How to become a locum hospital doctor in the UK

Step-by-step

1. 1

   Hold GMC registration with a licence to practise

   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.

2. 2

   Secure a Responsible Officer / designated body

   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.

3. 3

   Sort statutory and mandatory training (CSTF)

   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.

4. 4

   Apply to NHSP + direct trust banks

   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.

5. 5

   Register with framework and off-framework 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.

6. 6

   Arrange indemnity beyond CNST

   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.

7. 7

   Plan for IR35 from day one

   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.

Documents to have ready

• GMC certificate of registration + licence confirmation
• Enhanced DBS certificate (Update Service preferred)
• Occupational health clearance + immunisation evidence (Hep B titre, MMR, Varicella, TB)
• CSTF training certificates (within 12 months)
• BLS / ILS / ALS certificates as appropriate to grade
• Appraisal summary and revalidation status letter
• Right to work documentation
• Two clinical references covering the last 3 years

Keep expiry dates tracked. Sessional sends reminders 30 days before each document lapses.

Common first-year pitfalls

• Revalidation drift because no single employer is pushing you toward appraisal
• Losing NHS pension continuity by switching from bank (pensionable) to agency (not pensionable) without realising
• Accepting shifts outside your credentialled competence because a ward was desperate. The GMC will not accept "I was told to" as a defence
• Underestimating trust cancellation rates. 15–30% of booked shifts get pulled inside 48 hours at some trusts
• Letting CSTF modules expire and losing a week of shifts while you re-do them