Career guide
How to become a locum hospital doctor in the UK: GMC registration, Responsible Officer / designated body, bank vs agency, framework rate caps, and IR35 in 2026.
At a glance | Regulator
GMC registration with a licence to practise requiredA locum hospital doctor covers clinical work on a session-by-session basis for the organisations that need them, as a self-employed professional rather than a salaried employee. This guide walks through everything you need to do to start, in order, and the common pitfalls that catch people in their first year.
Guide | 7 steps
Full registration is the floor; most trust locum shifts now require post-FY2 status. Consultant locums need entry on the Specialist Register; trust grade rates track the grade you’re credentialled for. If you’ve been out of the UK, check your licence status before accepting bookings. Revalidation is every 5 years and requires an annual appraisal through a prescribed connection.
Pure locums with no substantive post need a designated body to appraise and revalidate against. NHS Professionals (NHSP), CQC-registered agencies, and local trust banks can all act as your prescribed connection. Drift here is the single most common reason new locums have revalidation deferred.
Core Skills Training Framework modules (safeguarding, information governance, moving and handling, conflict resolution) plus grade-appropriate life support (BLS / ILS / ALS) must be current. Trusts will not book you without up-to-date certificates. Renew every 12 months.
NHSP is the default for national access; local trust banks usually pay £5–£10/hr more than NHSP for the same work. Apply to 2–3 trust banks direct alongside NHSP. Trust-direct insourcing / weekend waiting-list clinics pay consultants £1,300–£2,000/day and rarely route through agencies.
Framework agencies (HTE, CCS, Crown Commercial) pay capped NHS rates but cover the vast majority of shifts. Off-framework agencies pay more for crisis, nights, and short-notice bookings. Medacs, ID Medical, Holt Doctors, Merco, and Athona are the most commonly used. Messly is a directory/marketplace rather than an agency.
Clinical negligence for NHS duties is covered by CNST/NHS Resolution. You still need personal indemnity from the MDU, MPS, or MDDUS for Good Samaritan acts, GMC investigations, coroner’s inquests, and any private work. Grade and specialty drive the premium; A&E, psychiatry, and obstetrics sit at the top.
Since 2017 NHS trusts have assessed almost all doctor locum engagements as inside IR35. That means umbrella or agency PAYE, not Ltd Co. Genuine outside-IR35 engagements are rare and usually involve mixed private practice. Don’t incorporate a Ltd Co unless your accountant has reviewed recent contracts.
Once you are registered
Log every session with its date, rate, and workplace, send invoices that chase themselves, keep your documents current, and watch your tax reserve build as you go.
Checklist | Documents
Sessional sends reminders 30 days before each expiry.
Checklist | First year
Related
Last reviewed April 2026. Rates and regulator details change. If something looks off, let us know.
From the first booking
Keeps the records, does the sums. Filing and advice stay with you and your accountant.
Sessional tracks every session, invoice, expense, and document from day one. No card to start.