Most doctors who ask how to become a locum doctor already have the clinical side covered. What slows them down is everything around it: a licence that has to stay live, a revalidation connection that agency work can quietly break, and a compliance file that every agency and trust will ask for before the first shift. If you are a doctor at SHO or registrar level thinking about locum shifts, between posts, alongside a training gap or as your main work, this is what to sort first.
Your GMC licence has to stay live, and it costs more this year
You need full registration with a licence to practise. Provisional registration does not cover locum work outside a foundation post. The GMC annual retention fee rose to £481 from 1 April 2026. If your worldwide income from all sources is below £38,500 a year, you can claim a 50 percent discount, which is worth checking in a year when you are working fewer shifts. Miss the fee and your licence lapses, and no agency can book you until it is restored.
How to become a locum doctor without losing your revalidation connection
This is the part that catches people out. Every licensed doctor needs a prescribed connection to a designated body, which gives you a responsible officer, an annual appraisal and a revalidation recommendation every five years. While you hold a trust contract, the trust is your designated body. Leave that post to locum full time and the connection can disappear.
Under the Responsible Officer Regulations, a contract with a designated body comes first. If you work only through agencies, the agency you did most of your work for in the previous year can become your designated body, but only if it is one that the regulations recognise, which in practice means an agency on an approved NHS framework. Check yours on GMC Online before you leave a substantive post, not after.
If you end up with no connection, the GMC can link you to a suitable person, a responsible officer or someone in an equivalent role who agrees to make your recommendation. It is slower and you carry more of the paperwork. Either way, keep your own appraisal evidence as you go: a log of shifts and specialties, reflections on cases, any complaints or compliments, and colleague and patient feedback. A locum year with no evidence is a hard appraisal.
Where locum shifts come from in England
NHS England’s agency rules, last revised in October 2025, require trusts to book agency doctors through approved framework agreements and to stop using off framework agencies altogether. Each trust also works within a price cap, which is the most it can pay per hour for an agency doctor, including the agency’s fee. The caps are a ceiling rather than the going rate. Shifts well above them need sign off from an executive director, or from the chief executive when the rate is £100 an hour or more.
Two things follow for you. Register with an agency that holds a place on an approved framework, otherwise most trust shifts will never reach you. And expect hourly rates to sit within published bands, with unsocial hours (anything outside 7am to 7pm on weekdays, plus bank holidays) paid at the higher rate. Northern Ireland, Scotland and Wales run their own arrangements through their trusts and health boards, so the England caps do not apply there, though the GMC requirements do.
PAYE, umbrella or limited company
Because NHS bodies are public sector, the trust decides whether the off payroll rules (IR35) apply to each engagement, and most agency shifts in NHS hospitals are treated as inside IR35. In practice that means you are paid through the agency’s PAYE payroll or through an umbrella company, with tax and National Insurance deducted before you are paid.
If you use an umbrella, check its payslips line by line. Since 6 April 2026 the agency that supplies you is jointly liable for the umbrella’s PAYE, so a good agency will only work with umbrellas it has checked. Your payslip should show the rate the agency pays the umbrella, every deduction, and holiday pay. If the money landing in your account does not match the hourly rate you were quoted after normal tax, ask why before your next shift.
The compliance file every agency will ask for
Agencies on NHS frameworks work to the same audit standard, so build the file once and keep it current. Expect to provide proof of your right to work (a share code or eVisa for most non British doctors), an enhanced DBS check with both barred lists, references covering your recent posts, and a CV with no unexplained gaps. Joining the DBS Update Service for £16 a year means you will not need a new check for every agency.
Occupational health clearance covers immunity to hepatitis B, measles, mumps, rubella and chickenpox, and TB screening. If you work in surgery, obstetrics or any specialty with exposure prone procedures, you will need the extra blood borne virus clearance as well. Statutory and mandatory training should map to the Core Skills Training Framework, and acute posts usually want advanced life support in date.
On indemnity, clinical negligence claims from work in an NHS trust in England fall under NHS Resolution’s Clinical Negligence Scheme for Trusts, which covers agency locums as well as employed staff. It does not cover a GMC investigation, an inquest or private work. Keeping your medical defence organisation membership is cheap protection against the things the trust scheme leaves out.
Your first month of locum shifts
Start in a specialty you have worked in within the last year. Ask the agency for the rota, the name of the consultant you report to and the IT logins before your first shift, not on the morning of it. Get timesheets signed at the end of every shift, because unsigned hours are the most common reason locum pay is late. And note every shift in your appraisal log the same day.
Flamingo Workforce places locum doctors at SHO and registrar level with hospitals across England, Northern Ireland, Scotland and Wales, and our compliance team will help you get your file ready before your first booking. See our current locum doctor jobs or get in touch and we will call you back.