Insourcing vs Locum Agency: Why Governance‑Led Insourcing Delivers Better Value and Better Outcomes  For NHS Trusts seeking safe, efficient and cost‑effective ways to increase diagnostic capacity, the distinction between insourcing and locum agency staffing is critical. Although both models can support service delivery, they operate under fundamentally different governance, financial and clinical risk structures — and these differences have real consequences for quality, accountability and total cost.  Insourcing: A Fully Governed, VAT‑exempt Clinical Service  Insourcing provides a complete clinical service, delivered under the provider's own governance framework. This means the insourcing organisation assumes full responsibility for: 

  • Clinical quality
  • Patient safety
  • Workforce competency
  • Service delivery
  • Audit, assurance and continuous improvement 

Because insourcing is classified as a clinical service, it is VAT‑exempt, immediately reducing cost pressure for Trusts compared with agency staffing.  Sanus Cor delivers insourced echocardiography and cardiac diagnostics as a turnkey service, not a labour supply model. Our governance includes structured clinical oversight, incident reporting, and continuous quality assurance. As part of our commitment to quality, 5–10% of all scans performed by our team are independently audited by another BSE‑accredited physiologist, ensuring consistency, accuracy and adherence to national standards.  Locum Agency Staffing: Temporary Workforce with Employer Liabilities  A locum agency provides temporary staff, not a clinical service. This distinction places several liabilities back onto the Trust: 

  • 20% VAT on agency invoices
  • Employer responsibilities (pay, pension, holiday pay, NI)
  • IR35 exposure
  • Clinical risk and governance responsibility
  • Oversight of quality, audit and performance 

Although a locum's daily rate may appear lower at first glance, the true cost increases sharply once VAT, agency fees, employer on‑costs and governance responsibilities are included. Trusts also retain full clinical accountability, meaning any variation in quality, documentation or patient safety sits with the organisation — not the agency.  The True Cost Difference  When comparing headline rates alone, agency staffing can seem cheaper. However, once the full picture is considered, insourcing consistently delivers: 

  • Lower net cost
  • Higher clinical assurance
  • Reduced operational burden 
  • Stronger governance
  • Better patient outcomes 

Insourcing is not simply a different procurement route — it is a safer, more efficient and more accountable model for delivering diagnostic capacity at scale.