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A cancellation can be devastating for a locum GP, particularly if it's last-minute. You may have put off other work in order to undertake the planned work, and of course may have dependents, a mortgage, loans. Same applies to anyone, which is why you have legal rights in this situation.
Firstly, refer to the terms and conditions that you agreed to - if you used the NASGP's model T&Cs, you will have a cancellation clause that means the practice must pay you a certain figure if cancelled within the agreed time limit.
If there is no agreement in place and the practice does not pay appropriate compensation the locum may be able to pursue a claim for breach of contract in a small claims court - have a word with your BMA or MPU Industrial Relations Officer or, if you get no joy, your local Citizens Advice Bureau should help you out.
Funding for locum appraisal was withdrawn by the NHS in 2013, but that doesn't mean you can't try claiming it from a CCG or other local PCO.
Complete NASGP's locum rates calculator to help you work out your baseline hourly or sessional locum rate. Once you've done this, you can then tailor the rate according to your experience, skills and different practices you work in.
If you're doing any sort of locum work as part of your portfolio career, you'll definitely need your own personalised Terms and Conditions to help protect both you and the practice you're working for. NASGP's model T&Cs has been specifically developed for us by a specialist employment law firm, and allows you to not only fully adopt all its recommendations, but also to add any necessary clauses, and tailor it to suit your personal needs.
LocumDeck's T&Cs generator allows you to
- Set your own cancellation sliding scale from 0 to 100% of your booked fee for 0 to 28 days in advance.
- Include your 14.38% employer's pension contributions
- Legal employment status
- Tax status, IR35 etc
- Duties (on-call, triage etc)
- Private fees (HGV medical etc)
- Cremation fees
- Payment terms (14 days? 28 days?)
- Plus much more.
As an NASGP member, go to your T&Cs generator, choose your settings and then save. You'll then be given a unique link "View my TCs" which will automatically be added to your automated invoices, confirmation emails and session request emails, or you can paste the link into your own website.
As an added bonus, you can update your T&Cs as often as you like, with each change being saved in an archive accessible by your practices for extra confidence.
Working in different practices, do you ever get that 4am brain worm about a patient you saw the day before? At NASGP, we're used to this experience, so have developed a tool that may not only keep those brain worms away but also help you improve patient care and help generate evidence for appraisal.
It's imperative that all GP locums receive a flu vaccine at the earliest opportunity to prevent us acting as an unsuspecting viral vectors as we move from practice to practice, typically working in 30 different practices a year.
As GP locums, we are arguably at our most needed during flu season, so it's in everyone's interest that we all get vaccinated.
Since 2016, it's also in a practices interest, since NHS England are incentivising practices to vaccinate 75% of all their front line staff.
Fortunately, employing surgeries are often fairly obliging when it comes to vaccinating ocus, and it really doesn't cost that much to get a shot from local chemist. But if you're minded to get it for, this download, even if it doesn't get you the money, will at least raise this as an issue.
Do you get your own username and password when signing into practice computers? Sick of always being signed in under various combinations of ‘LOCUM1/DRL/LARRYLOCUM’? Perplexed as to how it’s your first time at the practice but looks like you (DRLOCUM) have seen this patient twice already this month? Irritated because you can’t work out who all the other freelance GPs are who’ve already seen this patient? Demoralised for not having the fundamental means for recording auditable medical notes? Struck off for never having officially been enabled to record a consultati…OK, you get the idea.
Secret passwords and usernames are essential to working as a GP – recording contemporaneous medical information in the patient’s notes is a vital part of clinical management; and a medico-legal requirement. And if your password isn’t secret, and call me paranoid, someone else could falsify records in your name. So how come freelance GPs are so rarely given their own? Come on chaps, stand your ground and insist on one! Some of the clinical systems are pretty easy to set up, whereas others aren’t. For example, the procedure for setting up passwords on Microtest can be quite tricky. So we’ve been working with them (and what nice people they are) to make the procedure easier.
@NASGP Huge risk area. I had my name signed to referral letter for a pt I'd never seen. V diff to ensure audit trail in such a setting...
— Dr Catherine Harkin (@buletproofcardi) March 13, 2015
Meanwhile, here is a download to place under the noses of any defaulting practices.
There's an awful lot of confusion and inconsistency about what training is statutory, what is 'required', what is needed and what a practice wants or expects.
