Locum Doctors: Your FAQs Answered
Working as a locum doctor can seem like a complicated business when you’re first starting out. So, to help simplify things as much as possible for you, we've collated a list of the most frequently asked questions we receive from both new and experienced locum doctors alike. We've answered these for you here, to help you have a positive and successful experience while locuming.
If you have a question which doesn’t appear here, have a look at our Locum Doctor Hub or get in touch with us directly and we can provide the answer for you!
Is locuming right for me?
The benefits of locuming are well known. Locum doctors get more flexibility and autonomy, full control of your own schedule, higher pay, better work-life balance, and the freedom to work across different specialties. But there are some downsides to locuming, which might mean it isn’t suitable for everyone. For example:
- Financial uncertainty as work can often dry up sporadically
- Having to work at different and often unfamiliar settings
- Lack of sick pay and other employee rights
However, with the right organisation and financial planning, the downsides can often be negated for the vast majority of people. Making locuming a viable option for those looking to take some time out of training and gain more flexibility and better pay.
Can I locum in a specialty that I haven’t worked in before?
Yes! Locuming is a great way of exploring specialties you haven’t worked in before that you may be thinking of doing training in. It’s also a way of building up experience on your CV towards applying for a specific training programme.
If you’re thinking of locuming in a specialty you haven’t worked in before, it’s worth having a look at our set of specialty-specific locum doctor guides on our F3 Resource Hub.
If you want to get a locum position in a specialty you don’t have experience in, it’s important to optimise your CV to show what transferable skills you do have from other specialties, courses or exams, that will help you in this new role. For advice on how to write a CV specifically for locuming, click here to read our in-depth guide.
Are there any particular foundation jobs that make it easier to locum after F2?
This depends on which specialties you’re planning on locuming in. If you're looking to find locum jobs in General Medicine or General Surgery, you should already have some experience in these from your Foundation training, at least for on-call shifts.
If you’re looking to locum in something more specific that you haven’t had a rotation in before then it’s not necessarily a problem, but this can differ in certain Trusts. For example, some Trusts don’t allow locums to work in A&E unless they have previous A&E experience. If this might apply to you, it’s worth asking colleagues or rota co-ordinators to check what their rules are. In this situation, it might also help to use your taster days or to get some internal Bank shifts done in that specialty before you finish Foundation training!
If you’re planning to locum in a new specialty, it’s also worth having a look at our specialty-specific locum doctor guides on the F3 Resource Hub to see what you can expect!
Can I find locum work without any NHS experience?
The short answer is yes. But this will require being organised, patient, and potentially making some concessions on areas such as location and pay… at least until you have some experience under your belt.
It’s no secret that hospitals in the UK will generally prefer to employ doctors with extensive NHS experience, however, the demand for doctors far exceeds the supply, which will work to your advantage. Areas that historically struggle to employ doctors, particularly in more rural areas, will often open up their roles to those without NHS experience.
Can IMGs (overseas-educated doctors) work as locum doctors?
This depends on your visa status.
If you're on a Tier 2 visa, you can only work a maximum of 20 hours per week as a locum doctor and will need to remain employed in a substantive post which will sponsor your visa.
The 20 hours per week limit is currently paused during the COVID-19 pandemic. So a clinical fellowship or Trust grade role with sponsorship, topped up with a few locum shifts, is the only option.
If you're not on a Tier 2 visa, spousal visa, UK passport, or EU passport, then you're free to move around and find locum jobs as a UK grad would.
Which specialties have the most locum work?
According to a recent study we conducted here at Messly, based on data collected and analysed from all the jobs added to Messly in 2021, the three SHO specialties with the most work are:
1️⃣ General Medicine
2️⃣ Emergency Medicine
3️⃣ Acute Internal Medicine
For registrars, it was Emergency Medicine, General Medicine and General Surgery.
For Consultants, it was General Medicine, Anaesthetics and Geriatric Medicine.
Is there only locum work for F3 in certain specialties?
As an F3 Doctor, there are plenty of opportunities to find locum work in specialties such as Emergency Medicine, General Medicine, and Acute Internal Medicine. These roughly account for over 54% of all available SHO locum roles.
However, there are indeed some specialties with far less availability for F3 doctors, such as Radiology, Dermatology, Opthalmology, Occupational Medicine, Public Health, Infectious Disease and Maxillofacial Surgery. Together these account for less than 0.5% of available SHO roles.
It’s also worth noting that you can not work in a GP practice as your work will not be indemnifiable.
As an F3 can I pick up CT1 or ST1 locum shifts, or can I only pick up F2 shifts?
Yes, you can. There’s no actual hard rule about whether you can work CT1/ST1 shifts as an F3 Doctor, just make sure to show the experience and competencies you’d expect a new trainee in this specialty to have in your CV.
However, if you're looking to step up to an SpR role, you’ll need to again be able to show that you have what it takes to work this post. To this end, you’ll need a lot of experience as a locum doctor within a specific specialty, and will also need to have a good relationship with the consultants and rota-coordinator at the department you wish to work for.
As a result, whilst most F3 Doctors can easily make the jump to CT1/ST1 roles, it’s usually F4’s and very keen F3’s at the end of the year who step up to fill in SpR posts.
Do I need a CV to work as a locum doctor?
Yes, your CV is a crucial document if you want to succeed in finding good locum work. We’ve actually written guidance on this which you can find in our full article by clicking the button below.
To briefly cover some key points though
- Aim to keep your CV clear, concise, and to a maximum of two pages in length.
- Tailor it to the role and the specialty you want to locum in. This may mean having separate CVs for different specialties as you'll need to focus on the relevant experiences, skills and procedures you’re competent with.
- Don’t focus on audits and research too much, especially if at the expense of another section. The hospital is far keener to know if you can do the work, than how academic you are
How should I write my locum CV to make it stand out?
Unlike a CV for Research or Academic Fellowships, a locum CV should focus mainly on the experience you have in the specialty you are applying for, rather than how many research papers and audits you have.
