coull.net - so you want to be a locum

The BMA published recommended locum rates until the Office of Fair Trading stopped them in 1999.¬† Since then most people have simply added the Dentist and Doctors Pay Review Body pay awards for 2000 and 2001.

However, the out of hours (OOH) work still causes some variation (and, therefore, consternation).¬† The BMA had until 1997 published a series of complicated rates based on an OOH retainer and fees for each call.¬† Then in 1998 they simplified things dramatically and recommended that the OOH rate should be 100% of the day time rate when on call from an on call centre or 50% the day time rate if on call from home.¬† Personally, I vary the OOH rate depending on the rota and the size of the practice.

Click here to view my rates

Click here to see how much annual income various daily rates translate into after tax and expenses

It is important to define what your duties will be when you are working for a practice, as this varies considerably.

Normally, the duties will involve surgery or visits or both.¬† However, practice paperwork (results, repeat prescribing) should not be included (unless you are covering a single handed practice).

You should have an hour off for lunch - unless on call, in which case add the hourly rate on for that hour.¬†

The consulting times should be clear, and if you are uncomfortable with the number of patients to be seen in that time (i.e.: less than 10 minute appointments) then you should request a change.¬† Remember that to operate safely a locum usually requires more time in the consultation than someone who knows the practice and the patients.

Private work should NOT be included - the rates for private work are much higher than for NHS locums (about ¬£135 per hour in 2001) and if any private work is done then it should be outwith the normal consulting times and any fees payable should go direct to the locum (the practice may want a percentage for their overheads - usually about 20% - but remeber you have overheads as well).¬† Rates for various private work are published in MedEconomics (there should be a copy in the surgery).

It is advisable to send the practice a written quote for the work required - including dates, times, duties involved (and those not involved) and any travelling expenses.¬† I usually request that they confirm acceptance of this in writing or by email.

You should be paid by cheque on completion of the locum.¬† Make sure beforehand that the practice is happy to do this, and that someone who can sign cheques will be around to do so!¬† Occasionally, it may be necessary to agree to having a cheque sent to you after the locum.¬† This should be posted the next working day.¬† In the very unlikely event that you should have problems with payment, contact the BMA local office for advice.
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How much of my career do I want to spend being a locum?

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This will impact how much of an investment you want to make in being a locum (taking out income protection, a private pension, buying office and computer equipment, building up your own supply of medical equipment, organizing mail forwarding etc..).¬†

Remember, most locum work is booked up 2 to 3 months in advance so you need to plan ahead or you may find the first couple of months are very slow work wise.
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What extra expenses am I going to incur doing locum work?

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Remember you may need extra indemnity cover, excellent income protection and a personal pension plan.¬† [NHS locum work qualifies for the NHS superannuation scheme from 1st April 2001 - click here for more details and to download the relevant forms].
You need to pay all your own study costs (which can reach over ¬£3000 per year if you decide to take a diploma exam or a foreign entrance exam).¬† You also are going to have a sky high mobile phone bill and high petrol and vehicle costs if you travel a lot.¬† You may need to pay for airfares or ferry fares (which can reach ¬£800 for some locums in the UK) that will be re-imbursed later.¬†

You need to think about how are you going to get your mail while you are away and you may want to buy a laptop computer and other mobile data solutions (see¬† How can I keep in touch when I'm on the move? )

Overall, annual expenses can vary from ¬£5000 to ¬£30,000 depending on where you work and for how long.

See my income and expenses and how much various average daily rates translate into in real terms.

Remember to find a good medical accountant to advise you on how best to set your expenses against tax.¬† Medical accounting is quite specialized and a general accountant is often not adequate.¬† Ask local practice managers to recommend a medical accountant.
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How much do I need to earn each month as a minimum to stay solvent?

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Sit down and work out your monthly outgoing expenses: mortgage/rent, utility bills, mobile phone costs, vehicle costs, MDU indemnity and other medical subscriptions (see expenses above).

Once you've worked out how much will go out each month add on how much you think you will spend per week on routine things like food, petrol, entertainment etc..¬† Add all this up and subtract any other income you have to work out how much you need to earn each month.

It is wise to have access to three times this amount in savings or credit in case you should hit a slow period or fall ill for a couple of months.

How much work do I want to do each week/month/year?

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That depends on how much you need to earn each month and how much you are going to charge / get paid for work done.¬† See Income and Expenses.
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What will I do if I fall ill and cannot work?

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Make sure you have excellent income protection cover.¬† It's worth the money in peace of mind. I use an independent financial adviser for this ( Medical Life, Glasgow )
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main "So you want to be a¬† locum" page How to get locum work Practicalities of locum work