This week, we reviewed the latest analysis in The BMJ. It reinforces something many of us in workforce planning have recognised for some time:

Unpaid overtime across the NHS is now equivalent to tens of thousands of full-time roles.

That is not a minor operational issue. It represents a structural workforce gap being quietly absorbed by permanent staff.

The additional unpaid hours being worked are both significant and measurable. In effect, this is hidden capacity keeping services running where funded establishments do not fully match demand.

For our clients, this matters. ⚖️

What This Actually Tells Us

When unpaid overtime reaches this level, it signals three clear realities:

• Demand remains high

• Vacancy pressure remains significant

• Permanent capacity alone is insufficient

This is not a question of local management performance. It reflects a system operating under sustained pressure.

The Narrative Around Agency Use

At the same time, there continues to be pressure in some areas to reduce agency utilisation as a primary cost-control measure.

As an organisation working closely with recruitment agencies and healthcare providers across the UK, we believe it is important to be clear:

• Agencies did not create structural vacancies

• Agencies did not create waiting list backlogs

• Agencies respond to genuine rota gaps

When unpaid overtime already equates to tens of thousands of roles, reducing flexible staffing without increasing substantive headcount does not remove workload — it simply transfers it.

In practice, that pressure often falls back on permanent teams. ⚠️

Why Responsible Agency Supply Remains Critical

Our agency clients provide essential flexibility where the system requires it. They:

• Stabilise services during recruitment lag

• Protect continuity of care during sickness spikes and seasonal pressure

• Support safe staffing levels while long-term workforce strategies develop

When governed properly and delivered compliantly, agency supply is not a weakness. It is a pressure valve within a stretched system.

The Bigger Picture

The BMJ analysis should not be read as criticism of frontline staff. It should be understood as a warning about capacity alignment.

A sustainable NHS workforce model requires:

• Long-term recruitment and retention planning

• Transparent oversight of spend

• Intelligent integration of permanent, bank and agency resource

At Healthier Business Group, we remain committed to supporting agencies that operate to high compliance standards and helping providers maintain safe, resilient workforce models🤝

The data is clear. Unpaid overtime at this scale is not a strategy — it is a signal.

The solution lies in partnership, evidence-based planning, and responsible flexibility — not blunt measures that risk shifting pressure elsewhere.

If you would like to discuss how this evolving landscape may affect your organisation, we are always open to that conversation.