Working as a freelance GP locum

7th July 2020 by NASGP

Working as a freelance GP locum

The National Association of Sessional GPs was founded in 1997 by GP locums who all recognised the professional isolation of working independently in different practices, often in conditions that they we had not anticipated during the protected years of our training and partnerships. Back then, GP locums weren’t even allowed to contribute to the NHS pension scheme, so that was first on our list.

So here we’ve put together everything any GP needs to know about stepping into the exciting world of working as a GP locum. And we do really mean that. It can be a real thrill to explore new geographical areas, working in lots of different premises, helping out struggling practices, seeing thousands of different patients, giving your personal slant on their care, tweaking or reinforcing their existing management where necessary.

You’ll see that throughout, as well as explaining how to do all this yourself, we also refer to LocumDeck, our online locum management platform, that is packed with tools that take away a lot of the technical hurdles of being a GP locum, and replace it with really useful features to make sure you’re in full control of your very own locum practice.

The largest group of sessional GPs are freelance GP locums, and is also the most flexible and often the most in demand. Strangely, perhaps because of this, we are, by some, awarded the lowest professional status and are sometimes thought by patients, practice staff and some doctors to be some sort of failure.

Of course this is far from the truth – many freelance locum GPs are recently qualified members of the RCGP, whose only failing is to have suffered from diploma-titis and to have been workaholics since leaving medical school. And a sign of the times – a growing number of locums are mid-career ex-partners.

Freelance GPing provides a good opportunity to work in lots of practices, in lots of areas. You see a wide range of patients, buildings and ways of running a practice. It’s an education in itself and very useful if freelancing whilst looking for a partnership. It enables one to get to know the locality and to gain vital experience.

Join the conversation on working as a GP locum in NASGP’s GP-only Facebook Group

And of course it’s a great career choice in itself, providing a good balance of career and lifestyle.

GPs generally work freelance in three different ways:

Freelance GPs are small businesses in themselves. It can be daunting at first but, after a while you get used to it and, it’s often fun. Dealing with the money is the trickiest part, and the key is to keep a record of everything.

Paperwork

Get your identity, qualification, indemnity and occupational health documents together ready to show to practices. Even if working via a chamber or agency, practices may still ask to see these directly.

LocumDeck (free with NASGP membership) includes a ‘Credentials’ section where you can upload all your necessary information which is immediately visible to the practice when you confirm a session.

Performers List

The GP Performers List is the list that your name will have to have been on from 31st March 2002 in order to practice as a GP in the UK. From 2013, in England, Wales and NI, there is just one national performers list. If you’re already on a list, your existing registration will have been transferred to the national list. In Scotland, you currently have to apply to each Health Board you work in – ouch.

How do I get on the National Performers List (NPL)?

As a GP working, or planning to work, in the UK, you need to go through a three-step process.

Step one: Join the GMC’s GP register

If you are applying to work as a GP (general practitioner or family physician) in the UK, as well as being licensed by the GMC, you’ll also need to be on the GMC’s GP Register.

Step two: Join one of the four UK Performers Lists

If you you’re not already working, state your “intent to work” on your Performers List application, outlining roughly how many sessions a week you plan to work from a particular date.

Wales

England

Northern Ireland

Scotland

From 1 June 2016 there has been a Scotland-wide standardised application process. GPs still apply to the relevant local health board (HB), but entry to one HB list also includes you on all other HB lists, so you can work across Scotland.

Step three: Join the NHS appraisal process

Your Area Team will assign you to a ‘designated body’, who’ll oversee your appraisal and subsequent revalidation.

Health warning: in our members’ experience, the application process can be Kafka-esque. In England, it’s a 27-page online document and stumbling blocks for locums, or those newly-returned to the UK with no current employer include:

We strongly suggest you read these great top tips from a recent applicant.

Can I speed up the Performers List (NPL) application process?

After nine painful weeks of going through the process of joining the Performer’s list, NASGP member Dr Mark de Kretser gives a helpful rundown of how to get through the application process.

Mark provides some hints and tips, many of which we hope will avoid you having to discover the same many weeks into your application.

  1. The application form/guidance makes no mention of a face-to-face meeting to provide original documents and check ID or how or when to arrange this. This is best done once you have all the required documents ready and can be arranged by ringing your local Area Team (see NHS England National Performers List website for details).
  2. The application states that a DBS certificate should be provided, and links to the the DBS website which then states that individuals cannot apply for one. But in fact you can, and even use NHS England as a sponsor.
  3. The application form states that Level 3 child protection training is mandatory but implies that adult safeguarding and BLS training are not. This is completely incorrect – all three are now mandatory. To avoid being told this several weeks into the process, or worse still after your face-to-face meeting, we suggest including all evidence for this in your covering letter.
  4. You need to take a printed copy of the application form to your face-to-face meeting, as the form may not print properly and has boxes that won’t accept a tick or cross. This is a known issue, so we recommend you just print out as best you can and use a pen to check incomplete boxes.
  5. There is no mention anywhere of needing to provide a copy of original medical degree, but this is required. Again, add this to your covering letter.
  6. The English language requirements section implies that unless you have a degree from a UK medical school you would have do IELTS, even despite being on a Scottish list or having been on the English list previously. Fortunately they should accept your JCPTGP certificate of equivalent experience.
  7. Although not stated, if a reference is to be supplied by email it must only come from an nhs.net email address unless they have the applicant’s written permission – other email addresses are not considered secure.