However, here’s a summary of what you should know:
- Focus on the relevant skills and procedures that you are competent in with regard to the specialty you are applying for
- Mention your previous experience as a locum
- Specifically mention your experiences of working within the specialty you are applying for, if you have this
This will let future employers know that you have the ability and experience necessary to hit the ground running.
Working with agencies
How do I know which agencies to choose?
The best agencies have access to plenty of work in your region, a reputation for providing a good service for doctors, friendly and honest recruiters, and simple compliance processes.
One way to find out which are the best agencies is to speak to colleagues and rota co-ordinators who’ve worked with the agencies in your area, and then make your own judgement during the registration call with the agency’s recruiter.
You can also use Messly’s bespoke service, where pre-vetted agencies pitch shifts to you through the system, offering you their available shifts matched specifically to your preferences. This all happens before you’ve shared your contact details with them. This helps you to quickly decide which agencies would be best for you.
How do I get the most from working with an agency?
To get the best locum work, you need to keep in regular contact with your recruiter and maintain a good relationship with them. Being proactive will get you more jobs than waiting around for them to contact you.
You also need to be specific with your recruiter about what you’re looking for, and make sure to keep your CV updated with this same information, as well as any more experience you’ve had since you last worked on it.
For more tips about this, see our article explaining how to get the most out of your relationship with your locum agency.
Can I register with multiple agencies and staff banks?
Yes, you can register with as many agencies and banks as you want to.
In fact, best practice is to find a several agencies and Trust banks to work with. A good number is two or three agencies and a couple of banks. You’ll then have multiple avenues of finding work, and increase your chances of finding well-paid and rewarding locum shifts that are close to home.
Just beware that some banks are better organised than others, and in some situations it can be easier to get work at a Trust through an agency than through their bank.
It’s worth finding out from colleagues, or using your own experience, to decide whether it’s better to be with a bank or working through an agency for each Trust.
Am I limited to working with only one locum agency?
No, you’re not and why would you?
Each agency has a slightly different relationship with the hospitals that they work with. This means that one agency might be better than another for sourcing shifts at a particular hospital.
So if your aim is to have more options so that you can pick the best shifts for you (be it pay, location, specific specialties, etc), then it makes sense to join a few.
We recommend joining between 2-3 agencies. This gives you a great number of shifts to choose from, whilst not inundating you with emails.
Do I have to work for an agency after signing up with them?
No you don’t. It’s perfectly fine to join an agency to see what jobs they can get you. But if you don’t like any of these, there’s no obligation to pick up any shifts or work for them.
Just be sure to let them know the type of jobs you are actually interested in so that they can tailor their search to better fit your requirements.
Do all agencies have access to the same jobs?
The short answer is no, but you’ll find the long answer in this article here.
However, in summary, every agency will have a slightly different relationship with each hospital and sometimes even with the department.
This means one agency could be better at finding you work at a specific hospital compared to another, or even just better at finding you shifts in a specific department (i.e. A&E).
As a result, the shifts offered to you by each agency will differ depending on their own relationships with the different hospitals and Trusts.
At Messly, we recommend joining between 2-3 agencies as the sweet spot to give you a larger choice of jobs, without becoming too inundated with emails.
Do I have to accept every job an agency finds me?
No you don’t.
You should only ever accept the jobs that you actually want to do and joining an agency does not mean you are obliged to accept any of the jobs that they find you.
You are only committed to working a shift when you actually agree to it after they have clearly offered it to you with the full details and rates explained to you.
If you feel your recruitment agent is being quite pushy in getting you to pick up a shift, be firm and let them know that you’re not interested in the shift whilst explaining the type of work you would consider. This is more productive than just saying no or ignoring the agent who won’t know how to serve you better.
Do agencies take a cut from my pay?
No, locum agencies don’t take anything from your pay. Instead, they will charge the hospital a small fee for finding you and getting you compliant and managing the booking process.
Do agencies rip off the NHS?
When a locum agency finds you work, they charge a hospital a fee (called a ‘commission’) on top of your hourly rate. This covers the costs of finding you work, arranging all of your compliance and managing your timesheets and pay. This saves the Trust’s medical staffing team time from doing this work themselves.
Historically, agencies have been criticised for charging very high rates at the expense of the NHS.
At Messly, when we decided to help doctors find locum work with agencies, we reviewed this situation to ensure that we were able to ethically support this way of working. We found that, more recently, commissions have been capped by better policing from Trusts and the introduction of procurement frameworks.
So you shouldn’t feel like working with an agency is to be embarrassed about or is harmful to the NHS.
How long before I want to start working should I start speak to agencies?
Ideally, you need to begin entering your registration processes around 45 to 60 days before you want to start work. It’s important to give yourself enough time to complete your registration, with a bit of breathing space in case you encounter any issues or delays.
It also serves to give you the opportunity to book the more popular shifts in advance, which can disappear very quickly as it gets closer to the time (i.e. core hour shifts).
Find out more by clicking this link.
What are the steps to getting started with an agency?
Once you’ve found an agency you want to work with, the registration process is usually very straightforward.
It will typically start with an initial phone call with a recruitment agent, and you’ll then send them a number of your professional documents for their system. You can find out which documents you’ll need to submit here.
They will need to do a DBS check into your background, which they’ll arrange themselves.
This registration process is something you’ll need to go through every time you join a new agency, so if you’re considering joining several we’d recommend digitalising your documents to make things easier.
If you’re using Messly, however, you can make this far quicker and more convenient with our ‘Docs’ feature. Within our Messly app, this tells you exactly which documents you need and lets you store them securely on our platform, ready to access and share whenever you need to. You can send them directly to the agencies you want to work with in just one click. Learn more about Docs here.
What is a locum agency?
Locum agencies are organisations that specialise in filling vacant hospital shifts with locum doctors.
If you register with an agency, you’ll be assigned a recruitment consultant who will be your point of contact. The good ones are experts who know the locum market inside-out and will guide you through the process of finding the right locum jobs for you.
