Here to stay: what drives and motivates the NHS flexible workforce

By Kate Harper, Director of Research, Insight and Thought Leadership


The concept of flexible working hasn’t always sat comfortably with the NHS, but there was a definitive shift in September 2021 when the rules on flexible working in the NHS changed.

The NHS Staff Council amended the NHS Terms and Conditions, Section 33: Flexible Working, to reflect the ambitions of the People Plan. The changes meant that those on these terms could request flexible working from day one of employment. Flexible working is also a core element in the ‘Retain’ theme of the recently published NHS Long-Term Workforce plan which suggests that opportunities to work more flexibly are directly linked to the ability to attract and retain talent .

But what exactly is ‘flexible working’ and how might flexible working impact on the flexible workforce?

For an organisation like NHS Professionals, the largest provider of flexible staff to the NHS, understanding this dynamic is key. Since the changes were introduced, we have carried out further research into the issue and worked with our Members to understand more about the motivations for Bank-only employment. We’ve also looked at whether or not the new arrangements might mean that Bank-only workers should, increasingly, be encouraged back into the substantive workforce.


What does ‘flexible working’ mean?

Flexible working has been defined by NHS England and the NHS Staff Council as ‘an arrangement which supports an individual to have greater choice in when, where and how they work’. This may include changes to their working pattern, hours and role, and location of work. The implication is that, as NHS teams become more adept at accommodating individual requests, one of the key motivating factors for Bank-only employment may disappear.

In 2020, NHS Employers published a survey report – Nurses’ View on Flexible Working[2] - which was created to understand the enablers and barriers to flexible working, and how examples of success could be replicated at scale.

When asked what flexible working meant to them, the majority of survey respondents were split equally three ways: 32% chose ‘A fixed working pattern with predictable shifts’; 29% ‘A mixture of different shifts, week to week’; and 29% selected ‘The autonomy to decide your own start and finish times’. The remaining 10% suggested other options within the themes of working from home, self-rostering and being Bank staff. When asked what types of flexible working pattern they work currently, some 12% said they were Bank workers (other options included part-time working, compressed hours, flexi-time and annualised hours).

For some workers, therefore, the Bank is viewed as a legitimate and attractive vehicle for flexible working. The question then becomes, if the flexibility that the Bank currently offers could be accommodated through a substantive contract, would perceptions of Bank attractiveness change?


Why people want to work flexibly

It is important here to look more closely into what motivates people to work flexibly. The NHS Employers’ research reported:

“Most of the respondents answered for better work-life balance (38%) or caring responsibilities (33%). Other reasons included for study (10%), that it is organisationally enforced (10%), for health reasons (7%) and that an individual has a portfolio career (2%). ”[3]

On the face of it, it would appear many of these things could be accommodated through flexible working. However, some important questions remain unanswered, such as what do people actually mean by flexibility and ‘work-life balance’?

To understand this, it is useful to look at the survey’s verbatim responses. When people talk about work-life balance, it is often assumed they are talking about a simple preference for more time to pursue leisure, family or caring activities outside work. But in fact, it is more likely to be a necessity than a preference because more complex life circumstances make it hard to work a full-time, pre-determined shift pattern. The responses reveal all kinds of challenges being faced including:

  • fatigue after an illness
  • practicalities of childcare which don’t fit with variable shift patterns (meaning individuals do fewer hours than they are willing to offer)
  • older workers looking to wind down, or find work that is less stressful than a full-time, frontline post
  • ability to work longer hours and have more dedicated time off to look after relatives with complex care needs
  • difficulty working certain imposed shift patterns (such as 11.5 hours rather than 7.5 hours), which some individuals believe makes them unproductive

The fact is, flexibility means different things to different people. Guidance on ‘best practice’ in supporting flexible working places a huge amount of emphasis on the flexibility of time (part-time hours, job sharing, annualised hours, zero hours contracts, compressed hours, term-time working, phased retirement and sabbaticals) with significantly less attention to place, where the focus is typically on home working and tele-working .[4] There is very little attention to flexibility in role and work type. Therefore, a lot of focus on how to build flexibility for people doesn’t cover all of the reasons why people are looking for flexible working.


The six key drivers for NHS Bank staff

NHS Professionals has conducted research over several years to understand the different ‘personas’ of our 100,000+ clinical and non-clinical Bank Members. These personas define groups of workers that share characteristics, behaviours and motivations. From this it has been possible to establish an in-depth understanding of what drives people to work flexibly in the NHS via Staff Banks. The drivers can be grouped into six main themes:

The six key drivers for NHS Bank staff

  • Career: individuals can move in and out of the flexible workforce at different stages in their career to accommodate different balances between work and home life pressures. Students may enter the flexible workforce to earn while they learn, parents to have flexible work options while bringing up families and those close to retirement to ‘wind down’ and have the potential to choose their hours. It is also the case that flexible working can be used to ‘test out’ career opportunities for career changers or to ‘get the feel’ of a new employer before applying for a permanent job
  • Convenience: the ability to select when and where to work without formal commitment
  • Control: control over when and where people work – and even the teams with whom they work. For many, this is more important than flexibility per se and puts them in the driving seat with their own work pattern
  • Compensation: the potential to supplement other income (in the NHS or otherwise), to keep earning beyond retirement – particularly in the current economic environment as the cost of living rises; earning while studying; and, potentially, earning more than a part-time substantive role might offer
  • Compassion: the opportunity to care for patients simply and directly, one step removed from management and politics
  • Culture: the motivation to work for the NHS and be aligned to an employer brand they believe in and they are passionate about