We’ve provided this useful template for a covering letter.

National Performers List covering letter

Download – Word Save as – Google Doc

But if you do get stuck, our experience is that the staff are easy to contact and are very helpful.

Read our blog about staying on the National Performers List

You can keep up to date with news, and helpful blogs in our GP performers list section

Tax, national insurance and pension status

If any of your work is freelance, you can either:

There are three different definitions of being self-employed or employed, depending on whether you’re interpreting it from NHS pension status, tax status or employment law status. All explained here in our FAQ.

If you are employed by an agency, you will probably be PAYE. Check this is so. Your locum agency pay will not be pensionable under the NHS scheme.

How to get known as a locum GP

    • Sign up to NASGP’s LocumDeck and start adding practices; we’ll automatically let local practices know you’re using Locumdeck, where they can contact you from there.
    • Join a local chambers or group.
    • Use the service finder function on your local primary care organisation website (CCGs in England, regional health board in Scotland and Wales) to find the practices within your work radius.
    • Send a one sided CV to all local practices with a covering letter on the back. Include when you are available and your contact details.
    • Inform the LMC office that you are available for work.
    • If there isn’t a locum chambers in your area, and you don’t fancy setting one up yourself, tell a local agency but beware: agency rates are variable and you may find it difficult working for a practice directly if you originally worked for them through the agency.
    • Make yourself known at postgraduate meetings and to the centre manager – they are often asked if they know of any new freelance locum GPs.
    • Get some headed notepaper, preferably something slightly noticeable and use it for everything.
    • Print some business cards that will help you to be remembered.
    • Create a mission statement and add it to your LocumDeck credentials page – it adds to the professional image and will make you stand out (if it’s a good one).

How to operate

    • Honestly, set yourself up on LocumDeck. I know we’ve mentioned it a few times already, but it really is an incredible tool, developed by two GPs who’ve between them been locuming for 35 years in over 100 different GP practices.
    • Get a smartphone, password-protect it and activate your business email address on it. Nearly all locum work is organised by email – and even if you’re phoned about work, make sure it’s confirmed by email.
    • Always use email to confirm the dates, time, agreed length and intensity of work, and the rates of pay including pro rata payment for overrunning. LocumDeck includes automated booking confirmation emails.
    • In addition, use the NASGP’s online locum Terms & Conditions generator and adapt these for your personal use.
    • Fees – see the separate section on how to organise these. Be prepared to negotiate when work is lacking and similarly, consider asking for more if you are booked at short notice. LocumDeck allows you to fully customise and set rates, even to the point of setting separate rates for different practices.
    • Get a satnav – it’ll pay for itself many times over. Or use the Google Maps app on your smartphone which can give you the same – or better – service as a satnav.
    • Sign up for a cloud-based office-suite like Google – not only does this automatically back everything up and provide you with really easy-to-use but highly sophisticated software such as email, calendars, file storage, spreadsheets and letter writing, it’s also completely free.

When to take holidays

Traditional holiday times are the busiest times for GP locums to work. The quietest times tend to around Easter, November and January. These are also the cheapest times to take holiday, so take advantage. Christmas and Easter are traditional holidays that many doctors will have given up over the years. Consider using your locum flexibility to take them as holiday yourself and relax. There are perks to being freelance.

If you’re using LocumDeck’s Instant Book feature, we suggest you block off holidays in your calendar so that you or the practices can’t accidentally book you for an afternoon on call while you’re drinking a cocktail in Seville.

Local resources

A big misconception about working in different GP surgeries is that they’re all the same. They’re not. In fact, each practice has around 500 different ‘information variables’ unique to itself. The only safe, effective and efficient way to present this information is through what the CQC calls a ‘practice induction pack’.

To help GPs access this all in a standardised way, NASGP has produced the Standardised Practice Information Portal (Spip – part of NASGP’s Practeus GP web platform).

You can login to Spip right now and invite all your practices to add you to theirs if they have one set up. If they haven’t, asking them for all the contact details for the list below should be a good prompt for them to invest in Spip right now (and better still, its completely free to practices).