But what we do know is that NHS appraisal is a statutory requirement, so we have provided a template for you to adjust to your own needs, sign, and give to any practice who asks for it to reassure them that your NHS appraiser is satisfied that you are fulfilling any necessary requirements to practise as a GP.
It's now a requirement of the Care Quality Commission CQC that every member of staff working in a GP practice has an up-to-date Hepatitis B status. The MPS have prepared a summary of why this is needed, as part of the CQC's Cleanliness and infection control (Outcome 8, Regulation 12) "People are cared for in a clean environment, and are protected from acquiring infections".
If you're a chambers locum or are employed as an agency locum, they'll no doubt otherwise notify every practice on your behalf. Otherwise it's a sign of a well organised locum to provide this in advance of working.
If you're employed by a practice as a salaried GP, you'll be entitled to free immunisation status checks and boosters if they're a good employer. As a locum, unless you can persuade a friendly practice, you'll have to arrange this yourself with your own GP as a private service.
Added to this, the Green Book states:
Healthcare workers in the UK and overseas (including students and trainees): all healthcare workers who may have direct contact with patients’ blood, blood-stained body fluids or tissues, require vaccination. This includes any staff who are at risk of injury from blood contaminated sharp instruments, or of being deliberately injured or bitten by patients.
As a GP, if you're exposed to continuing risk of infection, you should have a single booster dose of vaccine, once only, around five years after primary immunisation. Measurement of anti-HBs levels is not required either before or after this dose.
The Disclosure and Barring Service DBS check (used to be known as the Criminal Records Bureau CRB check) needs to be performed only once in order to appear on the National Performers list. Once on the Performers List, there is no requirement to have further DBS checks for the Performer's List as this is part of Performers List monitoring. The purpose of the national list in England is to allow GPs to move to different parts of England without having to apply to a local performers list.
DBS in England
- NHS SBS Greenwich
6 Mitre Passage
- Tel: 0208 5363000
Scotland, Wales and Northern Ireland
- DBS checks for other UK countries are usually done as part of the performers list application.
If you work for locum agencies, not only will they each need a DBS check, but they may also have their own internal reasons to insist on one as often as they like. In which case, you may like to use the annual DBS update service for £13 per annum (which must be applied for within 19 days of receipt of your certificate being issued).
Further information on DBS checks, which reinforce the above, is available from the Care Quality Comission CQC.
With pressure for appointments increasing, it can be difficult to ensure that a patient of concern has access to the follow-up you had intended. Try using this form to flag up to reception when a patient really needs review.
Locums work in anything up to 40 different practices a year, and capturing feedback is a great way for practices to benefit from our wide range of experience and seeing everything with a fresh pair of eyes.
Our popular locum pension spreadsheet has now become LocumDeck - completely free to NASGP members. Within seconds, generate online automated pension forms, complete with paperless electronic signatures, including invoicing, bookkeeping, T&Cs, document manager and optional online 'Instant Book' booking.
Want to get some feedback from a practice, and even use it as a reference? We've developed a new online electronic form to make this a lot easier.
Simply send this page's link to the GP or practice manager you want a reference or feedback from, and we'll do the rest!
Locumdeck's Bookkeeper updates itself completely automatically from the rich information generated from all the travelling and locum work you do, and also allows you to add other financial data too to cover all your self-employed work. At any time, you can export any data you need, and also generate a smart financial report for your accountant or financial advisor.
Bookkeeper is integrated into LocumDeck - click on the Bookkeeper tab at any time to integrate the pages of information within.
- Smart session counter to help you work out the number of 4-hour equivalent sessions for indemnity purposes.
- Number of sessions worked.
- Total amount earned.
- Breakdown of employer pension contributions.
- 'Reimbursed' travel costs as applicable (not part of your pensionable pay).
- Paid/unpaid status of invoices.
- PDF copies of all invoices and automatically completed Locum A and B forms.
- Mileage (automatic)
- Between home and practice
- Between practices
- Individual journey details
- Cremation fees
- Medical reports
- Private work
- Work invoiced outside of LocumDeck
- Export reports
- Earnings (by date worked)
- Invoices and pension contributions
- Mileage (manually added)
- Other work travel
- Admin expenses
- Travel expenses (other than mileage)
So much of Bookkeeper has been made possible from generous feedback from our existing users of LocumDeck and the support of Liz Desnely and her team from Honey Barrett.