Importantly, these motivations vary over a person’s lifecycle. A recent survey of NHS Professionals’ Bank Members[5] revealed there are as many people on the Bank who describe their life stage as ‘preparing for retirement’ as there are those ‘settling into their chosen career’. In fact, across six identified lifestyle stages, from ‘still in training’ to ‘preparing for retirement’, the proportion of Bank Members is similar, as the pie chart below shows:

At each stage, however, motivations can vary considerably. Unsurprisingly, those still in training or starting out in their careers sometimes use the Bank as a means of gaining new skills and developing their career potential. On the other hand, those nearing retirement can use the Bank as a ‘semi-retirement’ vehicle to keep earning after they leave substantive employment. Those in mid-career – particularly with caring responsibilities - are more likely to suggest they can achieve a better work-life balance working on the Bank. Here, though, we also find people who are motivated by the opportunity to care and give something back to society - perhaps after becoming disillusioned with more commercially-driven employment.

Current workforce challenges are a motivating factor in a number of different guises. Over 50% of Bank workers in our survey suggested that working on the Bank was ‘a way of doing overtime to support colleagues’. That wasn’t just the case for substantive workers doing Bank shifts - over a quarter of Bank-only workers suggested they were motivated, at least in part, by wanting to help out their substantive colleagues. Another interesting result is that around 60% of Bank workers said they were motivated by the opportunity ‘to focus on caring for patients rather than management and politics’. This suggests that being able to focus more on their patients and the act of caring itself speaks to their vocational choice, and what drew them to the healthcare sector in the first place.

A final point here is that more than 25% of our survey respondents said they worked on the Bank in part to explore the opportunity of working for a different Trust. Some also made it clear they were working on the Bank only until a substantive role was advertised in their area.


Flexible working goes deeper than money

There are two big myths around the flexible workforce: first, they are only really motivated by wanting to work flexibly, and second, they only want to earn more money. This leads some to conclude that, with better pay and conditions – including options for flexible working - NHS staff will no longer be tempted to the Bank or agency except as a means of doing overtime.    

However, the reality is that even with better pay and more flexibility, there will still be those who want a different type of work experience, one where: 

  • they can be in control of when and where they work
  • they can choose different wards and areas so they can grow and develop skills
  • they can ‘keep their hand in’ after formally retiring, and feel like they are still giving value back to the sector they love without any sense of obligation
  • they can just work shifts and focus more on patients and what attracted them to healthcare originally
  • they can vote with their feet and decide not to work on a ward or in a team that does not provide them with a positive work experience  

In essence, that means that Bank is satisfying people’s wellbeing needs, as well as their desire for flexibility. 

The other reality is that the Bank – which is often associated with agencies under the general umbrella of ‘the flexible workforce’ - is typically viewed as a cost to manage down, rather than a vehicle for providing staff with the flexibility they are seeking. That is not to downplay the importance of team-working and continuity of care, which can be difficult to manage in highly flexible workforce models.

However, the scale and scope of that challenge may be less than first expected. The Bank staff survey[6] showed that 86.1% of registered nurses or midwives always or often work in the same department. Although the figure falls to 76.9% for nursing and healthcare assistants, the ‘peripatetic’ nature of the Bank workforce may be less than some people imagine. People’s natural need for work to provide them with a collegiate ‘sense of belonging’ means there is a strong tendency for many to seek out work with the same teams in the same departments– particularly those they enjoy working with.


Flexible staff are here to stay

Ultimately, if managed strategically, the Bank can serve as a part of the solution for the drive for flexibility, rather than as a cost. Understanding the value to the organisation of attracting (and retaining) staff that may otherwise be lost to the Trust, should be articulated in workforce plans, along with the emotional and financial wellbeing benefits to individuals. Where appropriate, staff should be encouraged to use the Bank as a vehicle to ‘step in and out’ of substantive employment at different stages in their career. This can be used as a means of engaging and retaining talent when substantive employment options may not be possible or desirable, for whatever reason.

Most importantly, we must recognise that the flexible workforce want more than just the opportunity to work flexible shifts with better pay and conditions. We know from our research that their motivations are more complex and that those who want and need to work flexibly are here to stay.





[3] Op cit, p6.

[4] Flexible working: Raising the standards for the NHS, NHS England, 20 January 2022, Version 1.

[5] Returned sample of over 9,600 individuals working in both clinical and non-clinical roles across the NHS. Full survey results due for publication 2023-24.

[6] An Overview of the Aggregate Bank Only Survey Results, 2022, Version 2, NHS Staff Survey Coordination Centre, NHSE, April 2023.