Getting Started as a Locum GP: The Complete Checklist

1. The checklist at a glance

Most of this is a one-off afternoon of forms, though a few items, such as the performers list change and indemnity, have to be done before you work a single session.

2. The GP Register and the performers list

Two registrations let you work in NHS general practice, and you need both on day one.

The GMC GP Register

It is a legal requirement to be on the GMC's GP Register to work in NHS general practice in any capacity, including as a locum. Getting there takes two applications:

• To the RCGP, through your ePortfolio, which checks your training evidence and recommends you for a CCT. Allow the RCGP around 15 working days.
• To the GMC, through GMC Online, which checks that recommendation and adds you to the GP Register from your CCT date. The application fee is £516 from April 2026.

Apply to both ahead of your final day, so the entry is in place when training ends. You can check it yourself on the GMC's medical register.

The performers list

You cannot provide NHS primary medical services in England without being on the Medical Performers List. As a registrar you should already be on it with the performer type GP registrar. If you are not, PCSE asks registrars to apply between six and three months before CCT.

After CCT you change your status, rather than applying again:

1. Wait until your GP Register entry date is visible on the GMC register.
2. Log in to PCSE Online and choose Performer Type from the performer home page.
3. Change it from GP registrar to GP performer.

That change sets your status to "registered with licence", which is what indicates you are working as a locum. It does not update your employment details, so if you also take a salaried post, add the practice under Employment Details separately.

While you are in PCSE Online, set your region to where you will do most of your sessions. That decides which appraisal team looks after you (section 9).

Outside England, Wales, Scotland and Northern Ireland each run their own performers list. The principle is the same; your deanery or health board will point you to the right one.

3. Indemnity

In England, NHS clinical negligence claims are covered by the state. The Clinical Negligence Scheme for General Practice (CNSGP) has covered everyone delivering NHS primary medical services since April 2019, and that includes locums. Wales has its own state-backed scheme. You do not buy that cover and you cannot opt out of it.

What it does not cover is most of what a defence organisation is actually for:

• GMC fitness to practise investigations
• Inquests
• Complaints, including to the ombudsman
• Disciplinary and contractual disputes
• Private work, such as insurance medicals, cosmetic or occupational health sessions
• Good Samaritan acts, like the collapse on the plane

So you still need membership of a medical defence organisation, usually the MDU, MPS or MDDUS. Tell them you are a newly qualified locum GP, say whether you do any private or out-of-hours work, and ask about newly qualified rates. Practices will ask to see the membership certificate, so keep a PDF of it in your compliance pack.

The subscription is an allowable business expense.

4. The paperwork practices will ask for

Before a practice books you, the practice manager will want to see proof that you are safe to put in a room. Having it ready as one set of PDFs, a compliance pack, gets you booked faster than chasing documents after every enquiry.

Two practical requests for every new practice: logins to their clinical system and any local systems, sent before the day rather than sorted at 8am, and an induction pack covering referral pathways, prescribing formulary, safeguarding contacts and who to call for help.

5. Your terms, and finding work

Put your terms in writing

Every booking is a contract, and it is worth having yours written down before a practice sends you theirs. The BMA publishes a locum practice agreement you can start from. Whatever you use, the terms should cover:

• What a session includes: its length, the number of patients, and whether visits, results, letters and prescriptions are part of it
• Your fee, and whether the employer pension is on top (it should be, see section 8)
• Cancellation: the notice a practice must give, commonly 7 or 14 days, and what is payable inside it
• Payment terms: how many days the practice has to pay your invoice
• Extra work: what happens if a session overruns

Send them with your booking confirmation, so there is no room for a later dispute about what was agreed.

Finding sessions

Most new locums use a mix of routes:

• Practices you trained in or near, which already know your work
• Booking platforms such as Lantum, where you set your rate and invoice the practice directly as a sole trader
• Chambers and sessional GP groups, which offer bookings, admin help and peer support
• Local locum WhatsApp groups, where practices post sessions

Check how each route handles your pension before you sign up. Direct bookings and chambers can be pensioned; most agency work and anything through a limited company cannot.

6. HMRC and setting up the business

As a trainee, tax, National Insurance, student loan and pension all came off your pay. As a locum you are a sole trader: practices pay your full invoice, and working out and paying each of those is now your job.

Register as self-employed

Register for Self Assessment as a self-employed sole trader. The legal deadline is 5 October after the end of the tax year you started in, so 5 October 2027 for work started in 2026/27, but register as soon as you start. The Unique Taxpayer Reference arrives by post, and you will want it long before the deadline.

Two bank accounts

1. A business current account. Every fee in, every business expense out. It does not have to be a business-branded account for a sole trader, but it must be separate from your personal spending.
2. A savings account for tax. Move a fixed share of every invoice into it the day the practice pays.

