Locum work appeals to a lot of healthcare professionals for good reason. You choose when you work, where you work, and how much you take on. For doctors and nurses who want more control over their careers without stepping away from NHS practice entirely, it’s one of the most practical options available.

But making the move into locum work for the first time raises a lot of questions. What do you need to have in place before you start? How do you find shifts? What are the compliance requirements? And is it actually as flexible as it sounds?

This guide covers everything a locum doctor or locum nurse needs to know to get started on the right foot.

Locum work means working on a temporary or flexible basis, filling shifts or covering gaps in staffing rather than holding a permanent post. Locum doctors and nurses work across a wide range of settings, from acute hospital wards and emergency departments to community clinics and specialist services.

The key difference from permanent employment is that you’re not tied to a single employer or a fixed rota. You choose the shifts you want to work and decline the ones you don’t. That flexibility is real, but it comes with responsibilities that permanent staff don’t have to think about in the same way, particularly around compliance and self-management.

Before you can take on locum shifts, whether as a locum doctor or locum nurse, you need to have a number of things in place. Getting these sorted upfront, rather than partway through the registration process, saves a significant amount of time.

For nurses and midwives, this means an active NMC registration. For doctors, a current GMC registration with a licence to practise. Your registration must be unrestricted and in good standing. If there are any conditions or interim orders against your registration, these will need to be resolved before you can work.

An enhanced Disclosure and Barring Service check is mandatory for all healthcare professionals working in NHS settings. If you’re not already registered with the DBS Update Service, it’s worth doing before you start. It makes your certificate portable across employers and removes the need for a fresh application every time you register with a new organisation.

You’ll need to demonstrate that you’re fit to work in a clinical environment and that your immunisation history meets NHS requirements. If you have recent occupational health records from a previous employer, some organisations will accept these. Others require their own assessment.

Most NHS organisations and locum frameworks require references covering the last three years from clinical supervisors or line managers. Start requesting these early. They are the most common source of delay in any locum registration process.

Core mandatory training must be current before you can work. This typically includes basic life support, infection prevention and control, manual handling, fire safety, safeguarding, and information governance. Renewal periods vary between modules, so check what’s current and what needs refreshing before you apply.

You must be able to demonstrate your legal right to work in the UK. The specific documents accepted depend on your nationality and immigration status.

The NHS locum market operates across several different channels, and understanding the landscape helps you make better decisions about how to find work.

The NHS Long Term Workforce Plan published by NHS England highlights the growing importance of flexible working models in sustaining the healthcare workforce. For locum doctors and nurses considering their options, this broader context matters. The NHS is actively moving toward more flexible staffing arrangements, which means demand for locum and bank staff is likely to remain strong.

You must be able to demonstrate your legal right to work in the UK. The Individual NHS Trusts run their own staff banks, pools of healthcare professionals available for flexible shifts within that organisation. Registering with a Trust bank gives you direct access to shifts without an agency in the middle, but ties your availability to a single organisation. documents accepted depend on your nationality and immigration status.

Traditional locum agencies match healthcare professionals to shifts across multiple employers. They handle some of the coordination work but take a percentage of the shift rate in return. For many locum doctors and nurses, agency fees represent a significant reduction in take-home pay over time.

A newer model that combines the direct Trust access of a staff bank with the multi-organisation reach of an agency, but without the fees. Collaborative staff banks connect healthcare professionals to a network of NHS Trusts through a single registration and compliance profile.

Once your compliance is in place, finding shifts depends on which route you’ve taken to market.

If you’ve registered with a Trust bank, you’ll typically receive notifications of available shifts by text or email and can accept or decline through a booking portal.

If you’re working through an agency, a consultant will contact you when relevant shifts become available. The speed and consistency of this varies significantly between agencies and between specialties.

If you’re using a collaborative staff bank, the platform matches you to shifts based on your role, location, availability, and skills. You receive notifications for shifts that are genuinely relevant to you rather than everything that comes in.

For locum nurses and locum doctors new to flexible working, starting with familiar clinical environments makes sense. Working in settings you already know reduces the adjustment period and lets you focus on the work itself rather than learning a new organisation at the same time.

This is an area many healthcare professionals underestimate when they first move into locum work.

As a locum doctor or locum nurse, your income is variable. Some weeks will be busier than others. Building a financial buffer before you transition fully into locum work gives you the freedom to make decisions based on what suits your life, rather than being forced to accept every shift that comes in.

Tax and National Insurance work differently for locum professionals depending on how you’re engaged, whether as a PAYE worker, a sole trader, or through a limited company. The specifics are worth discussing with an accountant who has experience in healthcare before you start, rather than after.

The NHS Pension Scheme access for locum workers is a separate consideration. Eligibility and contribution arrangements vary depending on how you’re engaged and which organisation you’re working with. It’s worth understanding your position on this early, as pension contributions represent a significant long-term financial benefit that locum workers can sometimes miss out on without realising.

Healthcare professionals who build successful, sustainable locum careers tend to approach things differently from those who struggle.

They treat compliance as an ongoing responsibility rather than a one-off task. They build relationships with familiar organisations rather than constantly working somewhere new. They manage their finances proactively rather than reactively. And they use tools and platforms that reduce admin rather than adding to it.

According to NHS England, flexible working is increasingly recognised as a key factor in workforce retention across the health service. For locum doctors and nurses who get the foundations right, flexible working isn’t a compromise. It’s a genuinely better way to build a long-term career in healthcare.

For locum doctors and nurses getting started in flexible NHS work, Flexzo AI offers a more straightforward route than traditional locum agencies or individual Trust bank registrations.

You register once, upload your compliance documents to a single secure profile, and get matched to shifts across Flexzo’s NHS Trust network based on your role, location, and availability. There are no agency fees eating into your earnings and no need to repeat the compliance process every time you want to work with a new organisation.

Here’s what joining Flexzo looks like in practice:

Browse current NHS bank staff jobs to see what’s available, or find out more about how Flexzo works and explore the full platform features.