Finally earning a wage for all your hard work is great and locum work can be a great way to boost your earnings, whilst gaining more clinical exposure and experience. You will soon start receiving offers for locum shifts, but ensure you consider the following important things before booking these.

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What is the difference between bank shifts & a locum agency?

The internal bank allows you to sign up to receive shifts from a single hospital or trust. As this is often cheaper for the hospital and the staff are more reliable (they’ve often worked at the trust before), this is often preferred and hence shifts are offered to those on the bank first. A locum agency advertises shifts across hospitals and they’re usually keener on people who are looking to do regular locums. Doctors frequently complain though about locum agencies incessantly calling them, so instead we recommend Messly as they let you see shifts without sharing your details with locum agencies.

Can you locum as an FY1?

As an F1 doctor, you are provisionally registered under the GMC and thus have limitations on your practice. With regards to locum shifts, this essentially means that you not permitted to work outside of your ‘training post’ – you cannot work in another hospital, NHS trust or specialty.

With this acknowledged, internal locum shifts at F1 level are generally accepted throughout the UK providing it is an area you either currently work in or a previous rotation. For example, you could do a medical on call shift should that be something you would do as part of your normal job role.

Each hospital has different procedures for offering internal locum shifts, so ask at your HR or bank team. Often emails are sent around listing shifts that need cover, but sometimes it could be at very short notice due to sickness, so it is worth making yourself known if you want extra hours.

F1 locum rates & ensuring you get paid

The rates are often around £30 per hour but the rate can vary greatly across hospitals. A higher rate might be offered for if the shift is at short notice or important to fill. If you are negotiating for a higher rate, ensure you do this professionally and put patient safety first. Ensure you get the negotiated rate confirmed in writing.

To claim the payment, you usually need to submit a timesheet with a senior signature or authorisation to confirm you have completed the shift. Always get it done on the day, as it can be very difficult to track consultants down at a later date. Remember to get it done before an admissions post-take ward round that you are not involved in, or you could be hanging about! Do check when you are expected to be paid as it can often take a while & make sure you keep a copy of all your timesheets, so you can evidence your hours should there be an issue with payment.

Personal responsibilities

Before accepting a shift, ensure it is at FY1 level with adequate support. You should confirm what type of shift it is and the start, end times and finally the hourly rate.

You have a personal responsibility to ensure you can safely carry out the extra hours. You must consider your own health and wellbeing in relation to doing extra shifts. Furthermore, you must consider the rota rules to ensure you don’t breach them. It is also your responsibility to ensure the shift is within your scope of practice. You can speak to seniors, the BMA or your medical defence organisation if you are unclear about whether the work is compliant or appropriate. You should never feel pressured into doing extra work. You are not obliged to cover rota gaps as your days off are entirely your own.

Locum work should be approached in the same style as regular on-call – be scrupulous when working with unfamiliar patients in different settings, document actions, write your bleep and name clearly – especially out-of-hours. Introduce yourself to unfamiliar team members, make sure you know who to contact if you need help. You still need breaks even when you are paid hourly.

Tax on locum shifts

Remember that you will continue to pay tax on your earnings and so your final rate will be much lower. Additionally, the tax office might think you have two jobs and therefore overtax you on both your wage slips. Ensure you review your tax code.

There will be plenty of times to locum as an SHO, which is often easier, gives much higher rates and offers a better clinical experience so always weigh up whether the shift is really worth it for you,

Written by Dr Amy Nixon (FY2)
Edits by Dr Akash Doshi (ST3)