Home > Information for doctors >Tutorials > Locums

Francisco Machado

Objectives, by the end of this tutorial you should be able to:

• Devise a action plan to set up as a locum
• Understand the financial implications of being a locum
• Find additional resources for locums

Case history

• Increased flexibility and freedom of working
• Increased exposure and experience of different practices
• Can be used to top-up your income
• You are able to visit a number of practices in an area and gauge if you want to apply for a permanent post in that area
• Doing locums may be a way of finding out about future posts in the area
• A way of getting known in an area for future job prospects
• Generally workload is less stressful than being a principal in GP

• Income is unpredictable
• No paid holidays
• No paid study leave (but this may change with initiatives to fund education for non-principals
• Practices may cancel bookings at very short notice e.g. same day!
• Locums may be seen as second best or as a new opportunity to get a second opinion on!
• Continuity of care may be difficult unless you do a long locum
• Different practices have different systems and procedures that can take some time to get used to, e.g. some practices may be paperless!

Getting work.

• Start early, don’t wait till the last week of your VTS, and remember many other recently vocational trained GPs will be entering the locum market at the same time.

• Circulate your CV to local practices, as FSHA to distribute using internal post
• Register with FHSA locum list
• Send copies to local health group/primary care group as likely to need regular locums
• Mention to drug reps that you are looking for locums
• Advertise in local Postgraduate Centre
• Contact local co-operatives and deputising services if you want "out-of-hours" work

Locum agencies:

• May offer contracts with increased chance of getting regular work, but once tied to a contract you will lose the flexibility that you might desire
• Agencies may ask you to sign a restrictive clause, such that you will not enter into personal contract with a practice that they have introduced you to. One way around this is to approach local practices before signing up with the local agency
• Working for a locum agency will mean that you rates of pay are not likely to be as good, also if you are receiving a salary you will not be classes as self-employed for tax purposes, see below.

• An answer phone and mobile phone are essential
• Have easy access to a fax machine
• Reply promptly to offers of work, even if you are unable to do the locum, hopefully next time you will be able to!!

Make sure that you are clear about:

• Where you are expected to work
• What length of time you are expected to work
• If you are doing a surgery, how many appointments will you be booked, e.g. compare an "all comers surgery" with a 2hr 10mins per appointment surgery.
• Rates of pay. The BMA publishes rates of pay for locums. It is important that you are clear about what you are going to get paid in advance, remember you are now a "business" and you will have to decide what your rates are. If the rates are not acceptable politely explain why you are unable to take up the offer and wait! Most people find discussions about money difficult but you must not undersell yourself!
• Find out when you are going to get paid
• Once you have agreed a "contract", prepare an invoice and keep a copy for your accounts and present it to the practice once you have worked at the practice.

• GP locums have been able to enter the NHS pension scheme since 1 April 2001.
• In order to gain entry to the scheme locums will need to be on a supplementary list to be held
  by a health authority.
• From 1 April 2001, locums should record their work and income on forms which have been
  created for this purpose. 
• These forms are available on the NHS Pensions Agency web site:
  www.nhspa.gov.uk
  

GP Locum work which qualifies for NHS Pension Scheme Membership

• The intention of the scheme is to recognise the validity of locum GP work which contributes
  to the NHS due to the legitimate absence of another GP who would otherwise have done the
  work. 
• Any work done as General or Personal Medical Services for NHS patients may be
  superannuable, provided that there is a clear and direct transaction between the locum and the
  employing practice or absent GP.
• This may include out of hours cover, provided it is based on such a direct and mutual
  transaction, such as for a named GP who is unable to do his/her scheduled co-op shift.
• Similarly, locum work which has been arranged by a third party simply to introduce the
  practice and the locum in order to satisfy a specific requirement is also acceptable, provided
  the subsequent transaction does not involve that third party. 
• But locum work which has been arranged and paid through a third party, such as a commercial deputising firm, a commercial
  agency, or a co-operative itself, is not superannuable via this scheme.

Accounts:

Once you become a locum and self-employed, you must:

1. Contact National Insurance contributions agency so that you continue to contribute your national insurance. There are two types of national insurance:
   Class 2 which are paid directly by yourself
   Class 4 which are paid on profits and are part of your six monthly demand from the Inland Revenue
2. Contact your local tax office and tell them your change in employment status

1. Appoint and accountant to look after you tax return.

It is essential that you keep some money back to pay your tax liabilities that are due on the 31st January and 31st July each year. Your accountant should be able to guide you regarding this. Some people keep a separate account for this purpose!

Remember to keep a careful log of all income and expenditure. Ignorance is no defence. Also you need to keep all receipts for atleast 6 years.

Contact your accountant regarding what expenses you can claim against tax.

But keep:

• Expenses relating to cars
• Mobile and home phone bills
• Professional fees
• Medical literature
• Use of home for professional purpose
• Accountants fees
• Stationary and postage
• Consider paying your spouse a salary
• Pension and ill health insurance cover

Ill health

Remember to cover yourself for ill health.
It can be set against tax.
Premiums will vary depending on age, health and also when you want the payments to kick in, e.g. one week or 3 months, one week start will be much more expensive than three months but may be necessary as you may not have any other income whilst being ill and a locum.

Education.

• For many this will be the end of life as a vocational registrar. So now you will be expected to keep yourself up to date.
• Locums often experience the ""double whammy", in order to keep up to date you have to take time out to study and attend courses and so lose earning potential, but you also have to pay for the course.
• Locums are not entitled to the PGEA payment!!
• Some postgraduate departments will subsidise non-principals attending recognised meetings.

If you intend to return to GP as a principal it is important to maintain your PGEA points. If you become a principal within 12 months of finishing your vocational training you will be entitled to a full allowance. But in order to claim a full allowance after more than 12 ,months you will have to demonstrate attendance at 30hrs/year PGEA approved meetings in the preceding years. The development of personal portfolios will hopefully help this process.

Try and attend local meetings. Remember that this is a good way of keeping in touch with your local peers. The local NANP group will often organise meetings for non principals that allow for peer support and are usually PGEA approved.

It is important to budget for time off. Holidays should not be missed. But try and take them at times outside the traditional holiday season.

The National Association of Non Principals

National Association of Non-principals
PO Box 188
Chichester
West Sussex
PO19 2ZA

Website: www.nanp.org.uk

Excellent resource. Also have published a handbook for non-principals

They are also able to put you in touch with your local NANP group.

Top