Even as a GP locum there are some simple and affordable steps you can take to reduce the risk of losing out financially if you can't work through illness.
Your ability to receive income whilst off work through ill health whilst working as a GP locum very much depends on your employment status i.e. whether you're an employee, self-employed or 'worker'.
Remember that your legal employment status is something that is not necessarily determined by you, and is different to your tax employment status and your NHS pension employment status.
This FAQ is from the perspective of being a GP locum in the same practice for a 'long time', rather than about choosing working as a GP locum as part of your career portfolio.
It explains it from four different perspectives - NHS pension scheme, HMRC tax perspective, employment law and 'mission creep', and there's even an audio podcast too.
I work for a locum agency
- If you're working through the agency as their employee and fulfil certain criteria, including having been ill for at least 4 days in a row, you will qualify for Statutory Sick Pay (SSP) for up to 28 weeks.
- You may in fact be entitled to more if the agency has a sick pay or 'occupational' scheme, but check your contract to see if that applies.
- Remember that even if a company has taken you on as self-employed, there may be factors within the way you work that may point to your employment status being otherwise.
- If you're classified as a 'Worker' because of the way you work for your agency, you may still be entitled to SSP.
- If you're genuinely engaged as self-employed...
- If you're locuming in different practices using your own Terms and Conditions, managing your own bookings and determining the way within which you work, either manually or through platforms like LocumDeck, then your employment status is likely to fall within the self-employed status.
- In which case, you don't qualify for SSP in that role.
- But if you already have a Locum Insurance Policy, then this could cover you for up to £3,000 a week or 75% of your earnings for a year if you’re ill or injured and can’t work.
I work for an online locum platform
- If when working for an online platform as a GP, engaging with practices under the platform's T&Cs and not your own, make sure you understand your employment status and entitlements, and be prepared to question your employment status if you're not entirely satisfied with what you're being told.
What about Permanent Health Insurance and Critical Illness Cover?
These are policies for much longer long-term benefits. Read this for more information:
We've created a calculator to help you arrive at a ballpark figure taking into account covering your professional and personal running costs.
But in addition to your circumstances, there may be local factors at play which could influence your locum pay environment. If you’re new to an area or new to locuming, how do you work out what rates to charge?
Simply asking around is not option, with anti-competition laws being quite clear about the illegality of discussing rates with fellow GP locums.
Local factors that may affect locum pay
- Supply of locums - the more locums, the more potential for downward pressure on rates. We hear this from members in the more vibrant towns and cities, perhaps with a local GP training scheme that then attracts and retains lots of GPs to start out as locums.
- Presence of a dominant practice-facing online platform or agency. We hear from members that having one of these in your area can sometimes skew the pay and conditions of local independent locums in a downwards direction.
So how can LocumDeck’s Instant Book help?
With Instant Book, the whole point is that you carefully pre-define your booking parameters for each practice, including the pay rate, in advance, and then publish your terms and availability and wait for bookings. So you can make calculated judgements about the pay you would like to receive and use Instant Book to do the talking for you. Bear in mind too that the Instant Book process itself will add to your ‘value’, as practices are being offered a speedy, transparent way of booking a GP - a task that might otherwise cost them significant workload and resources.
Here’s how you can use Instant Book to experiment with your rates
- Add a local practice to your LocumDeck address book where you haven't recently worked.
- Set a sessional/hourly rate for that practice at the level that you'd like to be booked at.
- Activate that practice for Instant Book.
- Add 'Committed Availability' to your LocumDeck calendar as far in advance as possible.
- As and when practices Instant Book you, you’ll soon be able to use your judgement if your rates are too high or two low, and you’ll be able to adjust your rates accordingly.
If you run this experiment for a range of practices and add availability over a range of periods in advance, you’ll soon start to build a picture of the local factors that may affect your rate decisions.
Our experience of using Instant Book is that once practices have used it, they return to it as their favoured booking method, further cementing its value to them. It is a win-win tool - locums have more control over their work and pay, whilst the practice saves significant resources in finding and directly booking locums.
