There’s a widely held assumption in AHP workforce planning that locum staff are significantly more expensive than permanent hires. It’s understandable, the day rate looks higher, the agency fee is visible and the comparison feels obvious.
But it’s rarely the whole picture.
The headline salary isn’t the full cost
A Band 6 AHP salary, whether that’s a physiotherapist, occupational therapist or speech and language therapist, sits around £38,000. That’s the number that tends to dominate budget conversations.
But once you add employer on-costs (National Insurance and pension contributions, typically around 23%), you’re already at approximately £46,700 before a single day of clinical work is delivered.
What you’re actually paying for
Here’s where the comparison shifts.
NHS Digital data puts average sickness absence across the NHS at around 4-5% – approximately 10 days per employee per year. In some AHP services, particularly those with high physical or emotional demand, the figure is higher.
Add 30 days of annual leave and bank holidays, and a full-time permanent Band 6 AHP is typically available for around 192 productive days a year. That brings the real cost per productive day to approximately £243.
A locum Band 6 AHP typically costs £220-£250 per day. No sickness. No leave. Every day paid for is a day of clinical delivery.
The gap is smaller than it looks
In most scenarios, the difference between permanent and locum cost per productive day is marginal. In some, it disappears entirely – particularly once you factor in recruitment costs, the time a post sits vacant, and the impact of unplanned absence on waiting lists and caseload continuity.
This isn’t an argument that locum is always the right answer. Permanent staff bring continuity, team cohesion, and long-term service knowledge that locum support can’t replicate in the same way.
But decisions should be made on accurate numbers and the numbers are often closer than the initial comparison suggests.
If this is something your service is thinking about, feel free to get in touch.