually getting extra money – you’re just getting your own money back later.

Pension Gap

Missing out on NHS pension contributions can cost you tens of thousands in retirement. The NHS pension scheme is one of the best available, but agency workers typically can’t access it.

Tax Complications

Working through multiple agencies and umbrella companies creates complex tax situations. Many agency workers end up paying accountants or missing out on legitimate deductions.

What About Collaborative Staff Banks?

A newer model is emerging that combines the best aspects of both approaches. Collaborative staff banks, like Flexzo Ai, work differently from traditional options.

Instead of being limited to one Trust or paying agency fees, collaborative banks create shared pools of healthcare professionals who can work across multiple NHS organisations without the traditional middleman markup.

How Collaborative Banks Work

You join a network that connects directly with multiple NHS Trusts. The technology matches you with suitable shifts based on your location, skills, and availability. There are no agency fees because the platform connects you directly with employers.

The Key Differences of Collaborative Staff Banks

• Work across multiple Trusts without agency fees
• Keep more of what the NHS pays for your work
• Simplified compliance management across multiple employers
• Better work-life balance through intelligent shift matching
• Access to NHS rates and enhancements

Comparing Your Real Take-Home Pay

Let’s look at what you actually earn, not just the headline rates:

NHS Bank (Band 5 Nurse, 37.5 hours/week):

• Basic: £28,407 annually
• Plus unsocial hours enhancements
• Plus 12.5% pension contribution
• Plus paid annual leave
• No deductions or fees

Agency Work (£35/hour equivalent):

• Gross: £35/hour × 37.5 hours × 52 weeks = £68,250
• Less agency fees (20%): -£13,650
• Less umbrella company fees: -£1,500
• Less no holiday pay equivalent: -£5,500
• No pension contributions: £0
• Net effect: Often similar or less than NHS bank

Collaborative Staff Bank:

• NHS rates plus enhancements
• No agency fees
• Simplified compliance
• Flexibility across multiple Trusts
• Better work-life balance

Which Option Fits Your Life?

The Future of Flexible Healthcare Work

The healthcare workforce is changing. Traditional models of permanent employment and agency work are being challenged by new approaches that give professionals more control while helping the NHS work more efficiently.

Collaborative staff banks represent this evolution. By cutting out expensive middlemen and using technology to match professionals with opportunities, they offer a third way that combines flexibility with financial sense.

Flexzo Ai has built exactly this kind of platform. Instead of choosing between limited NHS bank work or expensive agency arrangements, healthcare professionals can access opportunities across multiple Trusts while keeping more of their earnings.

Making the Right Choice for You

Your decision should be based on what you value most: security, flexibility, earnings, or work-life balance. But don’t assume you have to sacrifice one for another.

The key is understanding what each option actually delivers, not just what they promise. Look beyond headline rates to real take-home pay. Consider long-term benefits alongside short-term convenience. Think about how each option fits with your career goals and personal life.