The 23 Biggest Myths for New Locum Doctors in 2023
When considering locuming for the first time, doctors will often rely on information that they’ve heard from their colleagues, seniors and friends who may or may not have locumed before.
Unfortunately, this information isn’t always correct and can negatively affect your expectations about locuming.
We’ve written this article with the intention of correcting the most common misconceptions that we’ve heard over the years. Placing these right here for you to read at your convenience.
If you have a question which doesn’t appear here, have a look at our Locum Doctors Hub or get in touch with us directly and we can add the answer here!
Banks and Agencies
❌ I need to choose between either a staff bank or locum agencies, but I cannot work with both
False. 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.
❌ If I join an agency I will get kicked off all the staff banks I’m registered with
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.
More on that next.
❌ I can work through a bank and agency at the same Trust
The short answer to this is no.
Whilst you can work with both staff banks and locum agencies, if you’re signed up to the staff bank at a particular Trust then you must arrange your shifts through them, rather than an agency.
Their view is that if you are already registered with them, why should they pay a locum agency’s fees to arrange your shifts…
In some cases, you might find that you joined a staff bank but then regret it. Some are very disorganised: they only publish their shifts at the last minute, only pay monthly not weekly, or have a very slow registration process. In that case, you can choose to leave that staff bank and then work there through a locum agency. To do so, you’ll need to check the terms and conditions bank to see if there is a period of time you’ll have to wait before you're able to work through an agency there. This is known as a ‘cooling off’ period - the time period varies by Trust but 6-12 weeks is common.
As an aside, in some regions of the UK, you may also find that a number of staff banks from different Trusts join together to create a “Regional Bank” or “Collaborative Bank”. These types of banks will normally enforce the above rules across all staff banks in the group - so if you join the Regional Bank you can’t work in any of the hospitals in the region through an agency. We recommend checking these clauses if you’re considering joining or are already part of, a regional bank.
❌ All locum jobs get posted to banks first so agency doctors get the last pick
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.
Working with Agencies
❌ I have to choose a single agency and work only with them
This is a really common misconception!
There is no rule that forces you to work with one singular agency, and why would you? The more options you have for finding work, the better.
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.
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.
❌ Once I register with an agency I am obliged to work with them
This isn’t true. You should only accept the jobs that you actually want to do. Regardless of how far in the registration process you get or even if you've completed it.
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. You are only committed when you agree to work a particular shift 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 better serve you.
❌ Agencies will take a cut off 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.
❌ Agencies rip off the NHS and should be avoided
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.
❌ There’s so much locum work that I can sort my shifts at the last minute
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.
❌ I will be blocked from picking up locum work if I don’t have prior NHS experience
Providing you have a full license to practice with the GMC and the right to work in the UK, it is very possible for those without NHS experience to work as a locum.
Although, admittedly, this may be challenging at first as most Trusts will prefer doctors with extensive NHS experience.
However, due to a nationwide shortage of doctors, there are still opportunities available to you. But these will often need you to make a few sacrifices on your usual requirements and you may have to be flexible on where you work and the types of shift you cover. At least until you get a few months of NHS experience under your belt.
You can find out more about this, including our top tips for getting your first role in our article “How to Find Locum Work Without NHS Experience”.
❌ Messly is a locum agency
We’re not an agency, but we are a faster, simpler and more transparent way to find locum work, that has become THE way that doctors find locums.
Messly helps you find the best paid, most rewarding and most convenient locums by making the best locum agencies compete to find you work.
We’ve chosen just the most reputable locum agencies, who get regular access to the best shifts, and we make them pitch you through the app on why they're the best agency to meet your needs.
It’s like Compare the Market, or even Tinder for Locums… 💘
You get access to locum work from all the best agencies, at your fingertips. That means you’re likely to get better rates, less travel and your pick of departments.
Registrations and Compliance
❌ I don’t need to do any paperwork before I start working with a locum agency
When you’re working as a locum in any healthcare setting, whether with a staff bank or through a locum agency, there are checks in place to ensure you’re eligible and safe to work. If you’re working with an agency, they are responsible for certifying that those checks have been done.
The checks include:
👉 Your right to work (passport and visa)
👉 Your identity (ID, proof of address)
👉 Your criminal record (DBS check)
👉 Your work history (CV, references)
👉 Your professional registrations (GMC status and other certificates)
👉 Your occupational health status (vaccinations and blood tests)
❌ Agency registration can wait until I have secured a locum job
Hospitals won’t review your application for a locum position until they know that you’ve completed (or very nearly) the registration process with your locum agency.
The agency can sometimes 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.
