Under the Direct Engagement model, Litmus facilitates the sourcing and introduction of temporary candidates, and our healthcare partners engage directly with those candidates for payment and contractual purposes.
Direct Engagement remains an established engagement model used by NHS trusts and health boards to support the compliant engagement of temporary workers.
The model provides a compliant route for engaging workers directly, supported by robust governance, reporting and workforce administration processes.
Direct Engagement arrangements typically provide:
We consistently maintain 100% Direct Engagement compliance rates across all our managed service contracts, with a zero-tolerance policy on umbrella use.
HMRC’s updated guidance on the VAT treatment of eligible GMC-registered locum doctors, dated 17th July 2026 does not alter the operational and governance benefits delivered through Direct Engagement.
Our existing NHS partners continue to benefit from improved oversight of temporary workforce activity, transparent management information, reduced exposure to umbrella company arrangements, streamlined administration and robust compliance processes.
Direct Engagement arrangements also continue to offer VAT related cost savings across a wider range of non-exempt workforce groups, including many allied health professional and non-medical temporary staffing categories.
Litmus is continually monitoring the guidance to ensure we remain compliant and provide the best service to our NHS Partners.
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Save up to 22% on eligible temporary staffing costs
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Streamline time-consuming contractual processes and the administration of payroll files
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Realise benefits and cost savings in just eight weeks
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Access all bookings in real time with monthly MI analysis and a full audit trail
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Support better grip and transparency on rates and the supply process
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Strengthen governance in line with regulatory and employment law standards
“Increased our DE throughput to 100% with better processes and a lot more engagement with internal teams and supply chain partners.”
Director of Finance, NHS Foundation Trust
“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.”
HR Director, NHS Trust
“Massively exceeded our assumptions on the improvements in process compliance and the savings that would be generated. This approach will now be shared across our region.”
NHS Workforce Transformation Lead
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