As a locum, your earnings have to cover holiday and sickness leave, medical indemnity, use of your own business equipment, accountancy fees, travel costs, and the upkeep of your medical supplies. While this all needs to be borne in mind when negotiating your fee, at the end of the day, fees come down to supply and demand and vary greatly from one area to the next.

If you have the opportunity to ask existing locums for ‘the going rate’, this is perhaps the best policy. Some practices have a fixed amount they are willing to pay in all cases; others will be more open to negotiation.

Perhaps initially, it’s more important to just get some work and for you to be comfortable doing that work. You can always optimise your fee structure later and, once you’re established, you’ll find many practices will pay more for locums they know and trust.

While there may be a going rate for each area, it can be specified in different ways:

A time based approach

A fee is agreed for a specified duration of work, and extra time worked will incur further charges.

A workload based approach

A fee is agreed for a set amount of work, irrespective of how long it takes to complete. This is the more common method. A typical agreement might take the following form:

15 patient surgery

6 patients

  • Catch up break of x minutes

6 patients

  • Catch up break of x minutes

Then either 3 more patients or a visit

Sometimes additional visits may be undertaken at a fixed fee per visit.

If you aren’t able to do extra visits, it may help to state this up front.

On top of this, you may wish to consider:

  • If you are happy to sign repeat prescriptions, check pathology results and secondary care correspondence? If you are, will this be done in a block of ‘admin time’ at the end of the surgery, perhaps in place of a visit or for an additional fixed fee?
  • Who keeps the fees for any private services (crem forms, HGV medicals etc)?
  • Is visit mileage reimbursed or included in your fee?

Rates for on call work usually differ and it’s common to have a different structure for this kind of work.

As with overall fees, your surgery structure can be refined over time as you gain in confidence and see how the ground lies.

Terms and conditions

A terms and conditions document, sent to the practice as part of the acceptance of the booking can be really useful in avoiding misunderstandings and disputes after the event. Many locums will not work without such an agreement being in place.

It should contain the duties that you are prepared to undertake as a part of a workload approach or a sessional or hourly rate as part of a time based approach.
In addition, you should always protect yourself with:

A cancellation clause

If a practice cancels your booking at short notice, you may not be able to find alternative work in time and will suffer loss of income. It is only fair that you are compensated for this. The normal form is:
Cancellation within x weeks – no charge

Cancellation within y weeks – ½ agreed basic fee

Cancellation within z days – entire fee is payable.

Practices will often have a similar terms document with charges which you will have to pay if you cancel at short notice.

You should also make it clear that if you attend for a surgery arranged for x hours and that surgery is then curtailed by the practice (for example, if it’s a quiet day), then you still expect to be paid the full amount.

It’s good to be flexible and you can always waive a charge or reduce it if you can work something out with the practice, but having these terms in place will protect you where that’s not possible.

Late payment fee

Many locums specify that invoices must be paid in 14 days or 30 days to avoid a surcharge of, say, £25 or 10%.

It’s not just your cash flow which is at stake here. If you’re pensioning your work, you can’t make your contribution until you’ve been paid, and in England, Wales and Northern Ireland, you only have 10 weeks from the date that the work was performed to submit your pension forms. Pension contributions relating to older work won’t be accepted and then you’ll have to refund the practice their employer’s pension contributions – a real pain which is best avoided!

Prompt return of your ‘Pension A’ form

A ‘pension A’ form, stamped by the practice, is required to pension your work so, pension-wise, it’s just as important as being paid on time.

Confirm your bookings

Once you’ve agreed terms, it can be helpful to confirm in writing to avoid misunderstandings. In Locum Organiser, once you’ve entered your bookings in your diary, you can email the practice a booking confirmation showing all future sessions you’ve arranged with them. You can append your T’s & C’s document to this so everyone’s on the same page. Job done.

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