GP Locum Work – Pros and Cons
Many GPs now choose to work as locum GPs, either as their main job, or as part of a portfolio career. Here is a comprehensive guide to some of the pros and cons of working freelance:
As a freelance GP, you can have more control over where and when you work. If you wish to take time off for holiday, you are free to do so without asking a boss. If you need extra money for some reason, you could increase the hours you work. If you don’t like working at a particular practice, you can choose not to book more shifts there. On some days, you might choose to take a long shift at a walk in centre (8 or even 10 hour shifts are sometimes available), to allow you to have an extra day off later in the week without affecting your income.
Being self employed
As a locum, you are your own boss. You can set your own rates, and most locums can earn more per day than most salaried GPs and some partners. As a self employed contractor rather than an employee, you are also able to claim many more expenses against your tax bill, further increasing your take home pay.
A change is as good as a rest
Sometimes working in different environments, and being able to go in, deal with the patients then leave, without getting involved in internal politics or bureaucracy can be very refreshing. It also allows you a chance to see different ways of working, to take examples of good practice from different places, and also to see what does not work well. Working several sessions as a locum can give you a really good understanding of whether a practice would be a good place to work long term before committing to a salaried position or a partnership.
As a locum, you can realistically make a £100,000+ a year working full time, and if you are willing to put in some hours covering evening or weekend shifts, or doing longer shifts in urgent care / walk in centres, it is possible to earn over £125,000 per year based on 40 hours of booked work a week including 8 weeks off every year. If you prefer not to work evenings and weekends, you could still earn over £75,000 per year working less than full time. Working 24 paid hours per week at a realistic average rate in many areas of £75 per hour with 6 weeks leave, 2 weeks bank holidays, and 2 weeks study / CPD time (total 10 weeks without any earnings) gives an income of £75,600. Short notice locum work can be very lucrative (£100+ per hour), as can sessions that require additional skills or qualifications (e..g working in drug misuse, or in secure settings).
One of the big drawbacks with working as a locum is living with uncertainty. There is no guarantee that you will be able to work as many sessions as you would like, or that practices will be willing to pay the rates that you had hoped to charge. In some areas there many trained GPs fighting for both salaried posts and locum sessions, while in others there is no shortage of work. Agency locum rates have gone down in the last year in some regions. You may not know exactly how much you will earn from month to month, or exactly where you will work from day to day. For some people this is not really a big issue, but others find it difficult to cope with a variable income when they have large fixed costs to deal with each month (e.g. paying the rent / mortgage, bills, childcare, schooling costs etc.). Some locums will, over time get most of their work from a few regular practices, so that you might have a fairly fixed amount to your income, with the variation limited to the number of additional sessions that are available each month. Over the last 12 months though, there has been a marked increase in the amount and variety of locum work available all over the UK.
Lack of continuity
One of the downsides of working in many different practices can be the lack of continuity. You can miss out on the satisfaction of seeing a patient improve after making a diagnosis and initiating treatment, or the learning that comes from following up a patient that you referred or admitted. It can also be challenging getting used to new computer systems, or different ways of handling referrals (some practices ask you to dictate, others use Choose and Book, another will ask you to type the letter yourself). Doing visits in an area that you are not familiar with can also be more time consuming. Most locums find that they will establish a few practices that use them regularly (80% of my work is from 4 practices), with the remainder being more ad-hoc bookings.
Being a locum can be very lonely. In many practices, you will arrive for your session, be shown to your room by the practice manager or a receptionist, see 18 patients in 3 hours, then leave, without seeing or talking to any other colleagues. This can be a bit of a shock to newly qualified GPs who have had the regular contact that comes with being in a training practice, as well as the pastoral benefits of being in a VTS group. If you are doing the odd sessions in many different practices, it can be difficult to build relationships with the team.
No employment rights
As a locum, you are a self employed contractor, so you do not have any of the rights a salaried employee would have. This means no paid holidays, no paid study leave, no sick pay, no automatic increase in pay and no job guarantee / entitlement to redundancy pay. Of course you can take this all into account when setting your rates and calculating how much you will have to work in order to make enough to meet all your expenses and still have a decent amount of time for holidays and study leave. You will also need to make provisions to cover your expenses if you are off sick or unable to find work for some time.
Continuing Professional Development / Revalidation
Working as a locum GP can make it more difficult to engage in CPD – for example, you may not have the opportunity to attend weekly clinical meetings or journal clubs. Although the proposals for revalidation are not yet finalised, there are suggestions that it will be more difficult for any GP not working in a managed environment (e.g. salaried / partnership) to meet the requirements for revalidation. Taking part in complete audit cycles for example, can be quite difficult if you are not working regularly in any one practice. There are ways around these though – netowrking, and joining a sessional GP group in your area can be a useful way to keep up to date, and it is not necessary to complete an audit – you can do a quality improvement project instead.
In some areas, you may find that you need to be willing to travel quite large distances to ensure that you have enough work. This can lead to increased expenses, increased tiredness and stress if you have to travel in peak times.
Like any job, there are both advantages and disadvantages to working as a locum GP. Hopefully this article is a good starting point to thinking about how this style of working might suit you. If you are thinking of starting out as a locum and have questions, please feel free to contact us with any queries – we will always do our best to offer advice and support.
If you have been working as locum for some time, or recently started, please post a comment and share your tips and advice for new locums.
Dr Mahibur Rahman is the medical director of Emedica, and the author of GP Jobs – A Guide to Career Options in General Practice. He is the course director of the popular Emedica “Life after CCT: GP Survival Skills Course” for GP Registrars in ST3 coming to the end of training and newly qualified GPs. It includes a GP Locum Masterclass, which will cover different ways of working as a locum, pros and cons of setting up a limited company, pensions and tax as a locum, how to find work and build a good reputation, setting terms and conditions and rates, and more.
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