NHS-focused IR35/off-payroll support: consistent determinations, robust controls and audit-ready evidence
IR35 (off-payroll working) is straightforward in principle yet complex in NHS practice. Trusts, ICBs and ALBs regularly engage locums, clinical specialists and interim managers through agencies or personal service companies. Decisions about status are often distributed across finance, HR and procurement, with varying documentation standards. We help NHS organisations make consistent determinations and retain evidence that satisfies internal and external audit, as well as HMRC.
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What IR35 requires of NHS engagers
Where services are provided through an intermediary (for example, a personal service company), the engager must determine whether the engagement falls “inside” or “outside” IR35. The assessment is based on working practices as well as contractual terms – considering control, substitution and mutuality of obligation, alongside factors such as integration, financial risk and provision of equipment. For agency-supplied workers, responsibility for the decision can still rest with the Trust depending on contractual routes. A repeatable, documented process is essential.
Our approach
We begin with a concise discovery meeting to map current engagement routes – from initial request to payment – and identify where decisions, checks or records are missing. We then implement a practical framework that defines when IR35 applies, who is accountable at each stage, what assessment tools are used, and how atypical cases are escalated. We provide role-appropriate templates written for NHS use, guidance notes for managers and approvers, and briefing materials for agency partners to support consistent practice. Where HMRC is already engaged, we prepare the Trust’s position, explain historic decisions and work towards a proportionate resolution.
Outcomes
- A single, clear process for IR35 determinations.
- Consistency across departments and sites.
- Evidence that is ready for audit and HMRC review.
- Reduced onboarding delays and fewer disputes.
- Above all, confidence that workers are treated fairly and the organisation remains compliant.
Typical deliverables
- IR35 policy and workflow tailored to NHS engagements, with defined roles and approvals.
- Assessment template, guidance pack and record-keeping checklist suitable for audit.
- Targeted training for HR, procurement, finance and budget holders.
- IR35/OPW E-Learning modules for scalable training and HMRC compliance.
Next steps
If you would like a focused review of your current process, we can confirm priority risks, set out immediate actions and provide a realistic implementation timetable.
Go to: Employment Taxes for NHS Organisations (hub) · NMW for NHS · Expenses & Benefits (P11D/PSA) for NHS
IR35 for the NHS FAQs
The engaging organisation is responsible where services are provided via an intermediary (e.g., a PSC), even when workers are agency-supplied, depending on contractual routes. Your process should name accountable roles and escalation points.
Contract, statement of work, working-practices questionnaire, assessment outcome with rationale, approvals, and any agency correspondence. Keep records in a consistent format, time-stamped and accessible for audit/HMRC.
CEST can be part of the process, but outcomes should be checked against actual working practices and documented. Where CEST is inconclusive or facts are borderline, use a reasoned assessment and retain supporting evidence.
On material change (role, control, substitution, location, rota pattern) and at agreed periodic intervals for longer engagements.
Prepare a defensible narrative, collate evidence, quantify exposure and agree proportionate resolution. We support disclosure strategy and remediation planning.
Case Study – Trust-Wide IR35 Governance Refresh
Client: Acute NHS Trust
Situation: Mixed IR35 practices across departments led to inconsistent Status Determination Statements (SDS) and supplier friction.
Approach: Introduced a single, Trust-wide process with clear roles, simple documentation, and short manager briefings.
Outcome: Faster, consistent SDS decisions; fewer disputes; stronger audit confidence.
Case Study – Retrospective IR35 Look-Back & Fix
Client: Specialist NHS Provider
Situation: Internal audit highlighted gaps in historic IR35 decisions and documentation.
Approach: Completed a focused look-back review, corrected priority cases, and aligned contracts and onboarding for future engagements.
Outcome: Exposure understood and addressed; smoother supplier onboarding; improved assurance to Audit Committee.