This locum agreements guidance is for locum GPs and the practices that engage them. Its aim is to help locum GPs to put together written agreements with the practices for which they work, and should also be of interest to practices that engage locums.
It assumes that the arrangements made will reflect the locum's status as a self-employed GP, and that the agreement will be a contract for services, rather than a contract of service, which would apply to an employee.
Why create a written agreement?
The BMA recommends that locum GPs and practices use a written agreement that sets out the terms of their engagement. Practices vary considerably in the way they are organised and in terms of what is considered a standard working day. Using a written agreement ensures that both parties' expectations are clearly set out and should help to create a successful working relationship.
This also ensures that the locum is working within their range of experience. The agreement is normally made between the locum and the practice manager or someone with delegated authority to negotiate (deputy manager).
However, receptionists should also be made aware of the exact terms of the agreement (though not necessarily the financial arrangements), particularly in relation to agreed workload.
The content of any locum agreement is subject to negotiations between the locum and the contractor. Email should allow efficient and effective liaison between the parties to ensure that there is a clearly worded, finalised agreement in writing before the locum starts work.
Areas to consider
Any agreement should include details of the fees agreed between the locum and the practice. This includes the basic fee for each session, a rate for additional work, on-call work and travel reimbursement.
We also cover the two approaches to determining a locum fee: time-based and workload-based.
Read more about locum fees
Timetable of work
The agreement should include specific details about:
- the number of sessions that will be worked per week
- the start and finishing times each day
- where on-call duties apply, the time until which the locum will be available by phone if not at the surgery - this could all be included in the form of an easy-to-use timetable within the agreement
- details of the number of appointments expected to be completed during a day
- appointment length
- visits and the cut-off time for notification of routine visits (ie from what time visits would be considered the responsibility of the on-call doctor).
Consideration should also be given as to whether the locum can be asked to accept extra appointments or not during the course of the working day.
Definition of core work
The agreement should include a definition of the work that the locum will be expected to carry out.
The agreement could include a general definition of the locum's core work, as well as a more specific list of the work that might be undertaken in addition to basic duties.
Read some of the things to consider when defining core work
Additional and enhanced services
The agreement should clarify whether there is an expectation to undertake work associated with additional and enhanced services, as defined in the BMA and the NHS Confederation publication 'New GMS contract 2003 - Investing in general practice'.
As with the definition of core work, if additional and enhanced services are to be carried out, the agreement should specify what services will be undertaken, eg minor surgery or IUDs. Following discussion between the locum and the contractor, details should be specified in the agreement and specific fees detailed.
Definitions of contractor and locum responsibilities
There are a number of basic responsibilities that may be outlined within the agreement, which the locum or contractor would be expected to fulfill.
This can include providing basic facilities for the contractor, and providing evidence of inclusion on a medical performers list and medical indemnity for the locum.
Read more about the responsibilities of the locum and the contractor
Arrangements for termination of the agreement
Arrangements for the termination of the agreement should be included, particularly if the locum is engaged by the contractor on a longer-term basis.
Where such arrangements are outlined within an agreement, they will often include the following:
- Details of how the parties can decide to terminate the agreement, ie by mutual agreement, or by providing a certain length of notice (acceptable to the locum and the contractor).
- If the agreement is terminated by the contractor and the agreed period of notice is not given, details of the fee claimable by the locum (for example, this fee could be based on the difference between the notice actually given and notice that should have been given according to the terms of the agreement).
- A clause stating that the agreement can be terminated if its terms are breached by either party.
The BMA, including the GPC does not provide any form of tax advice, including advice on direct or indirect taxation and national insurance contributions, to its members as part of its membership offer.
This guidance assumes that the locum GP is self-employed for tax purposes. Before signing any agreement, both parties should be satisfied of the locum's self-employed status. While the Employment Status Indicator on the HMRC website may help, independent, professional tax advice should be taken if either side has any doubts as to the locum's taxable status.
Practices should be aware of the potential for a regular, long-term locum to gain employment rights. Furthermore, locums should be aware that if they are supplied through an agency, they may be employed by the agency, rather than self-employed.