Starting a locum GP career can give you more control over your working life. But it also means taking responsibility for areas that an employer would usually manage for you.
Whatever your reason is for starting a locum GP career, the first few months might feel confusing. You need to understand registration, the NHS Performers List, indemnity, appraisals, contracts, tax, pensions and finding reliable work. It is a lot to take in while also treating patients.
This guide explains the essential steps to launching your locum GP career and much more.
Let’s break it down!
Is Starting a Locum GP Career Right For You?
Starting a locum GP career sounds incredibly glamorous when you are exhausted from a sixty-hour week at a single practice. The idea of choosing your own hours, earning a great day rate, and avoiding workplace politics is of course highly appealing.
But you should also know that this way of working is not a perfect fit for every doctor.
To help you decide if starting a successful locum GP career aligns with your lifestyle, let’s just look at the pros and cons of starting a locum GP career.
The Upside of Starting a Locum GP Career
- Flexibility: You choose when and where you work. Perfect if you value control over your diary.
- Variety: Different practices, different patient groups. Keeps things fresh.
- Income Potential: Locum session rates can sometimes be higher than the equivalent salaried rate, although income is less predictable and locums must cover costs such as unpaid leave and professional expenses.
- Career Exploration: You can test different settings before committing to one.
The Challenges of Starting a Locum GP Career
- Uncertainty: Shifts aren’t always guaranteed. You’ll need to be proactive in finding work.
- Admin Load: Invoices, tax returns, pension forms; it’s all on you.
- No Fixed Team: You may miss the stability of working with the same colleagues.
- Financial Planning: Budgeting is key. Income can fluctuate month to month.
What Are The Steps for Starting a Locum GP Career?
Here is the order most doctors work through when starting a locum GP career:
Step #1: Confirm Your GMC Registration and Get on the Performers List
The first thing you need to do is have a full GMC registration with a licence to practise. GPs providing NHS primary medical services in England generally need to be included on the National Performers List, subject to the rules and circumstances of the role.
This is now managed via PCSE on behalf of NHS England.
If you are already included on the relevant Performers List, check whether your change in working arrangements requires you to update your details or notify the appropriate organisation. It is much easier than a fresh application.
Know that Scotland, Wales, and Northern Ireland have their own equivalent lists. So you need to check the right one for your specific area when preparing for a locum GP career.
Step #2: Sort Your Medical Indemnity
For NHS general practice work in England, most clinical negligence cover is now provided through the state-backed Clinical Negligence Scheme for General Practice (CNSGP). Note that CNSGP does not replace all professional indemnity arrangements.
This took a lot of the financial sting out of indemnity compared to a decade ago. That said, you’ll still typically need separate cover for things CNSGP doesn’t touch. For example, GMC representation, employment disputes, private work, and non-clinical negligence claims.
Major providers like the MDU, MPS, and MDDUS all offer specific packages for starting a locum GP career.
Don’t skip this step just because CNSGP exists. It covers much less than people assume.
Step #3: Decide How You Will Find Work
This is where preparing for a locum GP career gets a bit more personal. You’ve got three main routes:
- Locum Agencies: Locum agencies are quick to get set up with. They handle the booking admin, but they charge the practice a fee on top of your hourly rate.
- Locum Chambers: These are GP-run collectives. A group of local locum GPs team up to share the administrative workload of running a business. The chamber can provide administrative and booking support, although their structure and services vary between organisations. In return, you may pay membership or service fees, which may be deductible where they are incurred wholly and exclusively for the purposes of your business.
- Direct Booking: Direct Booking is a method where a locum GP secures shifts by interacting directly with a GP practice. Here, you completely bypass third-party recruitment agencies and digital marketplaces. In this arrangement, you act as an independent freelance professional. It means you have to manage your own terms, relationships, and paperwork.
Most doctors use an agency or chamber when starting a locum GP career. They then shift toward direct bookings once they build a solid local reputation.
Step #4: Build Your CV and References
Practices want to see recent clinical experience, any special interests, and up-to-date references. You should keep digital copies of your mandatory training certificates ready.
If you’re moving from partnership or salaried work, this step would be quite straightforward.
If you’ve had a career break, there might be a bit more scrutiny and possibly a period of supervised sessions first.
How Do You Choose Between Sole Trader, Limited Company, or Umbrella?
