Locum work keeps the NHS and private healthcare running, but the contracts signed by locum doctors, nurses, pharmacists and dentists are often hurriedly drafted by agencies and practices — and occasionally by practices with no legal input at all. For the locum, three things matter above everything else: tax status (IR35), indemnity cover, and cancellation terms. A misstep on any of these can mean an unexpected HMRC bill, personal liability after a clinical incident, or a week of lost earnings.
What is a Healthcare Professional Terms?
A UK locum agreement is a contract for the provision of professional healthcare services on a temporary basis — directly with a practice, trust, or through an agency. It sets out the scope of work, sessions, rates, indemnity, cancellation, and the tax and engagement status of the locum (self-employed, agency worker, or personal service company). The framework includes off-payroll working rules (IR35, Chapter 10 of Part 2 of ITEPA 2003), GMC/NMC/GPhC regulatory requirements, and NHS or private indemnity arrangements (e.g. CNST for NHS trusts, MDU/MPS/MDDUS for individuals).
Red flags to watch for
Under Chapter 10 ITEPA 2003, medium/large clients must issue a written SDS with reasons. Without it, you cannot rely on the outside determination and risk retrospective tax and NI.
Practice insurance may not cover every clinical situation, and professional indemnity (MDU/MPS/MDDUS) is personal to the doctor. Confirm exactly what is covered.
Asymmetric cancellation (you must give 4 weeks but practice can cancel same-day) costs locums thousands a year. Negotiate a minimum-hours payment if cancellation is late.
Restrictive covenants against locums are unusual and usually unenforceable, but some agencies include them to tie you to their book. Treat with scepticism.
A session is generally 4 hours 10 minutes in NHS general practice, but the contract should define it. 'Session' can otherwise mean anything the practice decides.
For IR35 'outside' status, a genuine right of substitution matters. No substitution clause strengthens HMRC's case for 'inside IR35'.
'We'll pay what we agree was worked' gives the practice the final word. Contracts should have a timely dispute mechanism with a deadline for challenges.
Your legal rights
UK locum agreements intersect several areas of law: the off-payroll working rules (IR35 / Chapter 10 of Part 2 of the Income Tax (Earnings and Pensions) Act 2003) govern tax status; the Agency Workers Regulations 2010 may grant rights after 12 weeks on a single assignment; the Conduct of Employment Agencies and Employment Businesses Regulations 2003 regulate agency practice (including prohibition on charging workers for work-finding services); professional regulation sits with the GMC, NMC, GPhC or GDC; and clinical negligence liability is governed by the common law of tort alongside indemnity under the Clinical Negligence Scheme for General Practice (CNSGP, 2019) for NHS primary-care GP work and CNST for NHS hospital work. Private work requires personal indemnity through MDU, MPS or MDDUS. Disputes can go to the small claims court (up to £10,000), the employment tribunal (for worker-status claims), or professional bodies.
Questions to ask before you sign
- 1Is this engagement inside or outside IR35, and where is the written Status Determination Statement?
- 2What indemnity applies to my clinical work here — CNSGP, CNST, or my own MDU/MPS cover?
- 3What is a 'session' under this contract in hours and minutes, and what duties does it include?
- 4What are the notice and cancellation terms on each side, and is late cancellation paid?
- 5Are there substitution rights, and any real ability to exercise them?
- 6What is your timesheet and invoicing process, and the deadline for disputes?
- 7Is there any restrictive covenant or exclusivity, and does it apply after the engagement?
Disclaimer: This guide is for educational purposes only and does not constitute legal advice. Contract law varies by jurisdiction and individual circumstances. Always consult a qualified legal professional before making decisions based on this information.