Essential contacts

  • Hospital phone numbers with direct lines for admissions, A&E, GUM clinics and pathology departments.
  • Counselling and psychological therapy teams.
  • Mental Health Team.
  • Ambulance service local numbers for urgent admissions and outpatient transport.
  • Social Services.
  • Local safeguarding teams.
  • Police.
  • Coroner.
  • Department of Public Health so you can report Notifiable Diseases.
  • Private physiotherapists, chiropractors and osteopaths.
  • Local charities, eg Relate, drug and alcohol support.

Other information that you may find useful

  • The local Trust of hospital’s GP websites or handbooks – these vary but may offer a staff directory and service information.
  • BNFs.
  • Links to your local CCG’s website.
  • Local postgraduate centre – get on their mailing list.

Setting your rates

See our full article on how to set your rates

How to book work

Decide when you are available and more importantly when you are not. If you don’t want to work, it probably isn’t diplomatic to tell practice managers you are planning to spend the day in the garden or on the beach when they have 30 demanding patients who need seeing. Just say you are not available that day – never feel guilty about booking time off to recoup and recharge.

Use LocumDeck’s add/block availability function to make sure you don’t get booked when you’re away on holiday.

Respond to offers of work quickly. If you are slow, you will lose the offer and if you never phone back, practices will stop phoning you. Or use LocumDeck’s Instant Book, which allows practice to book you, well, instantly!

Know how much you want to earn for x amount of work at y practice. Have an ideal rate and a bottom line. Be prepared to decline work when practices won’t pay your bottom rate (again, this is all built into LocumDeck). Don’t forget the travelling time and costs if you’re going some distance from home. And always use your own Terms and Conditions.

LocumDeck allows you to customise rates for different practices – for sessions, travel and visits, as well as book sessions, perform all invoicing and even automate your Locum A and B forms.

If you’re already using other packages like MyLocumManager and Locum Organiser and want to using LocumDeck, get in touch to see how we can transfer your information over.

Know exactly what you are being asked to do (LocumDeck enables you to precisely state all of this, customised to each practice). Confirm your understanding in writing and ask the practice manager to do the same (all handled automatically in LocumDeck).

Things to consider are:

  • How long do they expect you to be doing a surgery for?
  • How many patients does this include?
  • How frequently are you seeing patients, 10 or 15 minute intervals? Is this reasonable?
  • Will you be the only doctor on site?
  • Who will be taking urgent calls/visits?
  • How many visits are they expecting you to do?
  • Are you being paid anything for travelling costs?
  • Are you expected to sign repeat prescriptions? Are you sure they have a safe system for repeat prescribing?
  • Are you expected to review results?
  • Will there be a nurse on site?
  • Which computer do they use? Do you know it? If not, will they train you on it? If not, is it safe to practice here?
  • Do they have a standardised practice induction pack? (If not and they are disorganised it will take longer to do everything)
  • Are you going to make a no-cancellation agreement? The GMC’s Duties of a Doctor guidance states: “If you have formally accepted a post, you should not withdraw unless the employer will have time to make other arrangements”. Cancellation by either party at short notice causes considerable difficulties for the other party. The GMC would view that the interests of patients should come first but, if a practice cancels you, a written agreement will enable you to bill them for the lost work.

Working long-term in one practice

Be aware that this can have consequences in three different areas – employment law, your tax status, and your NHS pension arrangements.

Many of us choose locuming to maintain some control of our work boundaries so watch out also for the potential for ‘mission creep’ if based in one practice.

How to charge for work

Setting up Bankers Automated Clearing System (BACS) arrangements with practices that you work for more than a few times is worthwhile, provided they use electronic banking, as many now do.

If cheques are still in use at any of the practices you work at, pay them into your account quickly. This avoids cash flow problems and will earn you small amounts of interest. But beware: if there is a transaction charge on each cheque it makes sense to wait and collect a few up.

LocumDeck includes Bookkeeper, a comprehensive GP locum accountancy package, tracking all three different types of mileage, your pension payments, income received and all sundry expenses.

If payment fails to appear, call the practice manager and write formally requesting payment again. Keep a copy. If payment has not arrived, say two months after the work, you can turn to the small claims court for assistance.

What can I do if a practice or agency refuses to pay?

  • Speak to the practice manager and keep a record of your conversation. If you want to make an audio recording of the conversation, many mobile phones offer this facility – but you must explain to the person that you are recording the conversation.
  • If you have no joy with the practice manager, talk to one of the partners. Speak to someone likely to see your side of the argument.
  • Write to them explaining what they owe you – give dates and times and a further copy of your Terms & Conditions. Keep a copy of all such correspondence. Send such correspondence as Recorded Delivery. Try to avoid emails when pursuing unpaid bills – too easy to ignore.
  • Speak to your LMC, who will be able to talk to the practice on your behalf.
  • If you’re still not getting anywhere, start thinking about making a small claim through a County Court.
  • Members of NASGP Locum Chambers benefit from bookings and admin support from a chambers manager, who chases payment on members’ behalf.

It may be worth contacting an officer of the LMC who may be sympathetic and try to mediate.

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