Clinical Insourcing vs Transactional Recruitment: What’s the Difference for NHS Trusts?

When your NHS Trust needs additional clinical capacity, bringing in more people can feel like the obvious solution. But the real question is often whether you need individual clinicians to fill workforce gaps, or a complete clinical service designed around a specific capacity problem.

That is the key difference between transactional recruitment and clinical insourcing. Transactional recruitment, or locum staffing, can provide valuable temporary support when a service needs specific clinicians. Clinical insourcing goes further, bringing an external team, service model and clinical oversight into the Trust to deliver agreed activity, usually using existing NHS facilities and infrastructure.

In this guide, we’ll look at how the two approaches differ, when insourcing may be the stronger fit and what NHS decision-makers should consider when choosing a capacity solution.

What is transactional recruitment in the NHS?

Transactional recruitment focuses on filling individual workforce requirements, rather than delivering a complete clinical service.

A Trust may use locum clinicians to cover sickness, vacancies, rota gaps or periods of increased demand. Those clinicians join the existing service, while the Trust continues to manage patient pathways, operational delivery and the wider clinical structure.

This approach can work well when the problem is primarily a staffing gap. If a department is otherwise operating effectively but needs additional clinicians to maintain staffing levels or cover vacant posts, transactional recruitment can provide valuable flexibility.

What is clinical insourcing in the NHS?

Clinical insourcing is different. Rather than supplying individual clinicians, an external provider delivers a defined clinical service within NHS premises.

The provider brings together the workforce, clinical oversight and operational delivery needed to achieve an agreed outcome. This might involve running additional outpatient clinics, theatre lists, diagnostic sessions or other activity during evenings, weekends or periods when existing NHS facilities have additional capacity.

For example, a Trust may have theatres, clinics or diagnostic equipment available outside core hours but not have the internal capacity to run additional sessions. Athona Clinical Solutions can provide the clinical team and service model needed to deliver additional activity within the Trust’s existing facilities and patient pathways.

Clinical insourcing vs transactional recruitment: what are the main differences?

Filling workforce gaps vs solving a capacity problem

The simplest way to separate the two models is to look at the problem you are trying to solve. If your service needs another consultant or clinician to fill a vacant post, provide temporary cover or support the rota, transactional recruitment may be exactly what is required.

But if the challenge is a growing waiting list, insufficient throughput or a need to run additional sessions, adding individual temporary clinicians may not address the whole problem.

Clinical insourcing starts with the required service outcome, with the workforce and delivery model built around it.

Individual clinicians vs a complete clinical service

With transactional recruitment, temporary clinicians work within the Trust’s existing service model. Operational processes, governance, patient pathways and delivery remain largely with the Trust.

Clinical insourcing provides an agreed end-to-end clinical service. The provider is responsible for delivering the agreed activity, with the appropriate workforce, clinical oversight, governance and reporting built around it.

This is an important distinction: insourcing is a service delivery model rather than another route for supplying individual temporary clinicians.

How capacity is measured

Transactional recruitment is generally focused on workforce: does the department have the clinicians it needs to cover the required shifts or sessions?

Insourcing is more directly focused on service delivery. Success might be measured through additional clinics completed, patients treated, diagnostic activity delivered or progress against agreed waiting-list objectives.

That gives Trusts the opportunity to commission support around a specific operational outcome rather than individual staffing requirements alone.

When might an NHS Trust consider clinical insourcing?

Clinical insourcing may be a stronger fit when the constraint is service capacity rather than individual workforce gaps.

That might include situations where:

• Waiting lists require targeted additional activity
• Existing theatres, clinics or diagnostic facilities are available outside core hours
• Internal teams do not have the capacity to run additional sessions
• A Trust needs a complete clinical team rather than individual temporary clinicians
• Additional evening or weekend activity could improve throughput
• There is a desire to reduce reliance on repeated ad hoc temporary staffing
• The department needs short- or medium-term capacity while developing a sustainable longer-term model

Supporting waiting-list recovery

Where a service faces a backlog, clinical insourcing can provide targeted additional capacity around that specific requirement. A provider might deliver additional clinics, theatre lists or diagnostic sessions, helping the Trust increase activity as part of a wider waiting-list recovery plan.