They know which hospitals will have shifts, who pays the most, and where the work might be easier or more difficult. It’s a bit like working with an estate agent who understands the local area when looking to buy or rent a flat.
How many agencies should I register with?
At Messly, we would recommend 2 or 3 locum agencies as a good number for most doctors. If you have very specific requirements, you may want to work with more.
This is because each agency has a slightly different relationship with each Trust, which could heavily impact their ability to get shifts at a specific hospital. And these relationships can change over time.
So, if you want to increase your chances of finding the best shifts within an area, it makes sense to join multiple agencies to give yourself more shift options.
What should I ask on the agency welcome call
Your welcome call with an agency is your opportunity to ask them any questions you have about the whole process of locuming, so anything you’re unsure about can be clarified.
It's wise to prepare a list of questions in advance so you can gain as much value as possible from the call.
Some possible questions you might consider asking are:
- Which geographical regions do they tend to cover?
- Which Trusts do they get the most work from?
- Do they tend to get more long-term positions or ad hoc shifts from the Trusts they work with?
- Are there currently shifts available in the specialty and region you’re interested in?
- How do you find out about available shifts from them? For example, is there a daily or weekly email update they send out?
- Will the person you’re talking to become your dedicated recruiter, or would it be someone else?
- How do the shift bookings and pay work?
Find out more by clicking the link here.
Am I committed to joining an agency if I schedule a welcome call with them?
No. You should never feel obliged to join or work for an agency simply because you spoke to them on the phone. In fact, from your perspective, the main purpose of these calls is to find out which agency is right for you. To this extent, the calls work by:
- The agency asking for your requirement to figure out how they can best serve you and pitch you this
- For you to ask questions to ensure you are happy that the agency is the perfect match for you
As such if you aren’t 100% happy with what was discussed, or just simply needed more time to think, then there is absolutely 0 obligation to join them.
Banks vs Agencies
What’s the difference between working through banks and agencies?
Staff banks are the Trust’s pool of doctors who have signed up to find out about vacant shifts in their hospital. Generally, this is made up of people who’ve rotated through there before, but you can sign up to the bank even if you’re not working there already. Trusts will try to fill vacant shifts through the internal bank before going to agencies if it’s still vacant to save on the agency fees.
Locum agencies are organisations which specialise in filling vacant shifts for hospital Trusts. They charge the Trusts a fee for finding a locum doctor to fill their shifts and for managing the registration process. You can register to work through an agency to find shifts at multiple Trusts in your area.
Read our related article linked here to find out more about the pros and cons of working through a bank and an agency, which will help you make your decision about which is best for you.
Which is better: staff bank or agency?
At Messly, we feel joining a bank and 2 to 3 agencies gives you the best of all worlds and sets you up in having a successful locum year.
However, if you had to choose just one or the other then this will be solely based on your own personal circumstances. However, here’s a rough summary of each:
- Staff banks allow you to work within the hospitals of a singular hospital only, working directly with the medical staffing department. As a result, whether you have a good or bad experience here will vary massively depending on how well organised the individual bank is.
- Locum agencies are able to find you work at a number of hospitals and Trusts. They’re great for arranging long blocks and regular bookings and will have more options for regular pay (weekly and fortnightly). They’ll also negotiate your rates with hospitals on your behalf.
Do I have to choose either staff bank or an agency?
No, and why would you? As we’ve mentioned above, we feel the combination that gives you the best choice of locum jobs is by joining a bank and 2-3 locum agencies.
Will I get kicked from my agency if I join a staff bank?
You will not get removed from a staff bank simply for joining a locum agency. A caveat here is that you cannot book agency shifts at a Trust where you are signed up with their bank.
Can I work for a staff bank and locum agency at the same time?
You can work at both and we’d even argue that being signed up to 2-3 locum agencies and a bank or two is best - this gives you more options for giving yourself the greatest choice of shifts when looking for locum work.
Staff banks allow you to work within the hospitals of a singular hospital only, working directly with the medical staffing department. As a result, whether you have a good or bad experience here will vary massively depending on how well organised the individual bank is.
Locum agencies are able to find you work at a number of hospitals and Trusts. They’re great for arranging long blocks and regular bookings and will have more options for regular pay (weekly and fortnightly). They’ll also negotiate your rates with hospitals on your behalf.
The only caveat is that you can not get agency work as a Trust where you are a member of their bank. More on this below.
Can I work at the same Trust via both the Bank and a locum agency?
The short answer to this is no. If you’re signed up to the internal bank at a Trust then you have to book through them, rather than through an agency, because it saves them the agency fees.
If you want to work through an agency at that Trust instead (for example, because you want weekly pay and your bank only does monthly payroll), you can choose to leave the Trust bank, but you’ll need to check the terms and conditions of the Trust bank to see if you have to wait for a period of time before you're able to work through an agency there.
Are locum shifts posted to staff banks or agencies first?
This is dependent on how the individual Trust is managed, the circumstances leading to the rota gap that needs to be filled with a locum doctor and how they prefer to source additional staff.
Trusts with a high success rate for filling these shifts internally will often release short-term and last-minute shifts directly to their own staff bank at the first instance and only release the unfilled ones to agencies.
Trusts with a lower success rate or a less proactive staff bank will prefer to release these shifts simultaneously to both their staff bank and locum agencies, with the majority of doctors coming from locum agencies.
For expected longer-term rota gaps, often due to sickness or poor staff recruitment, Trusts will aim to fill these gaps well in advance and will tend to approach the locum agencies with who they have the best relationship and success to help them with this.
If I don’t enjoy working via bank, can I ‘unregister’ and work with an agency?
Yes, you can, but please do bear in mind that if you plan on working at the Trust whose bank you just left through an agency, there is normally a period of time that must elapse first. This is known as a “Cooling off” period and usually lasts 6 weeks, however, this can sometimes be more so make sure you check this with the Trust prior to making any decisions.
You should also try to factor in enough time to get registered and compliant with the agencies you're interested in so that you’ll have plenty of time to book shifts for the dates you want. We recommend starting registrations around 45-60 days prior to the date you’re looking to book shifts. Find more about this here.
