Hi, I’m Ryan  👋  I’m a Doctor in my  F4 year where I’m balancing a mixture of ad-hoc locuming and working for Messly as a Health Tech Fellow. I spent the last 2 years locuming and working various shift patterns (full-time and ad-hoc) and even took a 6-month break from Medicine due to a knee injury.

Over this time I’d like to think I’ve gained a good level of knowledge of what it means to be a Locum Doctor, both the good and bad.

In this article, I want to share some of the tips and tricks that made my life easier as a Locum Doctor, as well as raise some thoughts for you to consider before taking the plunge.

About me

I was a Foundation Doctor at Basildon and Thurrock University Hospital in Essex, Bedfordshire and Hertfordshire Foundation School and had a really good time there.

I took an F3 year as although I really enjoyed surgery and was building a portfolio for it, I was becoming slightly burnt out and didn’t feel ready to dedicate the better portion of a decade to training in a Specialty I wasn’t 100% sure of.

This led to me locuming in various specialties, working in a couple of different industries, and then taking an F4 year to ultimately do a 180 degree turn and apply for GP Specialty Training.

The main differences between locuming and working as a trainee

If you’re new to locuming then you’ll probably want to know if there’s any difference in the role itself, whether you’ll still get opportunities to develop your portfolio, and what the pay is like.

Looking back over the last two years, here’s what I learnt:

🔎  Finding work

Securing consistent work is ultimately down to you as locum doctor and can be difficult at first, especially as you won’t be used to proactively looking for work. This article here is useful for getting started as a new locum doctor and getting into the right mindset for finding locum work

My experience with the first agency I worked with was less than ideal and you can read about this along with the other mistakes I made as a new locum doctor here.

Additionally, consider using a free locum finding service like Messly, which makes it easier and quicker to register with agencies, and lets you see real available locum opportunities each agency has without having to first join any of them.

👷‍♂️  The job itself

Personally, I found the biggest difference between locuming and working as a trainee is not having the same rapport with your seniors and colleagues that you did as an F2. This doesn’t make a difference to the quality of care you deliver but can make the day drag on a lot. However, if you’re doing a block of shifts over a month or more, this does quickly change, providing you’re making an effort to be friendly.

In terms of the role itself, it's pretty much exactly same from a clinical point of view. You’ll just need to familiarise yourself with the different Trust Guidelines, Clinical Pathways and IT systems each time you join a new hospital. When I first started, in A&E, I assumed the consultants would expect me to hit the floor running and see a minimum of 15-20 patients a shift as I was being paid more. This was not the case and I was allowed the time I needed to learn and adapt.

Another bit of advice here is to make sure you secure login details before you start the shift, if possible. Speak to your agent to ask the Rota-Coordinator of the Hospital you will be working in. Some Trusts will even supply ‘Locum Packs’ which will contain login details as well as a quick run-through of how to use their IT systems. These Trusts are rare, but they do exist!.

Having these details will mean you’re actually able to do your job and not wait about for other Doctors to constantly log you into the system. I agree that Trusts should be more organised and actually arrange for you to have these details, but unfortunately, a lot of them are usually a bit disorganised.

This article on starting out as a Locum Doctor has a lot of good advice on this.

📚  Learning opportunities

It’s a lot easier to attend teaching and find seniors to supervise you when you’re a trainee. But it’s not impossible for Locum Doctors either, you just need to be a bit more proactive and ask seniors for advice, and reasonings for making certain clinical decisions. This is definitely easier to do if you’ve been working at a hospital for a couple of weeks, but there’s no harm in asking for a DOP or MINI-CEX from day 1 if you’re feeling confident, just make sure to be friendly and energetic.

For myself, I found my seniors opened up quite quickly as I would regularly engage with them, being friendly and occasionally asking questions when I was unsure of anything. After a couple of weeks, I let them know that I was interested in doing a Sports/T&O related QIP and ended up getting invited to help out with one which ended up being a research project.

I was also able to ask some of the SpRs to help me get better at certain things like suturing, who would call me to observe, and later on to supervise, where there was an opportunity to get a few stitches in.

