PAYE changes are not about the MIDDLEMAN issue rather the government reassessed our work as EMPLOYMENT:

Strengthened Position on Why Agency Nurses Should Not Automatically Fall Within PAYE / IR35
Agency nurses operate under a fundamentally different working arrangement from employed NHS staff, and their inclusion within PAYE/IR35 does not accurately reflect the reality of their engagements. The following points clarify this:

1. Nature of Engagement – Temporary, Non-Continuous Work
Agency nurses are engaged on a shift-by-shift or short-term basis, with no ongoing obligation between assignments. There is no guarantee of future work, and equally no obligation on the nurse to accept offered shifts. This lack of continuity distinguishes agency work from employment.

2. Absence of Mutuality of Obligation (MOO)
A key test in employment status is whether there is mutual obligation between engager and worker. In the case of agency nurses:
NHS trusts are not obliged to offer continuous work
Nurses are free to decline shifts without penalty
This absence of mutual commitment is a strong indicator of non-employment status.

3. High Degree of Worker Autonomy Over Engagements
Agency nurses retain control over:
Whether to work
When to work
Which locations to accept
They can choose assignments across multiple NHS trusts or private settings, demonstrating a level of autonomy inconsistent with traditional employment.

4. Multi-Client / Portfolio Working Model
Agency nurses typically provide services to multiple engagers over time, rather than working exclusively for a single organisation. This reflects a business-to-business style relationship rather than employment with one employer.

5. Provision of Skilled Professional Services
Agency nurses are highly trained professionals who:
Exercise independent clinical judgment
Are individually accountable to professional standards (e.g. Nursing and Midwifery Council)
Do not require the level of supervision associated with employees
While they operate within clinical frameworks, the manner in which they deliver care relies on their own expertise rather than direct managerial control.

6. Limited Integration into Organisational Structure
Agency nurses are not integrated into the core structure of NHS organisations:
They do not receive employee benefits (e.g. pensions, sick pay, annual leave)
They are not part of internal career progression frameworks
They are engaged specifically to address temporary staffing shortages
This supports the position that they are external resources rather than employees.

7. Financial Independence and Flexibility
Agency nurses often:
Manage their own availability and workload
Incur costs related to travel between assignments
Arrange their own compliance, training, and professional requirements
This reflects characteristics of an independent worker rather than an employee in a stable role.

Closing Position
While agency nurses operate within regulated clinical environments, this should not automatically result in their classification as employees for tax purposes. The current application of PAYE/IR35 risks overlooking the flexible, independent, and non-continuous nature of agency nursing work.