Am I automatically enrolled onto the bank where I am currently working as a trainee?
Whilst you are working in a Trust, whether as a trainee or in a fellowship or trust grade role, you will be able to pick up shifts through the bank easily. You may need to fill out an additional form or two, but the process is usually very simple.
If you want to work in the Trust after you leave your trainee position, then you’ll normally have to request an additional staff bank registration form from your Rota-Coordinator or HR team.
The process varies by Trust - some will make you complete a full registration process, and others will just ask for a simple form. In some cases you will be ‘auto-enrolled’ onto the staff bank without doing anything.
Is Messly an agency?
No, Messly is not an agency. Messly is an online service created to give you a faster, simpler, and more transparent way to find locum work.
With Messly, you simply create your profile in our app and tell us exactly what kind of work you’re looking for, from specialty, to shifts, to location, and even the rates you want to be paid.
You’ll then receive offers for locum work from only the best locum agencies which have all been pre-approved to be accepted into our community. The agencies will also have ratings and reviews by other doctors using the platform.
You’ll only be sent shifts that are matched specifically to your preferences. You can view full details and evaluate these within the app, comparing rates and travel distances, and reading the recruiters’ pitches to you.
If you find a shift you want to take on, you can schedule time to speak to the agency. Only then do you share your contact information with them, only ever with the agencies you’ve selected, so you won't ever receive any unwanted calls or emails.
We’ll then help you through the registration process, so you can start working your ideal shifts as quickly as possible.
How did Messly select the agencies to be part of the service?
Finding the best locum agencies to work with is hard! There are hundreds of agencies out there, all with varying reputations and access to work. And while the majority are at least honest, there are a small handful of agencies out there that tarnish the industry and which are best avoided.
We wanted to make this process easier for you. That's why we spoke to hundreds of doctors, ran polls, did secret shopper surveys, submitted 100s of freedom of information requests, and plenty of other research to come up with a shortlist for who the ‘best’ agencies are. We then approached them to use the Messly service, and thankfully they said yes.
Here’s some of the criteria we used:
- Have regular access to work, including being registered on the main NHS supply frameworks for locum doctors
- Good feedback from doctors about their service and access to work
- Efficient registration processes
Why is Messly better than just choosing an agency directly?
Here's 4 reasons why we think Messly is the best way to find locum work:
1. Every locum job in one place. Having more choice is key to finding the best type of work for you.
2. See jobs only from the best agencies. We pre-vet all our agencies and allow you see reviews left by other doctors about them, so that you can feel confident in who you work with.
3. A protected space. Our code of conduct ensures that you are treated fairly, and should agencies repeatedly break these then they will be removed from the platform.
4. Top Tech. We continue to invest in our app to make sure that it’s the best out there. Here's some of our current features:
- Personalised Service - find roles suited to the requirements that you set, and filter the roles you see accordingly. No more trawling through 100’s of dead jobs
- Access everything from your phone
- Docs - save yourself time by storing professional documents in our secure locker that you can share this with agencies in 1 click when you’re ready
Who owns and runs Messly?
Messly was first launched back in 2016 by Abrar, an Anaesthetics Registrar, and his friend Chris, who both wanted to make the process of finding locum work faster, simpler and more transparent.
Fast forward to 2022 and we’re now a small team of passionate doctors, techies and creatives working hard to help you have a more fulfilling career as a doctor and have become THE way that doctors find locum work.
What does the registration process involve?
The registration process of signing up for an agency is pretty simple:
- Find an agency you’re happy with
- Schedule a call with the agency to discuss your work requirements. You’re under no obligation to sign up to them if you’re not 100% happy with what they’ve told you
- Let them know that you want to sign up, this requires you to register by filling out a few forms and sending them over some of your professional documents (medical certificate, occupational health reports etc).
- Done. You’re now registered and can start looking for work
How do I sign up to an agency?
Once you've found an agency that you want to work with, you'll need to begin the process of registering with them.
This is a straightforward process and involves:
- An initial phone call with a recruiter (so they can find out the types of work you're looking for)
- Sending over your professional documents (they'll email you to tell you which ones they want)
- A DBS check, they can arrange one for you
You'll need to do this each time you join a new agency, so if you're considering joining a couple then we'd highly recommend digitalising your documents or using the Messly Docs feature.
Messly Docs, takes all the hassle out of the registration process for you. You’ll receive guidance on what registration documents you need to provide, store them all in one place, and share them seamlessly with your locum agencies in just one click. Doctors who used Messly Docs registered 70% faster with locum agencies.
How do I sign up to a staff bank?
The easiest way is to sign up whilst you’re still with the Hospital and Trust that you’re doing training or other substantive posts (i.e. Clinical Fellow).
You’ll be able to get a form from your rota-coordinator or from medical staffing. This lets you apply as an internal applicant which is usually a single-page form that needs yours and a line-managers signature. This normally takes 6 weeks to process but once done you can work.
If you’ve left a trust, or if you’re applying to the bank of somewhere new. Then the process is more difficult.
You need an external application form from medical staffing. This requires all the same professional documents as an agency would, but will also require you to answer a series of questions about yourself and your medical background (think of 250-500 word answers about your leadership qualities). Once complete, this too will take around 6 weeks to process.
Why do I need to register before I can start working?
Registering with an agency and completing the compliance process is an essential step to finding work as a locum doctor.
This is because hospitals won’t normally even consider reviewing your application for a locum position until they know that you’ve completed (or very nearly) the registration process with your locum agency.
Occasionally, if a hospital is extremely short-staffed, an agency may sometimes be able to submit your CV and references with the remainder to follow, but you’ll have to start the compliance process first before you have certainty about the job you’ll be working.
Can’t I just register with an agency a week before I want to start working?
Whilst there is indeed a lot of locum work available, you’ll want to get registered with your locum agency well ahead of time. They can't put you forward for shifts until you've completed the registration process.