Set aside 30% of every invoice for income tax and Class 4 National Insurance, or 35% if you are repaying a student loan. That is deliberately generous in your first year, because your first tax bill, due 31 January 2028 for work done in 2026/27, includes a payment on account for the following year and arrives at around one and a half times what you might expect. The GP locum tax guide works through why, with worked examples, and the locum tax calculator gives you your own percentage.

Records, software and Making Tax Digital

Keep every invoice, receipt, mileage log, pension Form A and Form B (see below), for at least five years after the filing deadline. The GP Locum app makes this easy.

Making Tax Digital for Income Tax already applies to sole traders with more than £50,000 of qualifying income, and the threshold falls to £30,000 from April 2027 and £20,000 from April 2028. A genuine first year is not caught, because the test looks at a tax return you have not filed yet, but most full-time locums will be within two years. Start with software that can do quarterly updates, rather than a spreadsheet you will have to move later. The Making Tax Digital guide for locum GPs covers the deadlines and filing routes.

An accountant

Not compulsory, but a specialist medical accountant usually earns their fee in the first year alone, on the pension relief claim, annualisation and the travel rules. The fee is an allowable expense.

Insurance you no longer get from an employer

• Income protection. There is no sick pay. A week in bed is a week with no income, and a long illness is far worse.
• Business use on your car insurance, if you drive between practices. Ordinary commuting cover may not include it.

7. Invoicing

Invoice each practice promptly, ideally on the day or at the end of each month, and make every invoice complete enough that nobody has to email you back:

• Your name, address and contact details
• The practice's name and address
• A unique invoice number and the invoice date
• The dates and sessions worked, with the fee for each
• The pensionable value and the employer pension contribution, on separate lines, if you are pensioning the work
• The total due, your payment terms and your bank details

The pension lines matter. PCSE expects invoices to show the employer contribution as a separate charge, and a practice cannot validate your Form A against an invoice that hides it in a single figure.

Chase late payers early. The 10-week pension deadline runs from the date you worked, not the date you were paid, so an invoice sitting unpaid for two months does not buy you any more time on the Form A.

The GP Locum app raises invoices from the sessions you log, with the pension lines already split out.

8. The NHS pension: Form A and Form B

You were a member of the NHS Pension Scheme as a trainee, and you stay in it as a locum using the same membership number. What changes is that no payroll does it for you.

The monthly routine, per practice:

1. Tell the practice at booking that you will pension the work. If you later decide not to, you must give them back the employer contribution.
2. Invoice the employer contribution on top of your fee. Your pensionable pay is 90% of the fee, and the employer contribution is 14.38% of that, so 12.94% of the fee. On a £500 session, that is £64.71.
3. Get a Form A validated by the practice for the work, either through PCSE Online or by sending it with your invoice.
4. Submit a Form B each month, summarising all your Form As.
5. Pay both contributions to PCSE by the 7th of the following month: the employer contribution you collected, plus your own. Most locums pay the top tier of 12.5%, because locum contributions are annualised.

Three rules that permanently cost new locums pension if they miss them:

• The 10-week rule. Work that ended more than 10 weeks ago cannot be pensioned, and in practice the window is shorter, because the Form A travels with the monthly Form B.
• Limited companies. Work invoiced through a company is never pensionable.
• Out-of-hours work is not locum work for pension purposes. It is pensioned as a Type 2 practitioner, on different forms, with a Type 2 form at year end.

The locum GP pension guide covers annualisation, the day-counting rules and both submission routes in full. The GP Locum app fills your Form A and Form B from the sessions you log, and keeps the 10-week deadline in front of you.

Your employee contributions also get tax relief, but only if you claim them on your tax return, so keep every Form B.

9. What to charge

This is the question every new locum asks first, and the one nobody will answer with a number. The BMA does not publish a locum rate, because recommending what self-employed GPs should charge risks breaching competition law. Your rate is yours to set.

What you can do is work out what a session has to pay you. Start from the one published figure, the salaried GP pay range, which for 2026/27 in England runs from £78,699 to £118,759. On the BMA model contract, a full-time salaried GP works nine sessions a week and gets eight weeks of paid leave a year, which makes that range worth roughly £199 to £300 for each session actually worked, with leave already paid for.

A locum fee has to cover things that salary does not:

• Leave and bank holidays, all unpaid
• Sickness, with no sick pay
• Study leave, CPD and course fees
• Indemnity and professional fees
• Running the business: accountant, software, phone, insurance and the hours spent on invoices and pension forms
• Gaps between bookings

The employer pension is not one of them. It is the practice's to pay, on top of your fee, and the BMA's guidance for practices says they must not cut a locum's fee to avoid paying it.

Then weigh what varies between bookings: the length of the session and number of patients, visits and admin, short notice, and whether the practice is one you know.

To see what NHS locum sessions have actually paid, the anonymous GP locum rates survey shows the ranges by region and kind of work, and the GP locum rates guide explains what competition law lets locums share.

