Your Locum FAQs Answered
Working as a locum doctor can seem like a complicated business when you’re first starting out, and we get a lot of similar questions cropping up from locums who are looking for advice. So, we thought we’d collate all of them here, with brief answers and advice about where to go to get more information!
If you have a question which doesn’t appear here, have a look at our F3 Resource Hub or get in touch with us directly and we can add the answer here!
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 to fill their shifts and for managing compliance. You can sign up 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.
Can I register with multiple agencies and Trust banks?
Yes! You can sign up to as many agencies and Trust banks as you want to.
In fact, best practice is to find both a small number of 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 positions that are close to home.
Just beware that some Trust 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 on the bank or working through an agency for each Trust.
Can I locum and bank at the same Trust?
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.
How do I know which agencies to choose?
The best agencies have access to plentiful 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 is the best agency for you is to speak to colleagues and rota coordinators who’ve worked with the agencies in your area for advice, 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” 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 jobs, 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 locum agency.
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 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 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 have for working in that specialty, so that other locums with that experience won’t necessarily be at more of an advantage than you. For advice on how to write a CV specifically for locuming, click here to read our in-depth guide.
Can IMGs (overseas-educated doctors) work as locums?
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 and will need to remain employed in a substantive post which will sponsor your visa. (Note: the 20 hours per week limit is currently paused ignored during the COVID 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, EU passport) then you're free to move around and locum as a UK grad would.
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 locum 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 guides on the F3 Resource Hub to see what you can expect!
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.
How much can I expect to be paid as a locum?
The pay rates can vary widely depending on region, the position seniority, and the number of hours you want to work.
As a rough guide, outside of London you can expect the following gross hourly rates for day or core shifts, with around £5 - £10 per hour more for nights and weekends:
- SHO: £40 - £50 per hour, sometimes a little lower in popular specialties
- Registrar: £55 - £80 per hour, or more as you get closer to CCT
- Consultant: £80+ per hour
See the following question for the London rates.
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 locums. This applies to locum work 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 - £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 longer 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 - £42 per hour for SHO core hours and £48 - £50 per hour for SHO non-core hours.
What could I earn as a locum?
An SHO working three days per week could expect to earn around £5,800 per month before tax. This assumes pay of £45 per hour and 10-hour shifts. You will then deduct tax, national insurance, and pension to get your take-home pay.
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 well 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.
Admin, Finances, and Appraisals
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 shift alongside a training programme.
How does working through a limited company work and should I do it?
It's much less common now for locums to be paid through a limited company within the NHS, especially at more junior grades.
Most locums will be paid through a process known as "direct engagement," which is where you’re set up as if an employee of the Trust and paid directly by them. This means you get paid through PAYE, where income tax and NI deductions are taken automatically on your payslip, as they would be if you were a permanent employee.
If you're thinking about working through a limited company, you should always always seek specialist advice from an accountant.
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 toHMRC 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.
How does locuming affect my pension?
As a locum 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.
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 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 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.
- 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.
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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