How to Pay Staff for On-Call Duties in Domiciliary Care — and Why Getting It Wrong Will Cost You More Than You Think

If you’re running a care service, you already know the reality: care doesn’t stop at 5pm. Needs escalate, medication queries come in, carers call in sick, families want reassurance, and somewhere in the middle of the night, someone has to make a decision that carries real responsibility.

That “someone” is your on-call.

And yet, across the sector, on-call is still one of the most misunderstood, under-structured, and—frankly—underpaid parts of care operations.

Let’s be direct about it. Too many providers are still relying on outdated, informal, or “that’ll do” approaches:

• Giving time off in lieu (TOIL) with no clear structure

• Paying a small flat fee regardless of workload

• Expecting managers to “just carry the phone” as part of their role

• Not tracking actual hours worked overnight

It might feel manageable in the short term. But from a compliance, financial, and operational standpoint, this approach is high-risk and unsustainable.

This isn’t just about fairness—it’s about legal exposure, service quality, and the long-term resilience of your leadership team.

Let’s break it down properly.

The Reality of On-Call: It’s Not Passive

There’s a persistent myth in care that on-call is “just having the phone nearby.” That’s rarely the case.

In reality, on-call often involves:

• Coordinating emergency cover for sickness

• Managing safeguarding concerns

• Supporting medication queries

• Dealing with late or missed calls

• Communicating with families and professionals

• Making real-time operational decisions

Even when the phone isn’t ringing constantly, the psychological load is significant. Your staff are not fully “off.” They’re in a state of readiness.

That distinction matters—because it directly impacts how on-call should be paid.

The idea that on-call is “quiet unless something happens” is one of the most damaging assumptions in the sector. Even during a calm night, the individual holding the phone is operating in a heightened state of awareness. They cannot fully switch off, they are mentally prepared to respond, and they are carrying responsibility that doesn’t exist in a standard shift. That ongoing cognitive load is work in itself, even if it’s not always visible on a call log.

When something does happen—and it often does—the intensity can spike quickly. A single call can escalate into multiple actions: contacting carers, reviewing rotas, liaising with families, documenting decisions, and sometimes making judgement calls that have safeguarding implications. This is not passive availability; it is intermittent, high-stakes operational work. Treating it as anything less undervalues the role and exposes a fundamental misunderstanding of what on-call actually entails.

Working Time vs Availability: Why It Matters

Under UK employment law, there’s a critical distinction between:

• Working time (when someone is actively working)

• Availability or standby time (when they are required to be available)

However—and this is where many providers get caught out—if restrictions placed on the worker are significant (for example, needing to respond immediately, not being able to leave home, or regularly being called), that time may legally count as working time.

This is not theoretical. This is exactly the kind of detail that gets picked apart during inspections or disputes.

The distinction between availability and working time is not just a legal technicality—it’s a defining factor in how your on-call model stands up under scrutiny. Providers often assume that because someone is not actively on the phone, they are not working. However, the law looks more closely at the level of restriction placed on that individual.

If your on-call staff cannot leave their home, must remain within signal range, are expected to respond immediately, or are frequently interrupted, then the argument that they are “not working” becomes increasingly weak. The more control you exert over their time, the more likely it is to be classed as working time. This grey area is exactly where enforcement action tends to sit, and it’s why loosely defined arrangements create risk. You need clarity not just for compliance, but to ensure your staff understand what is expected of them and how that time is valued.

HMRC and National Minimum Wage Compliance

Let’s talk about the part most providers underestimate: National Minimum Wage (NMW) compliance.

HM Revenue & Customs takes a very firm stance on underpayment. And they don’t just look at hourly rates in isolation—they look at total hours worked versus total pay received.

Here’s where on-call becomes a risk.

If your staff:

• Are required to stay at home

• Cannot use their time freely

• Are frequently interrupted overnight

• Are effectively “working” even if intermittently

Then parts—or all—of that on-call period may count towards working hours.

If you’re paying a £20–£30 flat fee for an overnight shift where multiple hours of work are carried out, you may inadvertently be dropping below minimum wage.

And when HM Revenue & Customs audits, they don’t accept “that’s how the sector does it” as a defence.

The consequences can include:

• Back pay for staff (often over multiple years)

• Financial penalties

• Public naming for non-compliance

• Reputational damage

This is where “saving money” on on-call becomes a false economy.

When HM Revenue & Customs investigates, they do so with a forensic lens. They are not simply reviewing payroll figures—they are reconstructing reality. They will look at call logs, rotas, expectations, restrictions, and actual behaviours. They will ask: how often was the phone ringing? How quickly did staff need to respond? What were they prevented from doing during that time?

