London NHS vacancies persist as agency cuts reset pay in 2024–25
London’s NHS workforce is operating with persistent vacancies while national moves to curb agency spending start to bite, with over 112,000 posts vacant across England in March 2023 and the NHS forced to spend around £3 billion on agency staff in 2023–24 before cutting that bill by nearly £1 billion in 2024–25, reshaping how trusts in the capital cover gaps on rotas.
NHS England’s Long Term Workforce Plan, published in June 2023, set out that there were more than 112,000 vacancies across the NHS workforce in March 2023, while independent analysis of official data suggests around 125,500 vacancies — roughly 9% of posts — between March and June 2023, with local evidence indicating that roughly four in five registered nurse vacancies and seven in eight doctor vacancies were being filled by temporary staff, either via agencies or internal “bank” shifts.
Royal College of Nursing figures, based on returns from 181 trusts, show that between 2020 and 2023 the NHS in England spent £3 billion on agency staff, with the London region accounting for about £616 million of that total — the highest regional spend and just over a fifth of the national bill — while the Northern region spent around £109 million, underscoring how heavily large London providers have leaned on external cover.
The financial context shifted in 2024–25, when government and NHS England reported that agency staff spending across the NHS in England fell by almost £1 billion in a single year following a policy drive to cut agency expenditure by 30%, after ministers highlighted that around £3 billion had been spent on agency cover in 2023–24 and directed trusts and integrated care boards to move more shifts onto in-house banks instead.
Alongside this, NHS England’s 2024–25 annual reporting records that the organisation and its commissioning support units spent £88 million on contingent labour, including agency staff and secondees, down from £157 million the previous year, with £179 million spent across the wider group, signalling that even national bodies are tightening their use of external staff as part of the wider workforce reset.
Workforce planning now also has to account for communication and language needs: the Accessible Information Standard was updated on 30 June 2025 to add a sixth “review” step and require every health and adult social care organisation to appoint a senior lead, with the refreshed standard intended to ensure disabled people and those who need interpreters or alternative formats can get information and support in ways they can use, a requirement that is particularly demanding in London’s multilingual services.
Taken together, the figures describe a workforce under strain but in transition: vacancy counts above 112,000 and vacancy rates around 9% in 2023, £3 billion spent on agency cover between 2020 and 2023 with £616 million of that in London, a reported £1 billion drop in agency spending in 2024–25, and a strengthened accessibility duty from mid-2025 that asks London employers not only to fill posts but to ensure staff, systems and communication channels can meet diverse needs without defaulting to expensive short-term fixes.
