BRITAIN’S SUBSTITUTE WORKFORCE
When flexibility stopped filling the gaps and became the system.
Britain has not simply developed a problem with zero-hours contracts.
Over decades, a much broader employment model has emerged: when a profession becomes expensive, difficult to recruit into or difficult to retain, Britain increasingly finds another way of delivering the work.
Permanent becomes temporary.
Direct employment becomes agency.
Qualified roles are supplemented by new grades of worker.
Experienced professionals leave and are bought back through banks, agencies or contracting arrangements.
The individual changes can all be defended. The question is what happens when you put them all together.
BANK STAFF
AGENCY STAFF
COMBINED
Agency expenditure has actually been falling — NHS England says it has dropped by roughly £1.4 billion from 2022/23 — which is important because we shouldn’t pretend the trend is still moving in one direction.
But £8.6 billion of temporary staffing expenditure in a single year gives us the question:
How did temporary labour become such an enormous component of a permanent national institution?
Doctors / Physician Associates
This is the controversial example.
Physician Associates are not doctors, but they are regulated healthcare professionals. The issue isn’t that Britain has literally employed thousands of people pretending to be doctors.
The issue is role substitution and scope.
As of December 2025, the GMC had registered:
The GMC expected roughly another 1,000 newly qualified PAs and AAs during 2026.
Why was Britain expanding an entirely new clinical workforce while simultaneously struggling to train, recruit and retain enough doctors?
Then examine training length, permitted responsibilities, supervision, patient identification, cost and where PAs were actually being deployed.
Not an attack on PAs themselves.
An examination of the system that created the demand for the role.
Teachers / The Classroom Workforce
England had approximately 468,300 FTE teachers working in state-funded schools in November 2024.
About 97% held Qualified Teacher Status.
That still leaves roughly 3% without QTS — around 14,000 FTE teachers, although the exact calculation and categories need explaining rather than simply calling all of them “unqualified teachers.”
Then add the wider classroom workforce:
Again, these roles aren’t inherently bad.
Are they supporting the qualified profession — or increasingly compensating for Britain’s inability to retain enough of it?
That’s the recurring test throughout the article.
Permanent / Bank / Agency
This is where the argument becomes particularly powerful.
NHS England itself says moving temporary staffing towards substantive staffing produces financial benefits.
Yet in 2024/25:
So approximately £1 in every £11 of provider employee expenditure was going through bank and agency staffing.
The institution requires the labour regardless.
Why are we purchasing so much of a permanent requirement through temporary mechanisms?
The Rest of the Labour Market
Then zoom out.
ONS figures show approximately 1.56 million temporary employees in the UK in January–March 2025.
Around 385,000 said they were temporary because they could not find a permanent job.
That’s roughly one quarter of temporary employees in that period.
That’s important because it challenges the language of choice and flexibility.
Some people genuinely want temporary employment.
Hundreds of thousands don’t.
Construction
Construction gives us:
None is automatically illegitimate.
In fact, genuinely temporary project work requires flexible labour.
Contingency labour versus structural labour.
If I need somebody for six weeks because I’ve won an unusual contract, that’s contingency.
If I’ve needed somebody every Monday to Friday for three years, but they’re still technically temporary, something different is happening.
That becomes one of the article’s strongest ideas.
Universities
Then move upwards professionally.
This matters because it destroys the assumption that precarious work is simply something affecting Deliveroo riders, warehouse workers and hospitality staff.
You can spend years acquiring specialist qualifications and still arrive in a labour market built around temporary employment.
Social Care
And then perhaps the bleakest example.
An essential service.
An ageing population.
Permanent demand.
But a workforce historically characterised by relatively low pay, turnover, vacancies, fragmented private providers and agency labour.
How can the need be permanent while the workforce providing it remains precarious?
Supplementation is not automatically substitution. The question is whether alternative roles are supporting a stable professional workforce or becoming the mechanism through which persistent shortages are managed.
This isn’t really an article about zero-hours contracts.
It’s about labour-market architecture.
Britain has spent decades introducing flexibility into individual pieces of the economy.
Every individual change sounds reasonable:
But eventually you have to zoom out.
Because if the hospital needs the nurse permanently…
the school needs the teacher permanently…
the university needs somebody teaching the module every year…
the care home needs carers every night…
and the construction company needs the same trades every week…
Why is so much of the workforce temporary?
That’s the actual article.
Britain didn’t wake up one morning and decide to abolish professional employment.
It happened incrementally.
Individually, almost every decision can be explained.
Collectively, they describe something much bigger:
IT DISASSEMBLED IT.
And now, in sector after sector, the country is discovering that flexibility is very easy to introduce — and extraordinarily difficult to reverse.