One of the biggest choices when preparing for a locum GP career is how you manage your income. A locum GP can choose between operating as a sole trader, setting up a limited company, or using an umbrella company.
The right structure depends entirely on your daily session rates, your overall expected earnings, and whether IR35 tax rules apply to your roles.
| Business Structure | Pros | Cons | Best For |
| Sole Trader | Simple admin, easy to submit via Self Assessment, and straightforward drawing of profits. | Income Tax and Class 4 National Insurance hit directly as your earnings rise. | Locums earning lower annual incomes or those who want minimal bookkeeping. |
| Limited Company | Greater tax planning flexibility if working outside IR35, and clear separation of personal and business assets. | Higher accountancy costs, strict legal director duties, complex dividend taxes, and no NHS pension access. | Higher earners who plan to leave significant funds inside the business long term. |
| Umbrella Company | HMRC tax and National Insurance are handled automatically through PAYE, leaving you with minimal admin. | Complete loss of self-employed tax advantages, and regular administrative fees are deducted from your pay. | Locum roles that fall strictly inside IR35 rules (often hospital or specific trust shifts). |
Understanding how the current 2026/27 tax year rules affect your actual take-home pay is really important before setting your daily or session rates.
How To Manage Your NHS Pension and the Annualisation Trap?
If you want to keep contributing to the NHS Pension scheme as a freelance locum, you will become very familiar with Form A and Form B.
- Form A: You complete this for every practice you work for, and they sign it to validate your sessions.
- Form B: You fill this out monthly to calculate your total tier contributions and submit your payments directly to Primary Care Support England (PCSE).
You need to watch out for the annualisation trap.
The pension scheme calculates your tier by tracking your total pensionable locum pay over the year. It then divides it by the number of days you actually worked and scales that figure up to a full 365-day equivalent.
If you earn a high amount across a small number of active working days and take large breaks in between, your annualised pay can scale into a much higher percentage tier.
This means you will have to calculate the shortfall yourself and send an expensive top-up payment to PCSE at the end of the year.
How To Build a Flexible Locum GP Career for the Long Term?
The secret to starting a successful locum GP career is managing your time like a finite resource. It is very easy to fall into the trap of saying yes to every single shift out of fear that the work will dry up. Before you know it, you might be working sixty hours a week. Ultimately, you will be feeling much more burned out than you did in your old job.
Therefore, you need to set a strict budget. Then calculate your required monthly income to cover your mortgage, living expenses, tax reserves, and holiday time. Once you know that number, you need to structure your diary around it. Planning your locum GP career this way gives you the work-life balance that you actually wanted when starting a locum GP career in the first place.
What Records Should A Locum GP Keep?
When starting a locum GP career, you need to keep clear records for each source of work. A basic system should track:
| Record | What to include |
| Income | Date, payer, practice, shift, gross amount and payment date |
| Expenses | Date, supplier, amount, purpose and receipt |
| Travel | Date, destination, reason, mileage and parking |
| Contracts | Agency or practice agreement and rate |
| Pension | Scheme details, deductions and statements |
| Tax | HMRC registration, UTR, returns and payments |
| Professional costs | GMC, MDO, subscriptions and training |
| Work evidence | Appraisal, CPD, audits and significant events |
Make sure that you are updating the records every week or at least every month.
Receipt-scanning software can definitely help, and under the current 2026/27 HMRC Making Tax Digital (MTD) rules, keeping digital records and using MTD-compatible software is a legal requirement if your qualifying gross income exceeds £50,000.
The Bottom Line
Starting a locum GP career gives you an amazing opportunity to regain control over your life, clinical practice, and schedule.
But flexibility works best when the financial side is organised too.
Before taking your first session, get your registration and professional requirements in order, understand your contracts and indemnity, and decide how you will handle your income.
You should also get a system in place for tax and pension records.
With the right guidance, you can build a flexible locum GP career that works for you.
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How CruseBurke Can Help
CruseBurke can help locum GPs understand the tax and accounting side of starting a locum GP career.
We specialise in helping healthcare professionals build a tax-efficient locum GP career.
From setting up your business structure to filing annual returns and managing pension paperwork, our expert GP accountants ensure your finances stay organised.
Disclaimer: This article “Starting Your Career as a Locum GP: Your 2026 Guide” is for general information only and does not constitute tax, financial or pension advice. Tax rules can change, and how they apply depends on your individual circumstances.
