Guide | Urgent care locums
Out-of-hours and NHS 111 locum work: pay, pensions and indemnity
Out-of-hours and NHS 111 work runs on different rules from daytime locum work in a GP surgery. A GP's out-of-hours sessions are pensioned by the provider through the GP Solo process, not on Form A and Form B. In England, stand-alone out-of-hours services are covered by the state indemnity scheme for general practice, CNSGP, while NHS 111 is covered by CNSGP only when general practice provides it under a GP contract.
Pay depends on whether the provider employs you or you invoice as self-employed, which also decides how tax is taken and whether IR35 can apply.
Checked on against the primary sources listed at the end of this page.
What counts as out-of-hours work?
NHS Resolution defines the out-of-hours period as 6:30pm to 8am on weekdays, and all day at weekends and on bank holidays. Its scope table lists the settings: GPs working in A&E departments or urgent care centres, including minor injury units and walk-in centres; teams working in primary care centres; clinicians other than doctors making home visits after a clinical assessment; and ambulance services taking patients to be seen.
NHS 111 is the NHS service that can help when you think you need medical help now, including when a GP surgery is closed. Clinical roles in 111 and integrated urgent care vary by provider, so read the job description for what the shift involves and who employs you.
How is out-of-hours work pensioned for GPs?
Through the provider, not through you. PCSE says salaried work and work for an out-of-hours organisation are Solo work: the employer deducts your contribution from your pay, pays both employee and employer contributions to PCSE each month, and completes the annual GP Solo form. Individual GPs should not submit Solo contributions themselves. The BMA adds that the provider will ask you to check and sign the form.
NHSBSA's Form A for 2026/27 says the same from the other side: do not use it for self-employed out-of-hours or ICB work. GPs who worked as a type 2 in the year, including Solo work, also complete an annual Type 2 self-assessment form, and your contribution tier must take account of all your GP income. The NHS pension guide for locum GPs covers the freelance side.
Which indemnity covers out-of-hours and NHS 111 shifts?
CNSGP covers clinical negligence for GPs and staff working under an NHS GP contract in England. NHS Resolution's scope table, published December 2025, answers the urgent care cases:
| Work | Covered by CNSGP? | Why |
|---|---|---|
| Stand-alone out-of-hours primary medical services | Yes | Commissioned under an APMS contract |
| Integrated urgent care under a Schedule 2L APMS bolt-on to an NHS Standard Contract | Yes | Treated as primary medical services |
| NHS 111 provided by general practice under a GP contract or sub-contract | Yes | Provided under a GP contract |
| NHS 111 under an NHS Standard Contract | No | Generally covered by CNST when the contract holder is a member |
CNSGP is for clinical negligence only: it does not cover non-clinical matters, advice or professional regulatory matters such as a GMC investigation. NHS Resolution recommends cover from a medical defence organisation or other indemnity provider for matters outside the scheme, such as non-NHS work. Ask the provider which contract the service runs under, and confirm your cover with your defence organisation before the first shift. Our insurance guide for sessional GPs goes further.
Am I employed or self-employed for out-of-hours work, and does IR35 apply?
You may be engaged either way. If you are on the provider's payroll, tax and National Insurance are taken at source. If you invoice as a sole trader, you pay your own tax through self assessment. IR35 only comes in if you work through your own limited company: GOV.UK says a public sector body or a medium or large client usually decides your status, while a small private client leaves the decision to your company. Our IR35 guide for locums explains what the determination means for your pay.
What do out-of-hours and NHS 111 locum shifts pay?
Rates vary by provider, role, region, and whether the shift is overnight, at a weekend or on a bank holiday, and we do not quote a figure here without a dated source. Before comparing offers, check three things: whether the rate is employed or self-employed, whether it is hourly or per session, and whether pension contributions come out of it. Then compare with our benchmarks for locum GPs, nurses and paramedics.
How do I log out-of-hours shifts alongside GP surgery sessions?