Making better use of existing NHS facilities

A lack of clinical workforce does not always mean a lack of physical capacity. Trusts may have theatres, clinics, equipment or diagnostic facilities that are less heavily utilised during evenings and weekends. Clinical insourcing can help extend the use of those existing assets by bringing in the workforce required to run additional activity.

This means more patients can be treated while continuing to use existing NHS facilities and pathways.

Reducing reliance on ad hoc staffing

Where repeated staffing gaps are part of a wider capacity problem, an insourcing project can provide additional activity against clear objectives rather than building capacity one shift or clinician at a time.

What should NHS decision-makers consider?

Once a wider capacity need has been identified, the next step is to understand what the service already has, what it is missing and what successful additional capacity should look like.

Does the Trust have facilities that could support more activity?

Look at the facilities as well as the workforce. Could additional theatre lists, outpatient clinics or diagnostic sessions run during evenings or weekends? If facilities and equipment are available but workforce capacity is limiting their use, insourcing can help unlock that capacity.

How much operational support is required?

Consider whether the Trust needs individual clinicians to work within its current service, or a coordinated team responsible for delivering specific activity.

A clinical insourcing project can incorporate workforce, clinical oversight, governance, reporting and service delivery around an agreed objective. This can be particularly useful where internal teams are already stretched and would struggle to absorb the operational work associated with running additional activity themselves.

How will success be measured?

Clear objectives should be agreed from the start. Depending on the service, that could include activity delivered, waiting-list reduction, utilisation, treatment times, patient outcomes or other agreed operational measures.

Defining success early also makes it easier to understand when the additional capacity has achieved its purpose and how the Trust can transition towards its longer-term model.

What happens when the project ends?

Insourcing should be a defined intervention, not an open-ended dependency. A strong project should include a practical exit strategy from the outset, considering how activity will reduce or transfer, what knowledge and processes will remain with the Trust and how sustainable internal delivery can be supported over time.

How Athona Clinical Solutions supports NHS Trusts

No two Trusts face the same capacity challenge. One department may need additional weekend clinics, while another may need theatre activity to reduce a defined backlog or temporary support during service redesign.

That is why Athona Clinical Solutions develops tailored clinical insourcing services for NHS Trusts, helping increase capacity, reduce waiting lists and improve operational efficiency.

Our projects consider the practical details of delivery from the start, including mobilisation, clinical governance, reporting, measurable outcomes and a clear exit strategy.

With more than 20 years’ healthcare experience and approval on key NHS clinical insourcing frameworks, we also give Trusts a compliant route to additional capacity with clear visibility over delivery.

Transactional recruitment or clinical insourcing: which does your service need?

The right approach depends on the problem your service needs to solve. Ask yourself: what needs to change about the service to treat more patients effectively?

If you need individual clinicians to cover vacancies, absences or rota gaps, transactional recruitment may provide the flexibility you need.

If your service has a wider capacity challenge, available NHS facilities and a specific amount of additional activity to deliver, clinical insourcing may offer a more structured solution.

Speak to our team about a tailored clinical insourcing solution for your Trust.

Explore Athona Clinical Solutions insourcing

FAQs

What is the difference between clinical insourcing and transactional recruitment?

Transactional recruitment focuses on supplying individual clinicians to fill workforce requirements within an NHS Trust’s existing service. Clinical insourcing delivers a defined clinical service, including the workforce, oversight and delivery model required to achieve agreed activity or outcomes.

Is locum recruitment a form of transactional recruitment?

Locum recruitment is one example of transactional recruitment, where temporary clinicians are brought into an existing service to cover workforce requirements such as vacancies, absence or rota gaps.

Is clinical insourcing the same as temporary agency staffing?

No. Clinical insourcing is distinct from temporary staffing. An insourcing provider delivers a defined clinical service rather than simply supplying individual temporary clinicians.

When should an NHS Trust consider clinical insourcing?

Insourcing may be appropriate where the Trust has facilities and patient demand but needs additional clinical capacity to deliver more activity, such as extra outpatient clinics, diagnostic sessions or theatre lists.

Can clinical insourcing reduce reliance on transactional recruitment?

It can help reduce reliance on repeated ad hoc staffing where the underlying issue is service capacity rather than individual workforce gaps. The right approach will depend on the Trust’s workforce, facilities and operational needs.

Can clinical insourcing support NHS waiting lists?

Yes. Clinical insourcing can provide targeted additional capacity through evening, weekend or extended services and can form part of a Trust’s wider waiting-list recovery strategy.