To illustrate the point, I spoke to a client this week who said their annual spend on agency nursing is 20M. He said if the trust applied the price guidance, but did not actually reduce the number of agency nurses used, they would potentially save 6M. I asked what the trust spent annually on interim managers. He responded "about 300-400K". Clearly the potential savings are not comparable, and I'm sure that when Monitor and the TDA evaluate trust compliance with guidance they will be looking at the highest spend temporary staffing categories first, which will always invariably be agency nursing. Spend on interims is going to be a far lesser priority.
I also spoke to an outer London trust this week who questioned how exactly they are going to persuade a locum doctor to cover their ED for the weekend, on a new below market rate, when they can go to a shiny teaching hospital like Guys (who are not receiving interim support from DH, and aren't in breach of their license) for full market rate. So despite the size of the prize, complying with the guidance when sourcing agency nurses and medical locums will still be a challenge for trusts, and one of the key reasons is the one I mentioned in my blog last week; for the guidance to be effective for all, all have to act in unison, and yet not every organisation will comply or is obliged to comply.