Working as a freelance locum GP

The largest group of sessional GPs are freelance locum GPs. A freelance locum GP is also the most flexible and often the most in demand. Strangely because of this perhaps, they 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.

 

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

GPs generally work freelance in 3 different ways:

  1. As independent freelance locum GPs (see below!)
  2. As part of a freelance GP chambers
  3. Or employed through an agency

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.

The paperwork

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!

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 some recent (2015) applicants;

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

Tax, national insurance and pension status

  • 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.
  • 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:

How to get known as a locum GP

  • Join a local chambers or group and circulate members’ names and phone numbers to practices;
  • 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; it adds to the professional image and will make you stand out (if it's a good one!).

How to operate

  • 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.
    NASGP Invoicing 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.
  • 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.
  • Organise essential medicines for your doctor's bag.
  • 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 freelance locum GPs to work. The quietest times are just after Easter, November and January. These are 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!

Local Information to get before you start

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 200 different 'information variables' unique to itself. The only safe, effective and efficient way to present this information is through what the CQC call a 'practice induction pack'. And to help GPs access this all in a standardised way, NASGP has produced the Standardised Practice Information Portal (Spip).

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!

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 Manipulators (in the nicest sense!) Physiotherapists, Chiropractors, Osteopaths;
  • Local Self Help Charities, eg Relate, Drugs and Alcohol.

Other information that you may find useful

  • 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!

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.

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. Don’t forget the travelling time and costs if you’re going some distance from home. And always use your own Terms and Conditions.

NASGP Invoicing 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 LocumA and B forms.

Or if not using NASGP Invoicing, other packages like MyLocumManager and Locum Organiser also exist.

Know exactly what you are being asked to do. Confirm your understanding in writing and ask the practice manager to do the same. 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 your work

Some practices will pay the day you do the work. If not send an invoice immediately after the work requesting payment within seven days - adapt the NASGP's for your own use. It is professional, efficient and effective. Practice managers like invoices as they aid their record keeping. It will also help you record your income - so keep a copy.

Pay cheques 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. 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 payment fails to appear, call the practice manager and write formally requesting payment again. Keep a copy. If payment has not arrived, say 2 months after the work, you can turn to the small claims court for assistance.

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

NASGP Locum Toolkit

See our full suite of downloadable Microsoft Word, Excel and Google Docs for you to download and customise for you or your practice's use.

Can't find what you're looking for? Have some tips you'd like to share with other locum GPs? Or even fancy contributing articles to the NASGP website? Leave a comment below or get in touch!

See also

Registering as self-employed

September 5th, 2014

Who these days doesn’t have a portfolio career? Even if you’re not technically locuming at the moment, it’s pretty likely there will be opportunities over the coming months when you’ll be offered work...

Read more