Popular shifts, such as 09:00 - 17:00 on weekdays, are snapped up very quickly. If you leave it to the last minute, these will have been filled and so you could find yourself delaying your start by a couple of weeks and having to work a mixture of late, weekend and night shifts, as these are all that remain.
It's also nice to get your schedule locked down, to give you some certainty over your income and so you know where you will be working.
So we recommend getting started 2 or 3 months before your ideal locum start date if possible.
For more information about the timeline that you should be aiming to register by and when to start applying for shifts. Read our article here.
When should I begin registering with agencies and banks?
You should aim to sign up around 45-60 days before the date you'd like to start working. This will give you enough time to get registered and give you plenty of time to correct any issues that might happen during this process.
If you're signing up to a new Staff Bank, give yourself at least 60 days. It can take 6 weeks or more for your application to be processed depending on how organised the Bank is.
How do I get a reference for my application to a locum agency or bank?
To put it simply, just ask.
It’s common to feel a bit nervous asking your consultant for a reference, but don’t worry. It’s something they’ve done countless times before, and won't usually have a problem doing again.
Just be sure to politely get their permission first by asking them in person or, if it’s more convenient for them, through email.
It can be useful to match up your reference to the specialty you want to locum in. For example, if you want to work in A&E, try to get at least one A&E consultant to provide your reference. While this isn’t essential it could help your recruiter find more shifts for you.
What if I want to sign up with multiple agencies?
The best thing to do here is simply to explain the situation. Most consultants will be willing to provide several references. But it might be worth spreading out your references among a few consultants, as you might need to ask them for further references later down the line when applying for specialty training.
Will my consultant be annoyed if I ask them for a reference?
If you have a good relationship with your consultant, then they’ll almost certainly be happy to help you by providing a reference.
Just make sure to politely ask their permission in advance of you providing their details to an agency or a staff bank.
Does it take longer to register with a locum agency or a staff bank?
The requirements for joining a staff bank and a locum agency are very similar.
If you’re applying for the bank you are currently working a substantial post in (i.e. as a Trainee), then there is normally an internal application route which requires filling out a fairly short form, but this can still take up to 6 weeks to be processed by the medical staffing team.
If you’re applying to join a staff bank when you’ve never worked there before, then you would need to submit the same information as you would for an agency, with the addition of a few extra steps which usually require writing 250-500 word essay based answers for questions about desirable traits (i.e. teamwork). This process takes 2 to 3 months, however, can occasionally be longer.
On average, signing up to an agency is slightly quicker. Whilst we still recommend that you sign up 6-8 weeks in advance, to give you plenty of time to book the shifts you want to do, the actual registration process will normally take about 4 weeks.
Can I register with all agencies at once?
Unfortunately, you can’t.
Each agency is individually responsible for the compliance of doctors they work with, and there’s unfortunately no system for sharing that information between agencies (or between hospitals and agencies).
However, we’ve found that once you’ve done it once it becomes much easier thereafter. Around 90% of the requirements are the same, and if you have your documents saved in one place you can share that folder with subsequent agencies, which will save you a lot of time.
We’ve also tried to make this process of registering with agencies easier with our Docs feature. You’ll receive guidance on what registration documents you need to provide, store them all in one place, and share them seamlessly with your locum agencies in just one click. Doctors who used Messly Docs registered 70% faster with locum agencies.
If you’re already a Messly user, you can access this now by clicking the Docs tab in your app and browser.
Types of Work
Can I locum in private hospitals?
Yes! Usually for locums this is work as a resident medical officer (RMO), where you're expected to be resident on-call for any medical emergencies that happen in the hospital.
The shift times and patterns can vary. For example, some are 24-hour on-calls, some are only day or night shifts, and some are a whole week resident on-call with weeks off in between.
You’ll need the right indemnity insurance for this, and will need to check the details of the post, including what kind of senior support is available, to check that you’re happy with what you’re signing up to. For more advice on indemnity insurance for locums, see our article on that topic here.
Can I locum in a GP practice as an F3?
Unfortunately, the answer to this is no.
You won’t be able to get medical indemnity to cover this scope of practice during your F3 year, unless you’re a GP trainee or a qualified GP.
If you’re being asked by a practice to cover this work in your F3 year, we’d strongly recommend talking to your medical defence organisation about this, as it can result in serious legal consequences later down the line.
What could I earn as a locum?
If you're an SHO working three days per week, you can expect to earn around £5,800 per month before tax. This assumes pay of £45 per hour and 10-hour shifts. You'll then deduct tax, national insurance, and pension to get your take-home pay.
If you want to estimate how much you could earn as a locum doctor, based on your own personal circumstances, check out our Locum Doctor Salary Calculator. This will help you determine your hourly rate based on our historical data, for the region, grade, and specialty that you enter. You can also use it to work out your annual salary based on the number and types of shifts you want to work each week.
Obviously, if you work more or fewer hours and get a different hourly rate this will change. But overall, you'll find that locuming is significantly more lucrative than a substantive post. However, it’s important that you plan your finances in advance before you start locuming.
Work can dry up quickly, and you probably won't be entitled to sick pay, so ensure you know that your fixed monthly costs will be covered each month, as well as being able to achieve any other financial goals that you have.
How much can I expect to be paid as a locum?
Your rates can vary widely depending on what region you're working in, the level of seniority, and the number of hours you want to work. If you have these details to hand, you can enter them into our Locum Doctor Salary Calculator and get a breakdown of your estimated hourly rate and annual salary.
As a rough guide, outside of London you can expect the following gross hourly rates for day or core shifts, with around £5 to £10 per hour more for nights and weekends:
- SHO: £40 to £50 per hour, or sometimes lower in popular specialties.
- Registrar: £55 to £80 per hour, or more as you get closer to CCT.
- Consultant: £80+ per hour.
We'd advise you to speak to a few different banks and agencies, and your colleagues, to get an accurate sense of what you should be paid in your own specific circumstances.
What are the pan-London locum rates and where do they apply?
Pan-London rates are agreed rates which hospitals within Greater London (roughly the M25 boundary) have agreed to pay locum doctors. This applies to locum jobs worked both through the hospital banks and agencies.
