Locum chambers FAQs

What are the benefits for locums working in chambers? 

1. Help with the administrative side such as bookings, (which is all done through a chambers managers which accesses individual member’s diaries), invoicing, completing superannuation forms and chasing payments.
2. The chambers manager will ensure the engaging practice provide adequate induction and will deal with any issues of practices expecting additional unremunerated work over and above the agreed fee schedule.
3. A set fee structure reduces the needs for negotiation over workload and fees and removes the stress of being pressurized to do more work than you can manage or have agreed.
4. Provision of professional support though chambers educational and SEA meetings.
5. Assistance from chambers manager in obtaining evidence for appraisal and revalidation (feedback, surveys and audits).
6. Being seen as part of an organisation with an established reputation. Chambers recruit and interview new members which helps to set professionals standards.
7. If you need to cancel due to an emergency, the chambers may often be able to arrange a substitution at short notice.
8. You can still superannuate your locum income, as long as payments are still made directly to locums.
9. Members can still choose not to work in certain practices.
10. Some medical indemnity providers may offer a discounted rate to locums working as part of chambers (compared to those working freelance).

 

What are the disadvantages for locums?

1. Members of chambers pay usually a set percentage of their income to the chambers (this can vary according to the chambers’ organisation, whether it is newly established or whether the Locum GP may also carry out a lead role in the chambers).
2. Setting up chambers requires time and energy by the founding members, unless they are set up as a satellite to an existing set of chambers.
3. Members usually work to the same fee schedule (set number of patient for a set fee) so individuals who don’t like the set schedule may find this constricting.
4. As a legal entity there may be legal challenges ahead (eg it is unclear whether to operate as a “single undertaking” all individuals would have to be jointly liable for each other’s tax).
5. Many chambers insist on exclusivity of locums, therefore restricting the ability to work outside the chambers. It is important to check the policy with the chambers before joining.
   
   

Chambers generally have a formal recruitment process which usually includes interviews thus ensuring a minimum quality standard.  This is maintained by assisting regular feedback from practices and supporting CPD and appraisal of its members. Chambers provide a single point of contact for reaching several locums. They also ensure important information about local services and guidelines are cascaded to locums. Chambers may also be able to mobilise cover for a sick locum at short notice so the practice has more protection from the inconvenience of cancelled locums.

Price fixing is a complex issue which needs careful thought when deciding to set up a locum chambers. The below guidance is based on the principles of competition law, as it relates to locum GP chambers, however it is advisable to seek individual legal advice based on your specific requirements and circumstances.

GP locums working as a chambers often agree a fee schedule or locum rates, and terms and conditions, removing the need for individual locums to negotiate rates.

Whether locums working as a chambers are seen as price-fixing and operating as a cartel is mainly dependent on whether they are considered to be a single undertaking (where a fixed price is permitted) or multiple undertakings (where price fixing is not permitted).

The main consideration when deciding if an entity is a single undertaking, is how payment is made. If payment is made from the practices to one place for all locums (ie a central chambers administration/joint bank account) then they are more likely to be regarded as a single undertaking.  However, as stated below, only those who receive payment directly from a practice can superannuate that income.

If payment is made from practices to individual locum GPs then they are more likely to be considered to be multiple undertakings and therefore should not fix prices.

Some chambers choose not to fix prices and therefore the locum members are paid directly by the practice and can superannuate their income. This means that locum members negotiate their rates on an individual basis.

If you are thinking of joining a chambers you should investigate the setup of that chambers, what works best for you, understand the implications of joining and how to mitigate any risk.

If you are thinking about setting up a locum GP chambers it is advisable and important to seek legal advice about the specific set-up to ensure compliance with competition law. Breaking competition law is a serious offence which can carry a fine of up to 10% of annual turnover, up to five years imprisonment, disqualification from managing a company for up to 15 years, and reputational damage to yourself and the chambers. For further information, including how to identify and how to mitigate risk, please read this short guide to competition law risk.

 

Further guidance

• Relevant guidance on cartels
• Important test case of anaesthetist’s chambers
• Further information about competition law
  
  

This would depend on how the chambers is set up, but generally the expectation would be for a percentage of the fee for your work to be paid to the chambers, rather than a fee being payable to join.

Most chambers organise education and SEA meetings however, as an individual GP you will remain responsible for ensuring that you carry out appropriate CPD to keep up to date and meet the requirements of appraisal and revalidation.

Many of the challenges faced by locum GPs in relation to revalidation and appraisal relate to locums being isolated from other GPs and also from the organisational structures that come with working in a practice on a regular and continuing basis. These challenges are referred to in our guidance on revalidation and appraisal for sessional GPs.

Being part of a chambers can help with this in two main ways. Firstly, it can help locums to feel less isolated with, for example, meetings to discuss significant events or less formal discussions which help locums learn from their experiences. Secondly, the organisational structure provided by the chambers can help locums collect the information needed for appraisal and therefore revalidation purposes – a prime example is patient feedback and colleagues who are readily available to provide colleague feedback.

While the chambers model can provide this help and support, we do not believe that the appraisal and the revalidation processes should be structured around the assumption that locums will be part of a chambers organisation. Due to lobbying from the sessional GPs subcommittee the requirements in the RCGP’s revalidation guide were amended to reflect the way in which sessional GPs work, and this is reflected in our guidance for sessional GPs.  Some of these issues are also addressed by a locum GP being part of a Sessional GP group.

Working in a chambers does not impact on who is responsible for locums’ NHS appraisal. All NHS GPs have to be on NHS England’s performers list in order to carry out their work, and NHS England is responsible for carrying out appraisal for all GPs on its performers list.