In Sessional you can log hourly shifts next to fixed-rate sessions, and each shift carries a billing mode. Out-of-hours and NHS 111 sessions booked direct are usually self-invoiced, so they become invoices; shifts where the provider pays you through payroll are PAYE at source, so your tax reserve leaves them out. See agency and PAYE shift tracking.
Sessional pre-fills NHS pension Forms A and B for eligible freelance GP work on Plus and Pro. It does not produce GP Solo or Type 2 forms, because the provider handles Solo and the Type 2 form is yours to complete.
Reference notes | Questions
Frequently asked questions
Can I pension out-of-hours GP work on Form A and Form B?
No. NHSBSA's 2026/27 Form A says not to use it for self-employed out-of-hours or ICB work: the provider follows the Solo process. PCSE says the employer or OOH provider deducts your contribution, pays both parts over each month, and that individual GPs should not submit Solo contributions.
Does CNSGP cover me for out-of-hours work?
In England, NHS Resolution's scope table says stand-alone out-of-hours primary medical services are commissioned under an APMS contract and covered by CNSGP. It does not cover non-clinical matters or GMC and other regulatory matters, and NHS Resolution recommends separate cover for anything outside the scheme, such as non-NHS work. This is not indemnity advice: confirm with the provider and your defence organisation.
Does CNSGP cover NHS 111 work?
It depends on the contract. NHS 111 provided by general practice under a GP contract or sub-contract, including a Schedule 2L APMS bolt-on, is covered. NHS 111 provided under an NHS Standard Contract is generally covered by the Clinical Negligence Scheme for Trusts instead, when the contract holder is a CNST member.
Is out-of-hours work caught by IR35?
Only if you work through your own limited company. Then a public sector or medium or large client usually decides your status. Sole traders and employees are outside IR35, though employment status still matters for how you are paid.
What do out-of-hours and NHS 111 shifts pay?
Rates vary by provider, role, region and time of day, and we do not publish a figure here without a dated source. Compare offers with our rate benchmarks for GPs, nurses and paramedics, and check whether a quoted rate is employed or self-employed before comparing.
Put every shift in one record
GP surgery sessions, out-of-hours shifts and 111 work, invoiced or paid through payroll, in one place with your earnings and tax reserve. Basic is free with no card. Nurses and paramedics: see Sessional for nurses and Sessional for paramedics.
Sources
Each source below was read on unless it says otherwise. Rules and rates change: check the source before you rely on a figure, and tell us if something here is out of date.
- NHS Resolution, General Practice Indemnity scheme scope table for CNSGP and ELSGP (published December 2025), PDF: stand-alone out-of-hours primary medical services under APMS are covered; integrated urgent care under a Schedule 2L APMS bolt-on is covered; NHS 111 is covered when provided by general practice under a GP contract but generally falls to CNST under an NHS Standard Contract; the out-of-hours period is 6:30pm to 8am on weekdays and all day at weekends and bank holidays
- NHS Resolution, Clinical Negligence Scheme for General Practice (26 June 2025): CNSGP covers clinical negligence for GPs and staff working under an NHS GP contract in England, does not cover non-clinical, advice or professional regulatory matters, and NHS Resolution recommends other cover for matters outside it such as non-NHS work
- PCSE, GP Solo: that salaried and out-of-hours work is Solo work, that the employer or OOH provider deducts and pays the contributions, and that individual GPs do not submit Solo contributions
- BMA, the NHS pension scheme as a sessional GP (17 June 2026): that SOLO forms are completed by the organisation for type 2 work, and that type 2 forms are needed each year by GPs who worked as a type 2
- NHSBSA, GP locum Form A: 1 April 2026 to 31 March 2027 (ref 20260226 V1), PDF: the 90% pensionable rule, the 14.38% employer rate including the 0.08% levy, the 23.78% overall rate with HM Treasury paying 9.4%, the 10-week rule, no Form A for limited company income, and that out-of-hours work goes through the SOLO process
- GOV.UK, understanding off-payroll working (IR35) (updated 26 February 2026): that a public sector or medium or large client usually decides the worker's status, and a small private client leaves it to the worker's intermediary
- NHS website, when to use 111: what NHS 111 is for, including when your GP is closed (out of hours)
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