- SHO: Rates are £36 per hour for core hours and £42 for non-core hours.
- Registrar: Rates are £44 per hour for core hours and £52 for non-core hours. There tends to be more flexibility for Registrars than SHOs, with £55 to £60 per hour for core hours achievable in some cases.
- Consultant: The rate is £75 per hour for core hours, but there's much more flexibility here, and variation between specialties.
There are cases where the hospitals can escalate rates above these levels, called ‘break-glass’ provisions, which vary from hospital to hospital. Typically, however, if you're looking for a long-term block of locums in London this will be at the pan-London rates.
Some locums living in London opt to travel outside of the M25 to work at hospitals with better rates, which tend to be around £40 to £42 per hour for SHO core hours and £48 to £50 per hour for SHO non-core hours.
Do the pan-London capped rates ever get exceeded?
Pan-London Rates, or the London Cap, is an agreed ”maximum rate” that all Greater London hospitals have collectively agreed to pay locum doctors. This was done as a cost-saving measure for these hospitals.
However, there are exceptional circumstances where the rate can be increased, this is a provision known as “Break-Glass” where hospitals can escalate their rate to address critical shortages.
It’s worth mentioning that this occurs infrequently, and those looking to locum in Greater London should expect to earn at the Pan-London Rate or consider working slightly further afield in a hospital that falls just outside of the cap.
Can I increase my pay as a locum doctor?
The short answer is yes, but this will depend on your individual circumstances and your clinical experience.
As an SHO, the easiest way to increase your rates as a locum is to focus on finding higher-paying shifts. This could require you to consider working in different regions, working non-core hours, or trying different specialties.
Another way to improve your rates is to register with more agencies and staff banks. This will give you more opportunities for work, which will increase your chances of earning more money.
You should also make sure any additional qualifications that could allow you to command higher rates are made obvious on your CV. For example, a long-term SHO who has qualifications like ATLS, MRCP, or MRCS will get paid more than the average locum.
Can you negotiate your locum rates or are they fixed?
Locum rates aren’t always as fixed as they may first seem.
Here are some of the top tips from our article “How to Negotiate a Better Locum Rate” to help you get started:
- Recognise your worth: Speak to colleagues of similar grades, specialties, and region, to gauge the ‘going rate’ for a doctor like you. If you’re getting less than this, bring this up with your agency or rota-coordinator
- Write a great CV: If you’re experienced at working above your level and have the evidence to back it up (CV), then you’ll find agencies and hospitals are a lot more receptive to increasing your rate to get you to stay on. This is especially true if the department and agency know you and your clinical ability well, so if you're just starting out, you may need to revisit this later on
- Work in hospitals with shortages: Hospitals with a history of staff shortages are far more likely to be authorised to increase their pay beyond the standard rate to fill up gaps
Do staff banks pay more than locum agencies?
Not necessarily. In some cases, bank rates are slightly higher and in other cases, you can secure higher rates with an agency.
Rates vary significantly based on the current need for locums within a department and this determines the rates far more than whether the shifts were booked with a locum agency or via the bank.
What could I earn in a year of locuming?
This is heavily dependent on your own situation, and will mainly be affected by:
- Your grade
- How many shifts you’d like to do a week
- Whether you’re willing to work unsocial hours
- What specialties you’d like to work in
- …and what region you are planning on working in
As an example, an F3 working 5 days a week as an A&E SHO in the East of England could find themselves on a salary of £102,000 annually.
Can I earn over 100k as a locum SHO?
Yes! It’s absolutely possible to earn over £100k as a locum SHO, however this is made far easier if you’re working outside of the pan-London cap area, which will reduce the amount you can earn within Greater London.
As an example, an F3 working in A&E outside of Greater London can expect to earn £102,000 a year for working 5 days a week, whilst also allowing for 5 weeks of annual leave. Whilst an SHO working in London with the same specifications would earn around £92,000 in London.
This means to earn £100K in London, an SHO would need to work 6 days a week, or reduce their annual leave to around 2 weeks.
How much do I need to locum to match my trainee salary?
As an F3 this will largely depend on where you’re working.
For those outside of London, on average, you could earn your entire F2 salary working just 2 days a week, without having to work any unsocial hours. Which is incredible!
For those locuming within London, you’d have to work 3 days a week to match your F2 salary. Whilst still a great salary, the extra day required to work is due to the fact that you’ll have to overcome the Pan-London Rates.
Can I try to negotiate a higher rate as a locum?
Locum rates vary significantly based on the current need for locums within a particular department.
You can use this to your advantage to secure a higher rate if you know that the department has a pressing need and so may be prepared to pay higher rates. Your locum agency can further advise you on which hospitals are currently prepared to pay higher rates.
You can usually also negotiate higher rates by showing that you have additional experience or skills that will make you more suited to a role than anyone else, just make sure to include these in your CV. It also helps if you’ve already worked in the hospital before and have a good reputation with the consultants.
Some more experienced locum doctors will hold out for last-minute shifts at very escalated rates, as the department gets desperate, and move between sites to capture the highest rates. Others will prefer the certainty of longer-term booking at slightly lower rates, which is more common for SHOs.
Who pays the employer National Insurance contributions for my locum shifts?
As a locum doctor, you will pay 'Employee' NI contributions. However, a common misconception is that you’ll additionally also pay 'Employer' National Insurance contributions, which is not true.
Instead, what actually happens is that the hourly rate you are quoted will often also include the Employer National Insurance contributions that the trust would have to pay for your services. This unfortunately falsely inflates the rate, thus when you receive your payslip, the rate is normally about 15.05% lower, as this is the cost of the employer contribution element.
For more help understanding this topic, have a look at our article on how to manage your locum pay here.
How do the tax codes work if I’m locuming at multiple Trusts?
If you’re working at multiple Trusts, either through the internal bank or through an agency, it’s important that you provide an update to HMRC with how much you expect to be working with each new employer.
This is to ensure your tax code is correct. If you don’t do this, you’re likely to get an emergency tax code on each payslip, which will potentially lead to you paying too much tax. This also affects your national insurance contributions.
