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Direct Engagement

Cost-efficient candidate employment

Direct Engagement (DE) is an employment model that enables NHS trusts and health boards to realise significant savings by changing the way they employ the doctors and allied health professionals they book for temporary work.

Recruitment agencies are used in the same way to provide and screen candidates, but workers have a direct fixed term contract with the trust, which allows their services to be procured in a more cost-effective way. In addition to cost savings, DE provides trusts with more visibility and control over their staffing supply and reduces IR35-related compliance risks associated with the use of umbrella workers.

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Why Medacs Healthcare?

Many providers offer Direct Engagement, but few work as hard as we do to maximise throughput, consistently achieving 100% DE-efficiency. Changing pay types for all workers is complex and needs positive collaboration between workers, the trust and all supply chain partners to succeed without impacting fill.

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Independently assured procurement

Our Direct Engagement services can be procured via a range of frameworks, either on a standalone basis or integrated with other providers or solutions. The model we use has been independently reviewed to ensure it adheres to all current employment, tax and pension legislation.

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Direct Engagement Efficiency Case Study

As LNWH’s managed service provider, Medacs Healthcare identified DE as an area that could generate significant savings and efficiencies – and reduce risks associated with tax legislation and compliance.

Only 54% of locum doctors were being processed via the trust’s direct engagement model and less than 31% of AHPs. The Medacs Healthcare team calculated that the use of non-DE-compliant umbrella workers was costing the trust over £80,000 per month.

Umbrella workers are contracted and paid through third party umbrella companies. As these types of locum workers are not VAT registered, VAT savings of up to £8 per hour are lost and responsibility for their tax obligations lies with the trust, creating risk.

Additional risks were also apparent as 25% of bookings were off-contract workers, not subject to the same stringent compliance checks.

“Working callaboratively with Medacs has boosted our direct engagement throughput to 100%, generating significant savings for our trust in less than four months. We now have a much more efficient operation, reduced risk and the highest rate of DE-compliance in our region." 


London North West University Healthcare, HR Director

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