I have a few friends who are also locuming who have had very different experiences to me with getting learning opportunities. In most cases, these have been down to them not really engaging with anyone on the job and not actively trying to be friendly or look for opportunities.

This article on career progression as a Locum Doctor will go into more detail on finding learning opportunities.

🕑  Out of hours shifts

Your rota is personal to you, but I thought I’d share how my own work schedule changed from being an F2 to a Locum Doctor. As a trainee, I struggle with nights and would go up to 72h without any or little sleep. I made a vow never to work a night shift as a Locum Doctor which had a hugely positive effect on my mood and productivity.

I also only wanted to work 3/4 days a week to focus on my other non-medical hobbies as well as to work on my surgical portfolio.

Here’s a very rough comparison

In my first rotation as an F2 (A&E) I worked:🌑  Night Shifts: 21 days

🥳  Weekends: 9 (18 days)

For the entirety of my Locum Years (F3 and F4), I worked:

🌑  Night Shifts: 0 days

🥳  Weekends: 4 days, and that was to buy myself something nice and pay for 2 holidays

There are definitely opportunities to work late, weekend and night shifts that will pay more than core hours, but for me, these were not worth it. If you’re keen to maximise your pay then know that there is usually an abundance of these type of shifts. Here’s an article you can read about maximising your pay as a Locum Doctor.

💰  Pay

I mean this is probably to no one's surprise, but as a Locum SHO you can easily outearn your consultant's salary working full time, and you can even earn more than your F2 salary just working 2 days a week.

To give you an idea of this, as an F2 trainee my average monthly pre-tax pay was about £3,400 a month working 5 days a week and having to work nights and weekends. As a Locum Doctor working 3 days a week, it was £5,850 without having to do any non-core hours.

If you want to work out how much you could potentially earn as a Locum Doctor, check out Messly’s Locum Doctor Salary Calculator which will give you an hourly rate and salary based on your grade, speciality and region you’d like to work in.

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My favourite parts of being a Locum Doctor

🤸‍♂️  More Free Time - as a Locum Doctor, I had a lot of time to pursue my own interests and work on my own projects. For instance, working 3 days a week, I was able to use the rest of the week to learn:

• Basic Python
• 10 songs on the guitar
• Start additional work as a Content Writer
• Keep a strict gym routine
• and a lot more!

😄  Feeling Happier - As an F2 Doctor, I was becoming burnt out by the work pressures, night shifts, and weekend work. I was bringing work home with me more often than not and would often wake up to an imaginary sound of my bleep going off. However, since Locuming, I’ve been in charge of my work schedule and have chosen to do no night shifts. Since then my sleep and mood have been better, I have more headspace, and I feel this actually helps me be a better doctor when I’m at work.

💰  Better Pay - Although it seems a taboo topic to talk about in Medicine, I have to say that the pay is exceptionally better and feels like I’m actually being rewarded for spending 7 years in uni and having over £50k in student loan debts. I’m able to make an F2 salary working 2 days a week and can afford to go on multiple holidays a year. I’m actually dreading going back into training and seeing the pay cut now that my F4 is coming to an end 🙃

My least favourite parts of being a Locum Doctor

👨‍⚕️  Less security - This is one I didn’t really consider when first going into an F3 year. Unfortunately, due to a bunch of reasons, I ended up knee-ding to have a pretty serious knee operation which meant I wasn’t mobile for many months. This, unfortunately, meant that I did not qualify for any sick pay, except SSP which is about £99.35 per week. Not enough for even rent.

If you’re expecting any long term illnesses to affect your ability to work and possibly needing you to take extended time off, I would strongly recommend keeping your training job or taking a fellowship role / trust-grade role which has more sick leave benefits. With these, you always have the option to work Less-Than-Full-Time and work ad-hoc locum shifts on the side, plus you’ll qualify for sick leave for these roles if you need it,

💻  IT Systems and Logins - The NHS IT System is unbearable enough without throwing login issues into the mix. When you join a new hospital occasionally you’ll be given a Locum Pack which will have all your login details, but more often than not, this doesn’t happen. Instead, you’re left in a 1h wait for the IT support desk to arrange new logins, which always need a signature that you’ll need to hunt down. You’ll then be expected to learn how to use the system yourself unless you ask a friendly colleague to help you....Sound like something good to write a QIP on.