For more information about managing your finances as a locum, you should read our article guest-written by our friends at Medics’ Money here.
Are locum shifts taxed more?
There is no such thing as a ‘Locum Tax’ - you just pay normal income tax on your earnings as a locum. However, there are a couple of situations where you could find yourself paying additional tax.
1️⃣ HMRC often gets the tax-codes wrong for doctors, and will often put you on an emergency tax code which would then result in you paying more tax in the short term. However, this is easily rectifiable with a phone call to them and you will get all the extra money that you have paid in tax back. You can find out more about tax codes as well as other financial issues in our article here.
2️⃣ Regardless of whether you’re working a full-time substantive post or as a locum, should you reach the next tax bracket then you would automatically pay a ‘higher rate’ of tax on income above this. This higher rate applies to all income earned over £50,271 where your rate will increase from 20% to 40%. You can find out more about this in our article here.
Should I locum through an Ltd. Company?
For the vast majority of doctors, the answer is no.
There was once a time when having your own Ltd. Company was a viable option for saving you money on tax. However, since the introduction of IR35 (legislation), this is no longer the case, except in a few niche circumstances where the scope of your practice falls outside of IR35 (i.e. GP locums and private sector work).
If you're given the choice of being paid via a Ltd. Company by an agency, we would always advise that you do your own due diligence in researching whether the role actually falls outside of IR35 and to consider speaking to a financial advisor or accountant.
What does a locum’s payslip look like?
Locum payslips look pretty much similar to the payslip you will receive in any substantive NHS post. However, due to the nature of work, it comes with a few extra requirements for you to look through to confirm that the amount you’re being paid and the tax is correct.
The article linked here will help you understand what you’ll need to do.
What are my employment rights as a locum?
- Annual leave: Yes, you do have rights for annual leave, but to make it simpler most Trusts will pay you a holiday pay allowance instead, which should show on your payslip.
- Working hours: You’re entitled to unpaid rest breaks. You may need to opt out of the EWTD if you want to work more than 48 hours on average per week, but as a locum doctor you're in control of how much you work. You’ll also need to take adequate rest in between shifts in accordance with the rules of the new Junior Doctors contract.
- Breaks: As a locum doctor, you're entitled for one unpaid 30-minute break for a five-hour shift, and two unpaid 30-minute breaks for a shift over nine hours. Be aware, though, that not all Trusts will follow this strictly, so you should confirm this with the rota co-ordinator prior to starting.
- Sick pay: You’re usually not entitled to sick pay for missed shifts as an agency locum, but if you’re on the Trust bank you may be entitled. Ask your HR department for advice on this.
- Maternity pay: Depending on your individual circumstances, you may qualify for Statutory Maternity Pay or Maternity Allowance. For more information about this, it’s worth getting your contract checked by a service such as the BMAs for advice.
- Notice period: Check your booking terms and conditions to find out your own specific period, but it's common that both parties are able to cancel a shift with no notice, or may only have to give 24 hours notice.
Can I contribute to my pension whilst locuming?
As a locum doctor, you will almost always be paid via PAYE (Direct engagement), especially if you’re working in an NHS hospital.
As such, your employer (the NHS Trust and not your agency) may offer you the option to continue contributing to your NHS Pension. This is at extra expense to the Trust as they will have to pay contributions on top of your pay, and as such not all Trusts will give their locum doctors the opportunity to enrol.
Instead, they may use a cheaper private pension scheme, such as Nest.
If your Trust does allow you to enrol into the NHS pension and you’re thinking about opting out, the advice from Medic’s Money is to think very carefully before doing so, as this can drastically impact your Final Pension benefits and Death in Service benefits later on.
How does locuming affect my pension?
As a locum doctor being paid through PAYE as “direct engagement”, you can choose whether to continue contributing to your NHS pension or whether to opt out.
The advice from Medics’ Money is that you should think about it very carefully, as opting out can have a detrimental impact on your final pensions benefits and Death In Service benefits. For more information about this and other financial considerations, see the guest post written for us by our friends at Medics’ Money.
After a locum shift, how long does it take to get paid?
This is dependent on your locum agency.
The most common arrangements are for weekly, fortnightly and monthly payments. However, for banks, the standard is usually for monthly payments.
What should I do on my first day to settle in?
Settling into your first day as a locum doctor can be daunting, but there are few things you can do to make your experience more enjoyable.
- Locum in a specialty you are familiar with. This will let you quickly settle into your new role and show the consultants that you’re able to do the job well, which may open future longer-term roles up to you.
- Research the travel route and parking. Arriving late is guaranteed to not do your nerves any good, so instead make sure to plan the route carefully and give yourself ample time to find parking.
- Be friendly and keen. Your consultants and other senior staff members are likely to be more responsive and helpful to those that make an effort to be friendly and work hard. So try your best to learn names, be keen to get involved with the team, and try not to be overly serious.
Will I get an induction when I start work as a locum doctor?
This will depend on where you’re working.
Some Trusts will give you a brief induction and tour of the department. This may also include a locum pack containing all your IT system log-in details, card access, and important numbers that you’ll need for your shift.
Others won’t give you anything and may expect you to organise everything yourself when you arrive.
Either way, it’s nothing to be too worried about. The consultants will normally be very welcoming and help you get your bearings before you start work.
Will I get any IT login details for my first day?
Some hospitals are very organised and will provide this to you at the start of your first shift, along with everything you need to get settled in. Others will expect you to organise everything yourself when you arrive.
Either way, try to speak to your recruiter or rota-coordinator about IT login details prior to your first shift, as they might be able to email these to you or prepare them for your arrival. Otherwise, they will be able to advise you on what to do when you first arrive.
Will I get staff parking as a locum?
Not automatically, but you can arrange it. This normally requires you to speak to HR or Payroll who will be able to advise you on the next steps.
