A locum GP is one who temporarily takes the place of another GP. Usually they are self-employed, although sometimes they conduct their work via a locum agency or their own limited company. Locum GPs are also generally paid fees for their work, differing from salaried roles which pay a salary. As a locum there are varied roles; contracts can be set
to cover anything from ad hoc sessions to a long- term maternity cover, whilst they can also cover a single service or a range of services. Locum GPs can be engaged to work for a variety of healthcare providers including GMS, PMS, or APMS practices, private practices and out of hours providers.
GPs engage in locum work for a variety of reasons. It can be conducted as part of a portfolio career or even to fit around family commitments. Newly qualified GPs can find it helps to assess different types of working environments or geographical locations whilst considering longer-term positions. Locum work brings increased flexibility and a high degree of autonomy, though patient continuity of care can be more difficult, and you have fewer working entitlements. For example, a locum GP is not entitled to sick pay, maternity/paternity pay or holiday pay, which are only available in a salaried role. You should also be aware that the rules surrounding ill health and death in service benefits are different as a locum GP compared to salaried roles and it is important to gain specialist financial advice on these differences.
You can begin working as a locum at any time once qualified. You will need to ensure that you are registered with HM Revenue & Customs (HMRC) as a self-employed individual, which can be done either online or by your Accountant. You will also need to ensure you are included on the GMC’s GP Register as well as the National Performer’s List. If you live near a border you will need to be included on the Performer’s List for both counties if conducting work in both. You will need to consider which geographical areas to work in and it may by easier to begin in an area you know and are known, as you will need to make contacts and build relationships with providers to find work. Joining your local Sessional GP Group can also help in finding work.
A contract will be required and there should be a clearly defined final agreement in writing, signed and dated by both parties. The contract should include details of your fees, timetables and core responsibilities for you and the engager. It should also include a substitution clause which states that you, as the locum, are responsible for finding a replacement if you are unable to conduct the work. This must also be a contract for services (rather than a contract of service, which is the case for salaried GPs) and state that you are conducting the work in a self-employed capacity, with tax and National Insurance (NI) to be met by you. It would be beneficial to have a standard contract which can be subject to changes to suit the provider if mutually agreeable.
To pension your locum work there are two forms to be submitted, Locum Form A and Form B. Form A is sent with your invoice for each engagement and details both your fee and the employer’s pension contribution to be paid by the engager. Each month you will then need to complete Form B, which summarises the income for the month along with your contributions (which are tiered depending on your level of income). Both forms need to be submitted to PCSE/your local area team, together with payment of both your own and the employer’s contributions within 10 weeks of conducting the work. Both forms are available on the NHSBSA website along with detailed guidance notes.
As a self-employed locum you will be required to submit an annual Self-Assessment Tax Return. This will include all your income during the tax year (ending 5th April each year) be it from a salaried role, locum work and any interest, dividends or rental income. Your total income is used to determine the amount of tax and NI for which you are liable in the year. The liability is paid in two ‘payments on account’:
The Tax Return is due to be submitted by 31stJanuary following the tax year. Any further liability due will be paid to HMRC by 31st January after the tax year, alongside the 1st payment on account for the next tax year.
However, in your first year you are unable to make any payments on account; instead you will need to pay for the full liability by 31st January after the tax year, together with the first payment on account for the following tax year. Effectively your first payment covers 11⁄2 years of tax liabilities, which as a higher rate taxpayer can equate to as much as 42% of your gross income. You will need to consider how much to save throughout the year for these payments and seeking professional advice can assist in determining the right amount to save.
A variety of expenses can be claimed to help reduce your tax liability. All records and receipts for the expenses claimed must be kept for six years after the tax year has ended. Items for which the full cost can be claimed include:
You may also make a partial claim for certain costs which have a duality of purpose, ie: costs both business and personal usage. Such costs include:
You may also claim for motor expenses, via a mileage claim or as a proportion of running costs. For either claim a mileage log must be maintained as evidence, detailing business miles and total miles. It should be noted that travel between home and the practice could be counted as private, not business mileage, depending on the circumstances. Specialist advice will help to ensure that only the allowable travel is included in a claim.
A limited company can be used to conduct locum work, although you should be certain that a company is the right structure for you and obtaining specialist advice is essential to ensure all necessary considerations are made. A limited company would limit your potential liability to the amount you had invested. This is in direct contrast to being self-employed where there is no limit to potential liability. Having a limited company can help lower the tax you would have to pay, depending on the company structure, your household cashflow requirements and pension contributions. Companies have a larger administrative burden, such as requirements to complete Corporation Tax Returns as well as your own Self-Assessment Tax Returns each year and Companies House compliance. In addition, by working through a personal company, the IR35 rules (intermediaries’ legislation) may apply. These exist to ensure that people who would be classed as an employee, if not for their limited company, do not benefit from tax advantages available to self-employed individuals. To determine whether your work could be regarded as employed or self-employed, HMRC has released an Employment Status Indicator. Since April 2017, however, the responsibility of determining if IR35 rules apply lies with the ‘employer’ (engager). There are significant changes for taxation, NI and pensions depending on the outcome of this test, although it does not affect the employment status with regards for statutory rights. Taking specialist advice in this matter before accepting an engagement will help ensure that the correct status is applied to each engagement.