❌ Agency registration is quick and easy
It normally takes a few weeks to complete the registration process with an agency. But this can be delayed unexpectedly by missing documents and delays with your DBS check.
We normally recommend doctors to register 6-8 weeks in advance, as this will give you time to book shifts with better pay and hours before they get snapped up.
For more information about the timeframe you should be aiming to register by and when to start applying for shifts. Read our article here.
❌ Agency registration is far more arduous than joining a 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 (training, fellow, Trust grade), then there is normally an internal application route which requires filling out a fairly quick 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 answers for questions about desirable traits, such as leadership and teamwork.
Some staff banks can be very slow to process new registrations, so if you want to go down this route you need to apply 2 to 3 months in advance to give you adequate time to book shifts.
❌ I can register will all locum agencies in one go
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.
If you've not used our locum service before, check out this link to learn more about how we can help you find the locum work you’re looking for.
❌ Locum rates are fixed and non-negotiable
Locum rates vary significantly based on the current need for locums within that 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 doesn’t hurt if you’ve already worked in the hospital before and have a good relationship 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.
❌ Some locum agencies can get me more than the Pan-London Rate
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.
As a result, doctors working in London will expect to earn less than the national average, which for SHOs is £40-45 per hour for core hours.
London-based locum SHOs can expect to earn £36.14 per hour for core hours, and £43.37 per hour for unsocial hours.
These rates apply in the Greater London area, which is essentially all hospitals inside the M25 boundary.
However, there are exceptional circumstances where the rate can be increased. Hospitals can escalate the rate in a provision known as “Break-Glass”. In these cases, SHOs can expect to earn £40-50 per hour depending on the type of shift, but it’s worth mentioning that these are very infrequent.
❌ If I do locum work I will pay a higher rate of tax
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%.
❌ I will pay less tax if I use a limited company or umbrella company for my locum work
Since 2017, under the IR35 rules, it is very difficult for the vast majority of doctors, especially those at SHO level, to work through a limited or umbrella company during their locum year.
This eventually means, in most cases, that locums are paid as if they were employees via PAYE, where your tax and National Insurance are automatically deducted from your pay.
Trying to avoid tax this way will usually result in a letter from HMRC detailing a large amount of unpaid tax which you will be liable for.
However, there are still some circumstances where locums would be considered to operate outside of IR35. Examples of this include locum GPs and locums with private practice outside the NHS.
You can read more about locuming through a limited company in this article here, and more about umbrella companies and managing your finances here.
❌ Bank rates are higher than locum agency rates for the same shifts
Not necessarily. In some cases, bank rates are slightly higher and in other cases, you can secure higher rates with an agency.
As explained above, rates vary significantly based on the current need for locums within that particular department. This determines the rates far more than whether the shifts were booked with a locum agency or via the bank.
❌ I don’t have any employment rights as a locum
As a locum doctor, you are entitled to many of the rights that a full-time worker would expect. These include:
1️⃣ 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.
2️⃣ 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.
3️⃣ Sick pay: You’re usually not entitled to sick pay for missed shifts as an agency locum, but if you’re on the staff bank you may be entitled. Ask your HR department for advice on this.
4️⃣ 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.
5️⃣ 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.
❌ I won’t learn anything as a locum and my career will stagnate
It’s true that Locum doctors do not have access to the same structured learning opportunities that their trainee counterparts do. However, finding opportunities to gain competencies, learn, take part in portfolio activities, and take part in research and audits is still perfectly possible. You just need to be proactive!
⭐ Here are some tips: ⭐
1️⃣ If you’re going to be locuming at the same hospital for a while, make the effort to tell your consultants and registrars what you’re hoping to learn, or what skill you’re hoping to develop. I.e. if you want to get better at suturing, ask them if you can watch or be supervised doing one. This could be an easy DOPS sign-off for your portfolio.
2️⃣ Locum in the specialty that you want to apply for later on. Not only is this a good gain experience whilst showing commitment to the specialty, but the learning opportunities you get will be directly relevant to it too, which would help during the specialty application process
3️⃣ Read our article on acing your annual medical appraisal. We share a lot of good tips in this article for collecting evidence of learning events as a locum doctor
4️⃣ You can also check out our Locum Toolkit for a list of apps and services to help you learn, collect CPD points and manage your portfolio
This article is part of a wider series of resources and guides that are designed to support you as a locum doctor, covering areas such as getting your first job, managing your finances, understanding your rights, and many more. Visit our Locum Doctor Hub for everything you need to know about locuming today.
Additionally, if you're considering an F3 year, you might also find it useful to look through the selection of resources we've put together in our F3 Resource Hub.