The risk for providers is that many on-call arrangements have evolved informally over time. What started as a practical solution becomes embedded without ever being stress-tested against compliance standards. By the time an inspection happens, those practices are deeply rooted—and potentially non-compliant. The financial implications are one thing, but the operational disruption of having to retrospectively correct systems, payments, and contracts can be far more damaging. This is why proactive structuring is far safer than reactive correction.

TOIL: The Hidden Risk

Time off in lieu sounds like a fair compromise. In practice, it often creates more problems than it solves.

The issues with TOIL in on-call scenarios:

• It’s rarely tracked accurately

• It doesn’t reflect the unpredictability of workload

• It can push staff into excessive working hours before they “earn it back”

• It doesn’t solve minimum wage compliance issues

Most importantly, TOIL does not remove your obligation to ensure that actual hours worked meet minimum wage requirements.

So while it might feel like a goodwill gesture, it doesn’t protect your business.

TOIL often feels like a fair and flexible solution, particularly in services where budgets are tight and goodwill plays a big role. But the problem is that TOIL assumes balance—give time now, take it back later. On-call rarely works like that. The intensity and unpredictability of the role mean that the “time owed” doesn’t always reflect the actual effort or disruption experienced.

In practice, TOIL can also create operational strain. When staff eventually take that time back, it leaves gaps elsewhere in the service, which then need to be filled—often at additional cost. It becomes a circular problem rather than a solution. More importantly, it can mask the real issue: that the original time worked may not have been compensated in line with minimum wage requirements.

So while TOIL may feel like a practical workaround, it often delays rather than resolves the underlying problem.

Flat Fees: Simple, But Dangerous

Flat-rate payments are common because they’re easy to administer. But they only work if they’re carefully structured.

The problem is variability.

One night might involve:

• No calls

• Minimal disruption

Another might involve:

• Multiple emergencies

• Hours of coordination

• High-stress decision-making

If both nights are paid the same, you create:

• Pay inequity

• Compliance risk

• Staff resentment

Over time, your strongest people will disengage—or leave.

Flat fees persist because they offer simplicity in an otherwise complex area. However, simplicity without accuracy is where risk sits. The core issue is that flat fees ignore variability, and on-call is inherently variable. You are effectively pricing an unknown workload at a fixed rate, which rarely reflects reality over time.

From a staff perspective, this inconsistency can erode trust. If someone has a quiet shift followed by an extremely demanding one, both paid the same, it doesn’t take long for frustration to build. Over time, this impacts engagement and willingness to take on on-call responsibilities. From a business perspective, it also makes it difficult to evidence fair pay if challenged.

Without a clear link between time worked and pay received, your position becomes harder to defend.

The Real Cost: Burnout and Attrition

Let’s step away from compliance for a moment and talk about something even more damaging: burnout.

When managers and coordinators:

• Work full days

• Then carry on-call overnight

• Then return to work the next day

You are not running a sustainable operation.

You are running on borrowed energy.

The impact shows up as:

• Poor decision-making

• Reduced service quality

• Increased sickness

• Higher turnover

• Loss of experienced leaders

And in care, losing experienced leaders is one of the most expensive problems you can create.

Burnout doesn’t happen overnight—it builds gradually, often unnoticed until it reaches a tipping point. On-call is one of the biggest contributors because it extends the working day without visibly doing so. Staff may technically finish their shift, but mentally they are still “on duty.” Over time, this lack of true rest takes its toll.

What makes this particularly dangerous in care is that your most experienced and committed staff are often the ones carrying the heaviest load. They are the ones you rely on, the ones who step in, the ones who don’t want to let the service down. And they are also the ones most at risk of burnout. When they leave, they take knowledge, stability, and leadership with them. Replacing that is not quick, and it’s certainly not cheap. Investing in sustainable on-call structures is, in many ways, an investment in retaining your strongest people.

On-Call and Service Quality: The Link Most People Miss

There’s a direct correlation between on-call structure and quality of care.

Think about it:

At 2am, when something goes wrong, your service is only as good as:

• The person answering the phone

• Their capacity to respond

• Their clarity of thinking

• Their access to information

If that person is exhausted, underpaid, or unsupported, the outcome will reflect that.

Consistency in care doesn’t just happen during scheduled visits. It happens in the moments in between—when things don’t go to plan.

That’s where on-call becomes your safety net.

And if that net is weak, everything above it is at risk.

Quality in care is often measured through audits, visits, and outcomes—but some of the most critical moments happen outside of those structured environments. On-call is where unplanned situations are managed, and how those situations are handled can define the overall quality of your service.

If your on-call system is reactive, overstretched, or inconsistent, it creates variability in how issues are resolved. That variability is what regulators and families pick up on. A well-structured on-call system, on the other hand, creates consistency. It ensures that no matter when an issue arises, the response is measured, informed, and aligned with your standards. In that sense, on-call is not just a support function—it is an extension of your care delivery model.

