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Don't leave your terms and conditions to chance

In the second part of his series on locum work,

Dr Robbie Coull looks at the business and practical aspects of

the job

It is advisable to send the practice a written confirmation or quote for the work that you plan to do, along with terms and conditions, and ask them to sign and return them. To prevent misunderstandings and disagreements it is important to define what your duties will be before a practice confirms a booking. For example:

·Face-to-face consultations. Number of patients per hour, breaks, 'clean-up' time at the end.

·Telephone consultations.

·Home visits.

·Results handling/routine paperwork/repeat prescriptions. Medical Defence Union advice is that the notes should be supplied and checked for every result/prescription done by a locum. This is time-consuming, and some locums feel this is not an efficient use of their time and are not willing to accept the risks involved.

·On-call/emergency cover.

You can either ask for payment by cheque on completion of the locum work, or at the end of set periods for longer bookings, or specify when payment is expected by, and any penalties for late payment (for example: 'payment is due within 14 days, there is a 10 per cent surcharge for late payment').

You should also be clear about your cancellation policy. For example, a 100 per cent cancellation fee if less than one to two months' notice is given.

Example templates of terms and conditions are available to download:

Business aspects of locum work


The personal tax year runs from April to April, and you need to submit your tax return/payment by the end of the following January.

When you submit your first tax return, you will be asked to pay the tax due for the year just ended, as well as 50 per cent of the estimate for next year's tax 'in advance'.

The other 50 per cent is due at the end of July of the same year. So it is vital that you set aside a proportion of your income for tax from the start (see the locum income and tax calculator on

National insurance

There are two classes of national insurance contribution that apply to locums:

·Class 2 ­ usually collected monthly (the tax office will send you a direct debit mandate on request)

·Class 4 ­ collected as part of your tax return at the end of each tax year.


You need to keep track of all of your business expenses, so that you get tax credit for them. For example:

·Vehicle/travel expenses

·Paper, stamps, envelopes

·Computer expenses

·Medical indemnity

·Mobile phone costs for business calls.

Practicalities of locum work

GP performers lists

Inclusion on a single English performers list allows you to practise anywhere in England. The same is true for the Welsh performers lists. However, in Scotland you need to be included in the performers list of each PCT/health board where you want to work. When you apply for your first (or 'home') Scottish performers list, you will be asked if you want to be included in any other PCT/health board lists as well. It's best to select every PCT/health board to prevent delays should you wish to work elsewhere at a later date.

Medical equipment

What medical equipment you take with you depends on the kind of locum work is involved, how long you are going for, personal preference and the transport arrangements. I find using someone else's equipment is quite a hassle, so generally speaking the more equipment you can take with you the easier your locum sessions will be.

Clinical issues in locum work

Loss of continuity

The first key difference you will notice when you start working as a locum is the loss of continuity of care, so there is no chance to correct any errors. One has to rely on the next doctor to pick up where we have left off, sometimes without any clear idea of who that next doctor will be. It is important to leave a clear indication of what has been done and what the plan for follow-up is.

Professional isolation

The professional isolation of locum work can produce problems with medical education and management of difficult cases. I find the internet an invaluable resource for overcoming isolation ­ for example via, a locum can maintain a 'virtual' network of colleagues.

Safety netting

Safety netting is even more important for locums, and it is important to leave a written handover of key outstanding tasks when you leave. I use the dictation list to record these tasks, and ask the staff to sign and return these lists to me when they have been completed.

Locum work is varied, interesting and exciting but also difficult and potentially risky. Hopefully the advice in these articles will have whetted your appetite.

For more in-depth advice download the Locum Doctor Survival Guide free from

Robbie Coull is a locum with

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