Getting started as a locum – Setting rates

Published on: 31 Mar 2022

Locum series 3Setting rates is probably the most ambiguous aspect of being a locum GP. No one seems to discuss what they charge, and local area rate averages are difficult to find. When I started in August 2021, I had no clue what I was doing. By March 2022, I was charging about 33% more

The rate hinges on the way you work. I book everything through NASGP, giving full flexibility. I set my fee, the number of patients, whether I do practice admin and whether I’m on-call. For each booking, the practice accepts my terms and conditions and if there are any quibbles, my T&Cs prevail and I have support from the NASGP team.

For a standard two-session booking with 26 to 30 patients, I’ve seen fees from £560 to £800+ per day, with pension paid by the practice on top. Work is currently plentiful, so you can afford to charge what you think is reasonable for what you’re doing and not worry too much.

Working through an agency or some booking platforms is quite different. One widely available platform has a ‘negotiate fee’ button. But that’s it. The important details like number of patients and whether you even get admin time aren’t to be found in most adverts.

When I messaged the platform’s helpdesk about this, I was told that locums can message each practice and ask them individually. That is seriously time consuming – it’s guaranteed that there’ll be a lot of back and forth and time wasted. This platform also has limited terms and conditions between the GP and practice in place either. Run into a problem with the practice and you could be in deep water. A practice usually enforces their T&Cs that you may not have been given before the booking and leave you high and dry.

Agencies, on the other hand, have more session information to hand and smoother processes. The remuneration is generally fixed because their agency fee doesn’t give much wiggle room. Again, there will be a lot of back and forth with booking each shift unless the agency can block-book you in one practice. There can also be issues regarding being able to claim pension.

Other types of work include private GP work, out-of-hours and hospital trusts in their ambulatory areas. Again, you may find that there isn’t much scope to determine your hours, pay or workload.

Whilst your headline daily rate could be anywhere between £500 - £800+, the take-home pay is often nothing quite like that - to be expected in any line of work.

An example £1,000 self-employed invoice could typically result in about £352.32 take home pay. This is based on:

  1. Having already earned £60,000 during the tax year so far from self-employment alone. This £1,000 income falls into the 40% income tax band and Class 4 National Insurance is at the reduced 2% rate as annual income so far is over £50,270.
  2. Student loan on Plan 1 - repaying at a rate of 9% of all monthly income above £1,657 a month or £19,884 a year.
  3. Class 2 and 4 National Insurance at 2021 to 2022 rates (set to change with the recent Chancellor’s Budget announcement).
  4. Paying into the NHS pension scheme at annualised rate of 14.5% (tier 7). The contribution rates are set to change in October 2022.

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The maths varies depending on your pension annualisation band, tax band, tax code and how much you’ve paid cumulatively for National Insurance. Once expenses are accounted for at self-assessment, you’ll get extra money back. It changes again if some or all income is through a limited company and you are drawing salary and/or dividends.

When deciding how much to charge you need to consider your expenses: indemnity (£520-£1000), medical and computer equipment, travel/vehicle costs, home office, GMC, BMA and accountancy fees, plus CPD/courses. You may want to consider income protection in case you were to become unwell during self-employment.

Once these are accounted for you will be in a good position to determine your rate. Online calculators could help you determine your session fee such as that provided by NASGP.

The Lockdown Locum is a locum GP in England, who wishes to write under a pseudonym