What Good Looks Like: A More Robust Approach

If you want to professionalise your on-call function, you need to move away from informal arrangements and into structured models.

A more sustainable approach typically includes:

1. Clear Payment Structures

• A standby allowance (for being available)

• Additional pay for active call handling

• Overtime or enhanced rates for night work

2. Accurate Time Tracking

• Logging actual calls and time spent

• Recording interruptions

• Monitoring patterns of demand

3. Defined Expectations

• Response times

• Escalation protocols

• Boundaries around availability

4. Rotation and Fairness

• Shared on-call responsibilities

• Limits on consecutive shifts

• Adequate rest periods

5. Separation of Roles (Where Possible)

• Distinguishing between day management and night support

• Avoiding over-reliance on a small leadership team

This isn’t about overcomplicating things—it’s about protecting your business.

Building a strong on-call model requires intention. It’s about designing something that works not just operationally, but legally and culturally within your organisation. The most effective models are those that balance structure with flexibility—clear enough to ensure compliance, but adaptable enough to handle real-world scenarios.

It also requires visibility. You need to understand what your on-call actually looks like in practice: how busy it is, what types of calls are coming through, when peak times occur, and how long issues take to resolve. Without that data, you are making decisions in the dark. With it, you can start to build a model that reflects reality rather than assumption. That’s where real improvement happens.

A Strategic Shift: Treat On-Call as Infrastructure, Not an Add-On

Here’s the mindset shift that changes everything:

On-call is not an inconvenience to manage. It is core operational infrastructure.

If you treat it like an afterthought, it will always:

• Create stress

• Introduce risk

• Drain your team

If you treat it like a structured, resourced function, it becomes:

• A stabiliser for your service

• A support system for your staff

• A differentiator in quality

Forward-thinking providers are already making this shift.

They are:

• Investing in dedicated on-call support

• Using technology to track and manage demand

• Removing the burden from overstretched managers

• Building resilience into their operations

The providers who are moving ahead in the sector are those who have reframed how they view on-call. Instead of seeing it as a necessary burden, they see it as a core part of their operational architecture. That shift changes how it is resourced, how it is managed, and how it is valued.

When on-call is treated as infrastructure, it becomes something you invest in, refine, and continuously improve. It becomes part of your growth strategy rather than something that holds you back. It also creates a more professional, scalable model—one that doesn’t rely on individual goodwill, but on systems and processes that can support your service as it expands.

The Commercial Reality: Doing It Properly Is More Cost-Effective

There’s often resistance at this point: “We can’t afford to pay more for on-call.”

The better question is: can you afford not to?

Let’s look at the hidden costs of getting it wrong:

• Recruitment costs from staff leaving

• Agency spend to cover gaps

• Lost business due to poor reputation

• Compliance penalties

• Management burnout and absence

When you factor these in, investing in proper on-call structures is not an expense—it’s a cost control strategy.

There’s a tendency to look at on-call in isolation when considering cost. But the smarter approach is to look at it in context. Poorly structured on-call doesn’t just affect that one area—it creates ripple effects across your entire business. Delays in response, missed calls, stressed staff, and inconsistent decision-making all have financial consequences.

When you start to quantify those consequences, the picture changes. Suddenly, investing in a robust on-call system isn’t an added expense—it’s a way of reducing risk, improving efficiency, and protecting revenue. It also strengthens your position when engaging with commissioners, clients, and regulators, because you can demonstrate that your service is built on solid operational foundations.

Final Thoughts: From One Care Team to Another

We understand the pressures. The margins are tight. The expectations are high. And the responsibility never really switches off.

But cutting corners on on-call isn’t the solution.

It’s one of those areas where what looks like a small operational decision can have a disproportionate impact on your entire service.

If your current model relies on:

• Goodwill

• Informal agreements

• Minimal compensation

Then it’s worth stepping back and asking a difficult question:

Is this sustainable—and is it compliant?

Because your on-call team is not just answering phones. They are protecting your service, your clients, your reputation, and your staff.

And they need to be supported accordingly.

At the heart of this conversation is something simple: respect for the role your on-call team plays. They are there in the moments when things are uncertain, when decisions need to be made quickly, and when your service is under pressure. That level of responsibility deserves more than an informal arrangement.

If you step back and look at your current model honestly, you’ll likely see areas that could be strengthened. That’s not a criticism—it’s an opportunity. Because getting on-call right doesn’t just improve compliance or reduce risk. It improves the experience for your staff, the consistency for your clients, and the overall resilience of your service.

And in a sector where pressure is constant, resilience is everything.