This will depend on the rules within which the chambers operates, but we are aware that some chambers require members to work a minimum number of sessions per week.

Our locum GP handbook outlined a number of pros and cons of working within different locum arrangements, as below:

	Pros	Cons	Other Considerations
Working as a sole trader	Most independence Can retain whole fee with deductions only for tax and superannuation	Administrative burden - invoicing /superannuation Professional isolation Difficulties with access to education and SEA meetings (freelance/locum GPs need to engage with peer review for the purposes of appraisal and revalidation, therefore may be harder unless you are in a CPD/learning group) Have to build up your own reputation and customer base when you start	If you employ any staff to help you, you must ensure you comply with employment law Be certain that any work you undertake is correctly designated and treated as self-employment or employment
Working for a locum agency	Will help you find work Can considerably reduce the administration involved in locum work You only need to present your certificates once to the agency not to every practice	May limit your freedom to contact practices yourself in the future Agency income is not pensionable under the NHS pension scheme	It is possible that you will be considered an employee when working for a locum agency For further details please see the BMA’s guidance on the agency worker regulations
Joining Chambers	Reduced administration Support with education and appraisal Less isolation Advocacy of chambers manager protecting you from exploitation Set fees mean no negotiations needed and may allow increased bargaining power Provides you with a corporate identity if you are new to an area and have to build up your customer base If operating under a legal structure which makes the chambers a single organisation, could increase your bargaining power with providers	Cons depend on the arrangements and legal structures in place Will probably lose some independence May be restricted to work exclusively with the chambers % of fee goes to chambers May be constrained by fee structure (which is linked to a set workload) Can’t accept work outside the chambers; May have to agree to work a minimum number of sessions per week	Particularly important to ensure that you do not break competition law. See below question on legal structures.

Locums who are members of Chambers, so long as they are paid directly by a surgery,  can superannuate their temporary or deputising GMS/PMS surgery based locum earnings, and also earnings in respect of work undertaken for a ‘classic’ (i.e. GP led) APMS surgery that qualifies as a NHS Pension Scheme Employing Authority.  

A freelance GP locum who trades as a limited company cannot ‘pension’ their income.

Long term practice fee based work is type 2 Practitioner work, not GP Locum work, in NHS pension terms.

A GP locum must declare at the outset if they intend to superannuate their income.

In order to superannuate their income a GP locum:

• Must be on a Medical Performers List and working as an individual
•  Must be deputising, or providing additional cover, in a GP practice on a temporary basis
• Must be performing appraisal work under a contract for services; i.e. fee based
• Must send forms A and B and all NHS Pension Scheme contributions to their area team (England) or LHB (Wales) within the 10 week window

 

A GP locum who wants to superannuate their NHS income must take the following steps:

1. Obtain forms GP locum A and B and read the guidance notes carefully
2. Ensure the commissioner (i.e. surgery) completes their part of form A
3. Ensure that they collect the employer contributions from the commissioner
4. Forward forms (A and B) and all contributions to their NHS Pension Scheme Employing Authority on time; i.e. no later than the seventh day of the month following the end of the month covered by the form GP locum B

 

If a GP locum informs a surgery, area team, or LHB that they are going to superannuate their income however it transpires that they do not (for whatever reason), they must return the employer contributions. It is illegal to keep the employer contributions.

GP locums are subject to the same tiered employee contribution rules as other GPs. They must ensure at year end that they have paid the correct tiered rate ‘across the board’. The commissioner (i.e. surgery) must, in law, pay the NHS Pension Scheme employer contributions.

There is no liability on a surgery, area team, or LHB to pay the employer contributions if a GP locum is not superannuating their income.

GP locums are afforded ‘Locum Practitioner’ NHS Pension Scheme status. If they continue to submit forms GP locum A and B will have continuous NHS Pension Scheme membership. If they fail to submit forms GP locum A and B for three calendar months, NHS Pension Scheme membership ceases at the point when they last performed pensionable work. Freelance GP locums are not afforded the same rights in respect of pensionable sick pay, maternity/paternity pay, and life assurance as other GPs.

Freelance GP locums cannot ‘pension’ income in respect of work undertaken for an Independent Provider (IP) even if that IP holds an APMS contract.

If you encounter any difficulties or have any queries about this then please visit the Locum GP Handbook or contact us ([email protected]).

 

For example, partnership or company limited by shares.

It is important that locums considering setting up chambers consider the implications of the use of different legal structures to do this.

The implications of putting different legal structures in place are explained in detail in Appendix 4 of our locum GP handbook, and we would advise anyone considering setting up a chambers to read through this guidance before doing so. Setting up locum chambers should also only be done with expert legal and accountancy advice. Whatever arrangements are put in place for establishing ‘chambers’, those involved should understand their legal and tax responsibilities.

It is important that locums entering into new business ventures are aware of relevant GMC guidance on, for example, financial interests and advertising as well as relevant law such as competition law.

It is important for those establishing ‘chambers', as well as individual locum GPs wishing to join ‘chambers’, to contact their accountant or an independent financial advisor to discuss tax, national insurance and superannuation implications.

• Locum GP handbook – BMA
• GP Locum Chambers – NHS information
• GP Locum Factsheet – NHS Business Services Authority
• GP Locum chambers advice – National Association of Sessional GPs
• Cumbria Medical Chambers
• Freelance GP Chambers
• Greenfields Medical Chambers
• Manchester Medical Chambers
• North East Medical Chambers
• Pallant Medical Chambers
• Sterling Medical Chambers
• Yorkshire Medical Chambers