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Finance diary, August: Covering holidays without busting your locum budget

This month often brings problems in ensuring enough locum cover. Bob Senior looks at ways to cut the cost

Finding locums has always been difficult – particularly in the summer months – and with partner vacancies becoming more frequent, demand for locums often exceeds supply.

The most realistic short-term option is to simply bite the bullet and allocate a bigger budget for locums. However, there are still ways to cut this inevitable staffing expense.

Better rates

Attempting to change your locum’s rates is the first thing to try. It might be difficult to drive a hard bargain during the summer months, but try this approach with individual locums rather than agencies as it may work better. The guarantee of regular work may attract locums and enable you to pay a lower rate, but beware that guaranteeing a minimum number of sessions over a period could result in your locum being taxed as a salaried, rather than freelance, employee. HM Revenue and Customs has become increasingly aggressive in its taxation of locums who are employed long-term (e.g. six months or more) at one practice.

Even if the practice and the locum both agree that the locum is self-employed, the HMRC could decide that for tax purposes they are an employee, which would result in the practice having to pay 13.8% employers’ national insurance contributions.

Flexible cover

The second way to reduce the cost of providing cover is to ask one of your existing GPs to work additional sessions for extra income.

Offering more flexible working to your existing GP employees will take less of your time than employing a new locum because the GP will be familiar with patients, processes (in particular the QOF) and colleagues.

One way to do this might be to look at whether you can create long-term flexibility for GPs who want to reduce their sessions (before retirement, for example, or to accommodate childcare arrangements). Typically, these GPs are offered a half-time schedule (four sessions a week, every week), but may welcome working eight sessions a week in school holidays, with the option to take whole weeks off in September.

Bob Senior is chair of the Association of Independent Specialist Medical Accountants and head of medical services at Baker Tilly

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