A large number of GPs are choosing to work as locums, accepting the uncertainty in terms of income for a better work life balance and flexibility in their working week. If you would like to join them here is some advice.
This is part one of Dr Farah Jameel’s advice on being a locum GP. Read part two on reslience next week.
First consider how you’d like to work (independently, through an agency or through a chambers) and also where (rural or urban, larger or smaller practices). Then sort out the admin:
1. Employment Status
Register as self-employed with HMRC and arrange to pay Class 2 National Insurance contributions. You can do this online by going to HMRC’s website or your accountant can do it for you. You may prefer to register as a limited company; this is a discussion to have with your accountant (remember you can’t claim pension contributions this way). If you work through an agency, you will be paid as PAYE and will not be able to pension these payments.
When booking work, you will be commonly asked for the following paperwork. Be organised and have electronic copies that you can forward easily: CV, indemnity, GMC, CCT certificate, performers list confirmation, identity document, child and adult safeguarding, BLS, hep B status and CRB/DBS check.
3. Terms of business
Ensure you have a comprehensive set of terms. Agreeing a job plan, setting out the type and timing of activity can help to avoid misunderstandings. Your terms can be as basic or as comprehensive as you like. Things to consider including are:
- How would you like to work? For example, seeing a certain number of patients with regular break slots.
- What you are willing to do? You may be happy to work as duty doctor, go out on home visits, process admin and see late arrivals
- How you intend to charge? Hourly, by session, day rates, duty doctor rates.
- Private work
- Terms of cancellation
- You can find a sample terms of business here
4. Set your rate
Locum pay does not include holiday, sick or maternity pay, nor funding for CPD. Take into consideration your tax, national insurance, pension, medical defence cover, GMC subscription, course fees and other costs when setting your rate. There is a helpful calculator in the BMA locum handbook which helps you work out a sessional rate taking into account all your expenses.
5. Finding work
There are several ways to get work as a locum:
- Contact local VTS schemes who will usually be able to send an email to all the training practices in the area.
- Contact practices directly, either via email or telephone – practice managers tend to communicate with each other and are usually aware of practices that use locums. They will pass your details around.
- Local sessional groups will usually have a local practice mailing list and email locums on a regular basis with any practice requirements.
- Advertise on your local LMC website.
- There are a growing number of websites like rLocums, network locum, GP networks, locumorganiser that connect practices directly with locums.
- Educational meetings can be a useful networking opportunity, print business cards and have them to hand when attending such events.
- Contact practices who have advertised vacancies on job websites, with an offer of interim locum services.
- Work directly with Agencies and Chambers who will find work for you.
6. Create an at-work checklist
Arrive early and familiarise yourself, it gives you time to ease in, switch the computer on, ensure all logins are working and have a test run on the system.
- Are you familiar with the IT system? If not, arrange to arrive early and organise for a member of staff to do a mini-teaching session.
- Have you been sent a locum pack? If so, do read through it.
- Do you know how to refer?
- What about requesting imaging, blood tests, common investigations?
- What is the practice policy for referrals?
- Do you know where the toilets are?
- How do you call patients in?
- Always check the printer
- Do you know where the emergency drugs are?
- It is always helpful to have a list of contact numbers or a go to person for clinical and admin queries.
Keeping on top of finances
Finding work is fairly straight forward but dealing with the money can be hard. The key is to keep a record of everything.
Subscribe to billing software like locumorganiser.com which helps you keep track of your sessions, invoice your practices, completes pension forms GP Locum A & B, keeps tabs on your finances, provides you with a tax report to download and hand to your accountant among other things.
8. Pension Payments
If you have decided to pay into the NHS pension scheme, you can contribute only 90% of your NHS locum income (this is not possible if set up as a limited company). The employing practice must pay a 14.3% employer contribution. You will need to ensure a locum form A is signed once a month for each practice you worked in that month. You should then use locum form B at the end of each month to include all your income for that month, and use it to calculate what you need to pay. The billing software is usually quite helpful and will auto populate this all for you. The NHS Pension Scheme for GP Locums (Forms A+B ) can be downloaded from the NHS Website.
9. Find an accountant, save for tax
Keep every receipt related to work; document all your expenses, payments received. Ensure you claim for all tax deductible expenses like business costs, medical subscriptions, medical indemnity, exams, courses.
A good accountant will save you a lot of money – they will provide you with sound financial advice and provide you with all the information for tax returns.
It is generally a good idea to get into a habit of saving for your yearly tax bill, consider signing up for a monthly direct debit to spread the payments out more evenly over the year.
10. Maintain cash flow
Having good software that auto populates and sends out invoices with one click helps run things to time from your end. It will also help you record your income.
Pay cheques into your account quickly, you can also ask practices to pay by BACS, many now do. Some practices can take a long time to pay; this is where your payment terms are important. Specifying terms in your invoices are also a helpful reminder to the practice to pay in a timely manner. If payment is delayed, in the first instance consider sending a reminder email, this usually settles the issue. If however this does not result in prompt action, it would be best to call the practice manager to request payment and then follow this with a formal email/letter in writing. Should payment continue to be delayed, over 30 days you can turn to the small claims court for assistance. It may be worth contacting the LMC at this stage.
Dr Farah Jameel is a sessional GP in London, and a member of the GPC and Camden LMC