As a locum GP working in the Glasgow area, I
wanted to write an article to help those of you registrars who will
be entering the world of locuming in August. My aim is to give you
an idea of how functioning as a locum works and to provide you with
some contact details for you to make your arrangements.
Prerequisites
I previously wrote an article for new registrars detailing
the paperwork you need to complete during your registrar year.
Suffice to say, you need to have completed summative assessment and
be on your local Performers’ List in order to work at all from
August (and the performers list of any other nearby areas you might
want to work in; you just tick the box on the back of the form and
your local area passes on your details so it’s slightly easier than
getting on the local area where you need to have loads of
documents). You will also need up-to-date GMC registration and
medico-legal defence union membership. The cost of the latter goes
up a lot and you need to pay it yourself now, which is a bit of a
blow considering you need to pay it before you’re earning the
money. Readers working in Scotland please note that with some
defence unions it is cheaper to work in Scotland than England, so
make sure you pay the correct rate. It is worthwhile putting
together a pack consisting of your CV and originals (or good
quality copies) of your GMC/defence union/PMETB Certificate – each
practice you go to for the first time needs to make a photocopy of
these documents for their records. Also include your most recent
disclosure Scotland/CRB check if applicable. You can get some nice
plastic document wallets to keep the papers in and it will look
really professional (it is also really useful when it comes to
appraisal).
Getting Work
At the start of locum life you may wish to use
an agency such as Medacs, http://www.medacs.co.uk/, or
http://www.cblocums.com/. Agencies
charge practices more money and keep a cut. Neither Locum123
http://www.locum123.com/, nor the
local sessional GP groups do this. Locum123 is a national service
that emails and/or texts you contact details of practices looking
for locums. Typically the text /email will be sent out to a few
hundred locums, so you have to be quick to respond to it to get the
work. Glasgow Locum Group, http://www.glasgowlocumgroup.org/,
is an example of a locum / sessional GP’s group as per the
NASGP. Some, but not all, local locum / sessional GP groups charge
a membership fee. GLG utilises an online availability calendar
which practices can access; they contact you directly if you are
free when they want cover, which gives you a chance to speak to the
practice. They also organise educational events which can be handy
for your Personal Development Plan. I’d advise looking on the
national association of sessional GPs website http://www.nasgp.org.uk/sgpgs/index.htm
(though some of the details on here are very out of date!) to
find out about similar groups in your area.
Another option is to write to all practices in
the area - this is worthwhile and your local PCT/health board
should have a list of local GP’s on their website. It might also be
worth getting business cards done to give a professional impression
– this can be done cheaply at a machine or at http://www.vistaprint.com/
As time goes on you will generally find that
practices will contact you directly as it saves them hassle and
money and they know what you’re like. I’ve only been to one new
place in the past 2 months, and even that’s become a regular; don’t
be disheartened at first if it seems difficult getting work, it
takes a few months to get established in a new area. A few months
down the line you will be turning down work because you’re already
busy.
Getting Paid
You should invoice a practice for work done. I
am not going to tell you how much to charge for a session; the
actual rates are variable in different areas and may differ
depending on your experience. You can consult GP magazine
who do a locum survey. Also try speaking to locums in your area to
find out what they charge. There is no “official” guidance on what
locums should be paid.
If you get a few sessions together at the same
practice, it is fine to issue one invoice at the end covering all
the shifts. As a locum you very much work on a monthly basis, as
will be discussed in the next session. Generally I invoice the
practice on my last session of the month for all shifts done in
that month.
The practice should pay you either by cheque
or BACS payment, then you supply a receipt. They should also fill
in your pension form (see next section).
It is up to you whether you charge late
payment fees and/or cancellation charges. For an example of terms
and conditions you may wish to visit the following site:
http://ianthompson.co.uk/
Tax and Pension
Right, income tax first. You will have to
register as self-employed, which includes paying different national
insurance contributions and filling in your own tax return. There
is a fine if you don’t register within a short time scale of
becoming self-employed (I think 3 months), so get on with it. For
information on how to do all this visit the Inland Revenue
website:
http://www.hmrc.gov.uk/
I have been advised by sessional GPs who have
paid tax that one should put aside 25-30% of one’s of income, NET
of pension contributions, for income tax purposes. I have not been
able to confirm this as I haven’t had a tax bill yet, but all
sources say the same so it can’t be far off the mark. You should
seek independent financial advice on what to do with the money you
put aside.
I would also recommend getting an accountant.
Glasgow Locum group have a yearly session from one in August, but
it is worth while asking around of practices to find one that is
both good and knows the medical field which is very different to
other sorts of business. It will make the whole tax return thing a
lot easier and less stressful.
GPs are in a unique position; we are the only
self-employed workers entitled to a state-run pension. So far your
superannuation has been taken automatically off your pay (as was
your income tax). In England you will now deal with the NHS
Pensions Agency regarding your pension, in Scotland you deal with
the Scottish Public Pensions Agency, SPPA. You pay to them 6% of
90% of your gross locum earnings (10% is deducted for ‘professional
expenses’), and the Practitioner Services Division stumps up the
other 14%. The percentage contribution you have to make on any out
of hours work may vary depending on your local arrangements, so you
should check locally. Basically you fill in a ‘Form A’ for each
shift (or group of shifts at the same practice) done, which a
partner or manager signs for you, and you total your Form As onto a
form B. You repeat the same for out of hours work. All the forms
are submitted to the Practitioner Services Division for your host
PCT or Health Board Area along with a cheque for your contribution
(6% of 90%). Generally this has to be done in the first week of the
month following the month for which you are contributing. I
strongly suggest you keep photocopies of each month’s forms as
evidence for your tax return. There are regional offices for the
NHSPA & SPPA; to find out the contact details of your local
office in England contact:
NHS Pensions Agency
Hesketh House
200-220 Broadway
Fleetwood
Lancashire
FY7 8LG
Tel 01253 774774
In Scotland contact:
SPPA
7 Tweedside Park
Tweedbank
Galashiels
TD1 3TE
Tel 01896 893131
To find out more general information,
including downloading Forms A & B, use the official websites of
the SPPA & NHSPA:
http://www.sppa.gov.uk/nhs/gmdp.htm
http://www.nhspa.gov.uk/site/Advice/GPLocum/index.cfm?parent=1&id=227
I hope this guide has been useful. Hopefully
it has given you an idea of some of the things you need to think
about now that you are no longer a registrar. Remember; speaking to
locums in your area could prove an invaluable source of information
and advice. Most will have been in your position recently and
should be happy to help.
You may wish to search the internet for other
locums who have websites and consider the locum survival guide
(http://www.locum123.com/index/html/survival_guide) published by
Robbie Coull. This is worthwhile looking at, even if it
now costs money to buy.
Many thanks go to Ian Thompson for allowing me
to reference his website and for his help in putting this article
together.
Happy Locuming!
Dr Craig J Masson
MBChB(Hons), MRCGP