Optimise your settings to maximise your bookings
- Adding a photo of yourself helps
- Help the practice manager by adding helpful documentation and information about yourself in your Credentials area
- You can upload your patient and colleague feedback surveys
- Highlight your experience or any special skills you have in the freetext Professional profile area
GP locums can work in up to 40 different practices a year. As practice prescribing systems vary, if locums have agreed to sign prescriptions generated by others, it is essential that they are clear about how the practice prescribing system works so they can make safe prescribing decisions.
This template helps practices explain the steps in their prescribing systems so that visiting GPs can make informed, safe prescribing decisions.
This FAQ deals with the steps you can take to reduce the risk of this happening, and what you can then do to both get paid what you're owed and the legal position around claiming interest.
State your terms
- State the 'terms' of payment on every invoice i.e. the date it must be paid by, or the number of days within which to pay.
- Bear in mind practices are very busy, and a well organised practice will have a set day at least once a month to lock themselves away, login to the practice account, set up new payees and make payments, so practices therefore tend to find it much easier to pay their locums once per month.
- The UK government says that if you agree a payment date, it must usually be within 30 days for public authorities such as an NHS Trust, or within 60 days for 'business' transactions, such as GP practices. You can agree a longer period than 60 days for business transactions, but it must be fair to both you and the practice.
- Be aware that if you're contributing to the NHS pension scheme, you must not leave submitting your contribution for work that was carried out more than 10 weeks previously.
- If you do not agree a payment date, the law says the payment is late 30 days after either the customer gets the invoice.
Clear, consistent invoicing
- Most practices pay by BACS, so always show your account number and sort code, and in the same place on the invoice each time, and state this as your preferred option.
- Just in case, give your account name too in case they need to pay by cheque.
Cockup vs conspiracy
- A likely cause for late payment is the practice simply being busy, or someone being on holiday.
- LocumDeck includes a simple way to resend an invoice, highlighting its due date.
- Failing that, a quick phone call might help.
Terms & Conditions
- Having clearly defined T&Cs makes it much easier to stand your ground if a payment is late.
- LocumDeck includes its own fully-customisable T&Cs pick-n-mix. The default late payment text is "If delayed payment results in the local Area Team refusing to accept my NHS pension contributions relating to any work at this practice, I reserve the right to later charge an additional 20% on top of my rates to compensate me for loss of NHS pension benefits."
- Some members copy this text into LocumDeck's 'other' box below the default text, and substitute 20% for 14.38%, just to make it simpler.
- 14.38% is the statutory employer's contribution for NHS pension scheme; if the payment is so late that the work becomes unpensionable under the 10-week pension rules, at least you don't have to pay anything back.
Charging interest on a late payment
- Once you've taken reasonable steps to clarify with the practice that your invoice has not been paid, you can then generate an invoice for the interest as stated in your T&Cs.
- Apply the interest to the full amount, including any pension contributions; the interest charge is itself non-pensionable.
- Send a new invoice if you decide to add interest to the money you’re owed.
- LocumDeck allows you to cancel an existing invoice for the original amount and then issue a credit note with an explanation. To keep things simple, we recommend not to do this until.
- You can also charge a practice a fixed sum for the cost of recovering a late payment on top of claiming interest from it.
- The amount you’re allowed to charge depends on the amount of debt. You can only charge the practice once for each payment.
Charging statutory interest
- The interest you can charge if another business is late paying for goods or a service is ‘statutory interest’ - this is 8% plus the Bank of England base rate for business to business transactions.
- You cannot charge statutory interest if you've already stated a different interest rate in your T&Cs.
- You cannot use a lower interest rate if you have a contract with public authorities.
If all else fails
- It's important that you do not allow yourself to be bullied, coerced or made to feel under pressure in any way to forgo late payment interest or a debt recovery.
- Even if you're not a member of your Local Medical Committee, get in touch with them - anonymously if you prefer - to pass let them know what's happened. The LMC are not just there to represent members, they're also there to ensure that employing practices behave responsibly for all concerned.
- Failing that, contact your trade union.
To be completed by practice or organisation to provide key information about Covid-19 to GP locums who are otherwise unfamiliar with the practice or organisation.
If your NHSmail address is Dr Dan Fantastic (Burberry Surgery), and you want to change it to Dr Dan Fantastic (GP Locum), ask your organisation to mark you down as a 'leaver', then contact firstname.lastname@example.org, using your NHSmail account, requesting they mark you as a ‘joiner’ to the GP Locum organisation.