Primrose65 I don't think you can blame the doctors because trusts are using other agencies apart from the NHS one. As someone who worked as a supply teacher when supply agencies first began taking on contracts and moving work away from LEAs I would imagine the situation is similar. Private companies are aggressive and resourceful in their attempts to gain customers. They offer discounts, tie in deals that mean they maintain clients and many other inducements. They are often active rather than re-active. So usually a trust would call an agency because they needed staff, private companies will have staff ringing on a chance that help may be needed. Doctors may be registered with one or more agencies and so will accept any offer. As with teaching supply this will be very profitable. One agency I signed up with originally had a small rather dingy office, it now has a 2 large office/shops, all very plush. LEAs of course no longer deal with supply teachers.