Insourcing. A phrase that is often bandied about in the same sentence as ‘the privatisation of the NHS’. It’s a service that is often misconstrued and seen negatively. But what actually is insourcing, and how can it help the NHS tackle elective recovery?

Insourcing is defined as ‘the employment of a third-party organisation to perform medical services and procedures on trust premises. It allows third-party suppliers to provide clinical diagnostic and treatment services that utilise NHS trust equipment and premises which may otherwise be unused. This is usually done out-of-hours, or at weekends, or in some circumstances, insourcing is used when there is a shortage of staff within a certain speciality.

As insourcing services mostly run outside of the usual clinic times, it gives patients out-of-hours access to services. In most cases, it is simply an extension of the trust’s existing clinical service over evenings and weekends.

Does the patient notice a difference? No – most of the time for the patient, everything is the same and it’s just like they are being provided the regular NHS service. In fact, they could be seen quicker as there is extra clinical capacity.

The need for additional clinical capacity remains significant. In England, the elective waiting list stood at more than 7.2 million pathways in 2026, with around 2.5 million patients waiting over 18 weeks for treatment. This continuing demand means NHS organisations are increasingly exploring flexible approaches to increase capacity while maintaining patient care standards.

What are the advantages and disadvantages of insourcing?

With NHS staff delivering record levels of elective activity, the health service is using a range of approaches to increase capacity, including surgical hubs, community diagnostic centres, evening and weekend clinics, and insourcing arrangements that maximise the use of existing NHS facilities.

Insourcing is designed to be a short to medium term solution. It aims to be results driven to reduce the size of the elective backlogs or to reduce pressures within certain departments.

It provides organisations with more control over a service than alternative routes. Services are generally covered under NHS trusts’ Care Quality Commission (CQC) registration which means the policies and processes in place at that trust are adhered to by the supplier offering services under an Insourced model.

Insourcing can help to drive savings to the NHS by utilising equipment and diagnostic or treatment rooms which would otherwise be dormant out-of-hours, at weekends or where the trust may not have the staff volumes to cover a certain speciality. Treatments under insourcing may be carried out at, or below, NHS Payment Scheme rates.

While every organisation’s circumstances differ, these are some of the key benefits that an insourcing model can deliver.

When it comes to disadvantages, insourcing can be trust dependent and what works for one trust may not work for another. It can also depend on the availability of the rooms within a trust, or other resources needed to make a particular service work such as administrative support.

Why is insourcing still relevant?

While waiting lists have reduced from their peak, demand continues to outstrip capacity in many specialties. Diagnostic performance remains under pressure, with a substantial proportion of patients still waiting longer than six weeks for key diagnostic tests. Targeted insourcing can help trusts address these bottlenecks by increasing access to specialist clinical teams and making greater use of NHS estates and equipment outside core operating hours.

In summary, insourcing can play a crucial role in alleviating NHS pressures, reducing waiting lists, and enhancing patient care. It provides a cost-effective solution by pricing on or below the NHS Payment Scheme cost and enables NHS trusts to meet referral to treatment targets (RTT) and achieve the Faster Diagnosis Standards (FDS). By using spare capacity and employing medical teams, providers can see a high volume of patients in a short amount of time, and the insourcing service procured will be tailored to meet the specific needs of the NHS trust.

Insourcing is not a substitute for long-term workforce and capacity planning, but when used appropriately it can provide NHS organisations with a flexible, governed and cost-effective way to address immediate capacity pressures and improve patient access.

If you would like a conversation about how our Insourcing of Clinical Services Framework Agreement can support your trust, please contact us at sbs.hello@nhs.net.

This article was last updated in August 2026.