Working as a locum GP is a common starting point for many newly qualified GPs, with some doctors choosing to work as a freelance GP long term. In this article, Dr Mahibur Rahman looks at some of the advantages and disadvantages of working as a GP locum.
Advantages

Flexibility

As a freelance GP, you can have more control over where and when you work.  If you wish to take time off during school holidays, or go for an extended trip, you are free to do so without needing authorisation from anyone else.  If you wish to spend 6 months working just a few sessions a week you can.  If you need extra money for a specific purpose, you could increase your working week temporarily.  If you do not like the way a particular practice works, you can choose not to book more shifts there.

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.

Income

As a locum, you can realistically make a £100,000+ a year working full time if you are willing to be flexible about where / when you cover sessions.  You could still earn over £75,000 per year working less than full time. Working 24 hours per week at an average rate of £75 per hour (this is a modest rate for most of parts of the UK, although there is a lot of variation between areas) 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. Some locums that put in 40+ hours per week including a mix of longer shifts at walk in centres or urgent care or additional portfolio roles earn more than £150,000 per year.

Disadvantages

Uncertainty

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, and due to lower demand due to the coronavirus pandeminc, thre are some locums that had so little work, they needed to claim unemployment benefits. 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.

Isolation

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.  Some parts of revalidation are more challenging – e.g. taking part in complete audit cycles can be quite difficult if you are not working regularly in any one practice. The latest guidance does allow alternative quality improvement activities to account for this. As a locum, you will not get any paid CPD time or study leave, so need to account for the cost of courses or e-learning as well as the lack of income while on a course when considering your fees.

Travelling

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.

Summary

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 ask via our Facebook group or post a comment below.

Dr Mahibur Rahman is the medical director of Emedica and author of GP Jobs – a Guide to Career Options in General Practice. He teaches on the Emedica Life after CCT: GP Survival Skills course which includes an extended session on how to succeed as a GP locum – including how to get work, set rates, set terms and conditions, expenses, pensions and all the paperwork and forms you will require. There are also sessions on salaried GP contracts, partnerships and portfolio careers and practical advice and demonstrations on how to negotiate contracts. You can see more details at www.emedica.co.uk/cct

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.