Hospitals are regularly resorting to emergency “break glass” rules to meet soaring pay demands from temporary locum doctors. Under an NHS clampdown, hospitals should only exceed an agreed “capped” hourly pay rate in exceptional circumstances when an unfilled vacancy for a doctor would put patients at risk. However, hospitals in England notified NHS Improvement that they had breached the cap on 241,195 occasions in just three months. NHS Improvement, which is responsible for measures to cut spending on agency workers, admitted far more needs to be done. It wants hospitals to target the highest earning locum doctors and has appealed to medics to do their bit to ensure the NHS is not overcharged. The NHS spends £250m a month on agency workers.