However, unless your exclusively going to be working at one or two hospitals or your Trust offers free Car Parking (which is rare), it normally isn’t worth paying a monthly fee at each hospital to use the Staff Car Park. Instead, it might just make more financial sense to use an app like Parkopedia to find free nearby parking, use the hospital’s public Car Park, use public transport, or use another app like JustPark to hire a private parking sport for the day.
Will I get interviewed by hospitals before being offered locum work?
This is common practice for Trust Grade or Fellowship roles, but not required for locum roles.
As a locum, the only vaguely similar process you might have to attend is a video call with the Staff Bank or Agency during the registration process. This is to discuss your ability to work, your reasons for wanting to locum in a specific speciality and a few non-clinical issues. This is not a test and is usually super informal, so try not to worry about them.
Do I need to do an annual appraisal as a locum?
Usually, yes. For revalidation with the GMC, which happens every five years once you’re qualified, you need evidence of annual appraisals.
Some locums do manage to get away without doing one in their F3 year, perhaps if they’re starting specialty training just after their F3 year then they can ask their educational supervisor to do an appraisal in August. But this is a bit risky, so it’s up to you whether you want to take the risk or whether you want to arrange your appraisal, either through a consultant in your Trust or by paying the agency to arrange one for you. It’s also worth remembering that locum agencies require you to have a yearly appraisal to continue working with them.
Whatever you decide to do, you’ll need to collect evidence of Continuing Professional Development activity and reflective working during your F3 year. Click here for more information about keeping a portfolio and arranging your appraisal in your F3 year.
What portfolio do I need to keep as a locum?
As a locum doctor, you will have to submit evidence of your continued learning, development and professionalism, every year of as part of your mandatory annual appraisal. This is very similar to the Annual Review of Competence Progression (ARCP) that you had to do as a trainee and contributes to your GMC revalidation cycle.
To this end, we recommend keeping an ePortfolio for easy evidence collection and storage. You can learn more about what ePortfolio we recommend and the evidence you’ll need to collect in our full article “How to Ace Your Annual Medical Appraisal As A Locum Doctor”.
Do I need a different type of indemnity insurance for locuming?
It’s important to make sure you have the right indemnity insurance to cover all of your work whilst locuming. This includes just doing the odd locum job alongside a training programme.
Are there any locum specific apps and services that I can use?
Yes! We've actually created 'Your Locum Toolkit' which features a list of our favourite free apps and services for locum doctors. Here you'll find useful tools to help you with all things locum related, such as: managing your finances, finding work, organising your portfolio, accessing clinical resources, and many more.
Can I still progress in my career if I work as a full-time locum doctor?
Yes, you can. Spending a year or more working as a locum doesn’t have to come at the expense of career progression.
While locuming isn’t as structured as a training post, there are still opportunities to get involved with learning, teaching, audits, and research, as well as having competencies signed off, especially if you’ll be based at the same hospital for a while. To keep this moving forward, you’ll just need to be proactive in your efforts to get involved with these activities.
Be friendly with your consultants and registrars, and let them know you’re eager to continue learning while locuming.
What you’ll need to do, though, is carry paper forms from the Royal Colleges, and register with a free e-portfolio service like MedAll, so you can get a signature for any impromptu opportunities that come up.
Can I still learn and progress in my career as a locum?
You shouldn't feel excluded from training or learning opportunities as a locum.
Many doctors feel like they are, and it will put them off. They feel like in return for the flexibility and financial benefits of locuming, their career will stagnate and they'll learn nothing. . . But that's actually not the case at all and you can have both.
All you need to do is ask.
If you approach the Consultant and say that you'd like to get involved in some of the lunchtime teaching sessions, for example, or that you'd like to contribute to an audit. In most cases, they'll say yes. That's especially true if you're working in a department in a longer-term locum post, so they get to know you a little bit better. And they'll also see the benefits of you attending that training because you'll be working with them for a little while.
It can be harder if you're just doing occasional ad hoc shifts and you don't have much of a relationship, but nevertheless, just ask them and you'll have the best of both worlds.
Are locum doctors excluded from department teaching
Many new locum doctors assume that they’re automatically barred from attending any departmental teaching.
This is not always the case.
When compared to trainees, it’s true that as a locum doctor you might be one of the last in line to be invited to attend departmental teaching sessions, especially if working in a busier department.
However, If you let your consultants and seniors know that you’re interested in attending these teaching sessions or learning new skills, then you can find yourself being invited along on less busy days, and even being given impromptu teaching when they have time.
Is it possible to get direct entry to specialty training having spent some time locuming?
This depends on your level of experience, and whether you have proven all the competencies you'd need to have done in the relevant training pathway whilst you've been locuming.
You may also be expected to have done a similar length of experience as you would have in training. For example, for medical training, they would likely expect you to have done a variety of medical specialties as if you were a trainee, and have done all the core competencies for CMT/IMT.
For this reason it’s unusual to be able to apply directly to the ST3 level of training unless you’ve previously done SHO-level training in that specialty, for example in another country.
If you’re planning to apply for ST3-level training, it’s worth checking out the person specification, and other guidance documents on the HEE website, for your specialty to make sure that you’ll be eligible for the application.
Can I step up to an SpR as a locum SHO?
There’s no fixed milestone to signify the difference between a locum SHO and SpR. Instead this is a fluid boundary that is often determined by a combination of factors:
- The specialty you work in and the demand for middle grades
- Your experience within that specialty, and whether you have similar competencies and the clinical knowledge that you might expect an SpR to have - professional examinations are a bonus
- The confidence your consultants have in your clinical ability
This means that as a fresh F3, it’s unlikely you’ll be given the opportunity to work as an SpR.
However, if you’re going to be with a department for a while, then it’s worth letting your Consultants know that you’d like to eventually make this jump (usually at 6 - 12 months). In a supportive department, this will mean your seniors take a lot more interest in making sure your learning and development as this will eventually help them out in the long run when you step up.
This article is part of a wider series, supporting doctors like yourself with a comprehensive set of guides to ensure your F3 year is a success. These guides cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience. Click here to visit our F3 Resource Hub to explore the full list of guides and articles.
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