Insourcing - the unsung hero of the NHS elective recovery

IHPN’s Head of Acute Policy John Hopgood looks at the role insourcing has played in the NHS’ elective recovery and what more can be done to help NHS Trusts make full use of insourcing provision to treat even more patients safely, effectively and efficiently.

This month, NHS England was able to announce that they had hit the government’s first interim target on 18-week waiters – with 65.3% of patients now waiting for fewer than 18 weeks. The final two months leading up to the March 2026 deadline saw a particularly dramatic improvement, a combination of the national Q4 sprint and a huge drive on waiting list validation enough to get the NHS over the line.

Delivering the patient care needed to hit the 65% target involved hundreds of providers – hospitals, community providers, community diagnostic centres, specialist treatment centres and more – up and down the country. But among all of them, very little will be said about one of the unsung heroes in helping the NHS reach the target – insourcing.

For the uninitiated, insourcing refers to the practice of NHS Trusts contracting with third party providers to supply complete clinical teams to deliver additional activity using NHS facilities. Typically, this activity will take place outside of regular hospital hours – evenings and weekends – and helps ensure a more efficient use of NHS capacity.

Crucially, insourcing providers supply entire clinical teams, who deliver complete patient lists. Insourcers are not staff agencies, sending one or two clinicians to cover a few shifts, nor are they the trust’s own consultants working overtime. Rather, these providers are fully managed services with dedicated teams who can flex to stand up services quickly wherever they are most needed. And they all deliver activity inside NHS tariff prices.

Measuring the impact of insourcing is a challenge, not least because there is very limited reporting of the scale of their work. Patients treated by insourcers are included within the host trust’s data, rather than being reported separately like other independent sector providers. Data gathered by IHPN from its members suggest that at least three-quarters of a million patients are treated every year by insourced provision – but the true number is likely to be significantly higher.

This activity covers a huge range of services, from diagnostic tests, to outpatient clinics, to surgery – and everything in between.

Though it may not be visible, many trusts already rely on insourcing providers to help them hit their activity targets. For trusts, it’s a win-win. Additional activity, delivered on site, at or below tariff cost, and all managed totally separately.

As things stand, there is no national strategy for insourcing, but the multiple contracting frameworks speak to a delivery model of growing importance to the NHS. Greater standardisation – along with better education for systems on how insourcing works, what good looks like, and how to best utilise insourced provision – would help deliver even more activity.

IHPN have produced an overview on what insourcing is, aimed at dispelling some of the myths that still surround the model. We’re encouraging NHS England to make sure that all commissioners and trusts understand what good insourcing looks like, and to make sure that activity reporting properly reflects the role that the sector plays in meeting NHS activity targets, to allow for even more systems to understand how insourcing provision could help them treat even more patients safely, effectively and efficiently.