Search the website

Guidance for negotiating fees for locum services in general practice

January 2007

Detailed factors to consider during negotiations to agree fees
Identifying what other GPs earn
Primary medical services providers who are also GPs provide a benchmark against which GPs’ incomes may be compared. This may take into account the average superannuable income of GP providers and the figures published by the Doctors and Dentists Review Body (DDRB) for salaried GPs.

Medical experience and skills held by the locum
Postgraduate qualifications, background skills (eg familiarity with local healthcare systems), knowledge of the local geography of the practice area, as well as the actual contracting practice itself, may all add to a locum’s increased value.

Local training in primary and secondary care and experience in general practice (including experience as a principal) will also add to the skills of a doctor to a practice; clinical experience may well prove more applicable than previous management skills.

Experience increases with the length of service as a GP. This cumulative experience may be reflected in the rates charged.

Working environment
A locum will sometimes be engaged in a working environment in which they are unfamiliar. Such a position means that the high standards of care the locum should aspire to may be difficult to obtain. Experience of working in these situations is therefore highly valuable and may be reflected in the fees set. When discussing and negotiating a level of payment for the session of work required, both parties should consider the type and intensity of the work and ensure that this is reflected in the level of the fee.

Factors that should be considered may include:

• large volumes of high workload patients, eg patients in nursing homes, the homeless, asylum seekers, those with drug misuse problems etc
• familiarity with practice procedures, eg ordering investigations, referring patients to secondary care
• familiarity with practice equipment, eg computer systems
• availability of practice partners for advice, support etc
• the type of session, eg open access, booked appointments, enhanced service provision
• practice staff support, eg availability of practice nurses

and any other factors that could have an influence on the degree of intensity experienced within a worked session.

It should be noted that the difficulties of an unfamiliar working environment can be helped with the introduction of a practice induction pack.

Job security
By being self-employed, locums have taken the risk that if they fall ill, take time off for family reasons, take any form of holiday or study leave, or have unfilled sessions, they will not get paid.

Expenses incurred by locums (see additional paragraph below*)

Locums will have to pay many of the following expenses:

• subscriptions to professional organisations including the GMC, medical defence organisations and the BMA. There may also be fees for the RCGP, the local medical committee, (LMC), the NASGP and other professional organisations
• accountancy costs
• office costs including revenue costs such as office rental (if applicable), a proportion of council tax and water charges, lighting, heating and cleaning costs and consumable items including postage and secretarial costs and capital costs such as furniture including desk, filing systems and other furnishings
• telecommunications including: mobile telephone, landline rental and calls, internet access, answer phone services, faxing and paging costs
• information technology including: personal computer, modem, printer and scanner, website (if applicable), invoicing, bookkeeping and accounting systems, general administration, including booking systems
• travel expenses, if applicable, including fuel and the costs of wear and tear on vehicle used. When requested to work outside their usual area it would be appropriate for the locum to agree rates with the practice for attending surgery and visits to patients
• appraisal costs (while local GPs should receive a contribution towards the cost of their NHS appraisal from their PCO, this might not cover the full costs).
• course fees.

* Self employed locum GPs should be registered with HM Revenue & Customs as a business and the profits of their business subject to schedule D income tax. As a self employed tax payer they can claim some of the above expenses as a deduction against income including, for example, subscriptions and course fees. It is also possible to claim a portion of the cost of capital assets acquired such as computers and printers as a taxable deduction against income. It is important to appreciate that not all costs to be used in calculating locum fees are tax deductible for schedule D income tax purposes. The treatment of capital and revenue expenses against income tax for self-employed doctors must be in accordance with current UK taxation law and professional advice should
be sought where necessary.