Two calculators do the arithmetic:

• Session rate calculator. Works backwards from the take-home pay you want, through your expenses, weeks off, tax and pension, to the rate you would need to charge.
• Salaried vs locum calculator. Compares a salaried post with a locum rate like for like, including paid leave, pension and benefits, and gives the break-even locum rate.

10. Appraisal and revalidation

As a trainee, your deanery handled revalidation. After CCT it moves to your designated body, which for a locum GP in England is NHS England, through the performers list. Its responsible officer allocates your appraiser and makes your revalidation recommendation to the GMC.

• Your first appraisal should be within the first year after CCT. Your CCT marks the start of a new five-year revalidation cycle. Hurrah(!)
• If nobody has contacted you within about six weeks, get in touch with your regional appraisal team. Having an appraisal each year is your responsibility, not theirs.
• The region is the one set on PCSE Online, which should be where you do most of your sessions.

Locums find some of the supporting information harder to collect than salaried colleagues do, so start a portfolio from the first week:

• CPD, with a line on what you learned and changed.
• Quality improvement and significant events. Ask practices to include you when an event involves your patients.
• Colleague and patient feedback. Patient feedback is needed once per revalidation cycle, and is harder when you rarely see the same patients twice. The RCGP's advice is to tell your responsible officer if you are struggling to get replies.
• Complaints and compliments, which you must declare truthfully.

Frequently asked questions

Can I start locuming the day after CCT?

Yes, if you are on the GMC GP Register and the performers list. You are added to the GP Register from your CCT date once the RCGP and GMC applications are complete, and GP registrars are already on the performers list, so the change of status to GP performer can be made on PCSE Online as soon as your GP Register entry shows. Have indemnity in place before the first session.

Do I need medical indemnity as a locum GP?

In England, NHS clinical negligence claims are covered by the state-backed Clinical Negligence Scheme for General Practice, and Wales has an equivalent. It does not cover GMC investigations, inquests, complaints, private work or Good Samaritan acts, so you still need membership of a medical defence organisation such as the MDU, MPS or MDDUS.

When do I have to register with HMRC as a locum GP?

By 5 October after the end of the tax year you started in, so by 5 October 2027 if you start locuming in 2026/27. Register as soon as you start: you need the Unique Taxpayer Reference it produces, and it arrives by post.

Can I pension my locum work?

Yes, if you work as a sole trader on the performers list. You tell the practice you intend to pension the session, invoice the employer contribution of 14.38% of 90% of your fee on top, and submit a Form A and a monthly Form B with both contributions by the 7th of the following month. Work that ended more than 10 weeks ago cannot be pensioned, and work through a limited company never can.

What should I charge as a new locum GP?

Nobody can tell you a going rate: the BMA does not publish one, because recommending what self-employed locums charge risks breaching competition law. Work out what a session needs to pay you once tax, pension, unpaid leave, indemnity and business costs are covered, compare it with the salaried GP pay range, and set your own fee.

Do I charge VAT on locum sessions?

No. Medical care provided by a registered doctor is exempt from VAT, so locum surgery sessions carry none. Some non-clinical work, such as certain reports, can be taxable, and only matters once it passes the VAT registration threshold.

Who does my appraisal as a locum GP?

In England, being on the performers list connects you to NHS England, whose responsible officer arranges your appraiser and makes your revalidation recommendation. Set your region on PCSE Online to where you do most of your sessions. Your first appraisal should be within the first year after CCT; if nobody has been in touch within about six weeks, contact your regional appraisal team.

Sources

Checked 15 September 2026. Where a primary source disagrees with anything here, the primary source wins.

• GP registrars completing training, PCSE: changing performer type after CCT, and the default locum status
• Assessment and award of CCT, RCGP, and Specialist and GP application types, GMC: the two CCT applications
• Getting ready to qualify as a GP, Wessex LMCs: the GP Register requirement and the first revalidation cycle
• Clinical Negligence Scheme for General Practice, NHS Resolution: who the scheme covers
• Insurance, indemnity and medico-legal support, GMC
• BMA locum practice agreement, BMA: terms for a locum booking
• Navigating the appraisal process as a locum GP and Performers list, RCGP: designated body, region and supporting information
• Register for Self Assessment and Making Tax Digital for Income Tax, GOV.UK
• Salaried GP pay ranges, BMA: the 2026/27 figures
• Locum pension contributions: guide for GP practices, BMA: the employer contribution paid on top of the fee
• GP locum Form A and Form B, NHSBSA: the 90% rule, the 14.38% and the 10-week rule

A note on advice

This guide is general information for GPs starting locum work in England. It is not legal, tax, financial or insurance advice, and it is not a recommended rate. Registration and indemnity requirements differ in Wales, Scotland and Northern Ireland. Check with PCSE, the GMC, your defence organisation and a specialist medical accountant before acting.