Hiring locum GPs: the fees, responsibilities and negotiations

Our guidance for employers includes factors to consider when employing a locum – responsibilities, negotiations and what to pay

What all locums must have

• All locum doctors must have the same training and postgraduate medical education and training board accreditation certificates as the medical provider they work for.
• All doctors must be included on one performer’s list in the country in which they practise.
• Doctors can only be registered on one performer’s list in each country.
• It is in the GP practice’s interest to support trained and qualified locums so that they can cover for annual, maternity, sick leave or management time.

Negligence

GP practices are responsible for any negligent acts of locums providing cover for them; this is only when these acts are related wholly to the services that are being provided, and not something that is outside the remit of what is expected of the locum in the ordinary course of providing those services.

Locums are required to practise under the GMC guidance Good Medical Practice. GP practices have some responsibility to support their locums to maintain their professional skills. For example, it is the responsibility of the GP practice to have insurance cover for the practice as a whole; this would include the negligence of locums providing services.

Who is involved in negotiations?

Contractor: any person or organisation entering into a contract to provide primary medical services.

Performer: a healthcare professional who assists with the provision of primary medical services under a GMS, PMS, alternative provider or primary care medical services arrangement. There are equivalent arrangements under Scottish, Welsh and Northern Irish legislation where the terms differ.

Provider: a person or organisation who contracts to provide primary medical services with a primary care organisation under arrangements to provide general, personal, alternative provider, or primary care trust, medical services; there are equivalent arrangements in Scotland, Wales and Northern Ireland.

Deciding on a locum GP’s fee

What is a session?

A locum session is an agreed period of time, or agreed task of work, usually around four hours. A session should include adequate time for administrative work arising as a result of clinical contacts in that time.

Each session length and content has to be negotiated and agreed with a realistic assessment of work involved. Any additional administrative workload is negotiable with the contracting organisation.

Deciding a fee

The fee paid to the locum GP must take into account all duties performed during their session. When deciding a fee you should consider:

• self-employed locums have to bear similar professional costs of practice as other GPs;
• what other GPs earn; 
• postgraduate qualifications;
• background skills (eg. familiarity with local healthcare systems);
• knowledge of the local practice area and practice;
• local training in primary and secondary care, and experience in general practice (including experience as a principal);
• experience increases with the length of service as a GP – this cumulative experience may be reflected in the rates charged;
• job security – locums take the risk that if they fall ill, take time off for family reasons or take leave, they won’t be paid;
• previous experience of working in a similar practice or situation;
• the type and intensity of the work – read below.

What is your practice like?

Consider the impact of the following in making an assessment of the work environment:

• 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.