🍀  Finding the right agency - Most agencies are good or at least decent. However, a small minority of rogue agencies can ruin your entire experience as a Locum Doctor, especially if you’re just starting out. These agencies will often persuade you to work further out than you want, in exchange for broken promises of better rates and shifts next time.

As you can’t usually see shifts before you sign up for an agency, the idea that your whole year could be ruined due to pot-luck really bothers me and so I would really recommend that you do your due diligence on Locum Agencies before you begin.  This article here will help talk you through what a good agency should do and how to find one.

My personal top tips for locuming successfully

1️⃣  Proactively speak to your agent (if locuming through an agency)

I find it’s best to aim to speak to your agency every couple of weeks (phone or email) or so to let them know your availability or if you’re planning on booking annual leave or if you need to make changes to your bookings. The more time you give to cancel or change shifts, the better it will look on you and keep you in a friendly relationship with the hospital you’re looking to work at.

I found the more engaged I was, the more active they were in finding me work and I could leave it to them to book me into for all the shits as I know they knew my exact preferences and availability.

2️⃣ Register and book shifts with your local Hospital’s Staff Bank early

Personally, I ended up using the Staff Bank a lot for ad-hoc shifts and wish I signed up sooner. Be aware that most with have a lengthy sign-up process for external applicants, so if you’ve worked with them in your Foundation Years, try to sign up as an internal employer which is super fast and straightforward (1 sheet to sign vs what appeared to be a new sign on pack + essay based questions). The turnover time can be up to 6 weeks when joining a Staff Bank, so if this will be your main source of finding locum work, get this done before you finish F2.

The main issue I found with Staff Banks was that the rota-coordinator would release all the shifts at a specific time each month. All the best core hour shifts would get mopped up in minutes after this, meaning if you forgot to check your phone for a couple of hours on the release day, you’d have to pick up Weekends, Nights or Late shifts to meet your weekly quota goals, or get shifts through a Locum Agency.

3️⃣ Check your timesheets against your payslips

This is a rare occurrence, but occasionally you’ll find the Trust or your agency has paid you incorrectly and you’ll have to figure it out yourself as to why this is the case. Usually, it’s super easy to spot i.e. a whole day or even a week missing from a payslip. However, occasionally it can be a bit more difficult, especially if your hours were entered incorrectly onto the recruiters or Trust’s payroll system. So keep your timesheets and always check them against your payslips

4️⃣ Use Messly’s Locum Toolkit

I actually had the pleasure of contributing to this. The Locum Doctor toolkit is a collection of the free apps and services that my friends and I found the most useful in our Locum Year. We tried to include apps to help with you all parts of your Locuming such as:

👉  Finances

👉  Finding work

👉  Working in a new hospital or specialty

👉  Useful apps to help you manage, diagnose and stratify patients

👉  Keeping a portfolio (start early with this)

👉  Prepare for exams

👉  and a more miscellaneous things

5️⃣ Start your portfolio early

Unfortunately, this is a mandatory part of the appraisal and thus revalidation process with the GMC and you’re still responsible for keeping one as a Locum Doctor, although many doctors do get away with it. I personally wouldn’t bother risking not having one without a good excuse.

You can find guidance from NHS England on what evidence you need to collect here.

If you’re working through your Staff Bank, you can normally get an appraisal for free. If you’re working through an agency then this usually comes with a charge of £350-£500, however, you can usually negotiate for them to void this after working a certain number of shifts.

Start speaking to your seniors and colleague about QIPS early, and aim to collect a couple of DOPS or Mini-CEXs each month. You can find free CPD courses as well as links to a free ePortfolio, or paper forms if you prefer that, in the resource in Messly’s Locum Toolkit above.

Do bear in mind that there a lot of F3s reported a lot of leniency regarding what they needed in their F3 years, i.e. not needing QIPs or minimal CPDs, however, I would aim to speak to my Responsible Officer first about this to ensure you’re not purposely planning to shoot yourself in the foot by missing anything.

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Anyway, I hope this helps!

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