Guide
What is locum work?
A locum is a qualified professional who fills a role temporarily, covering a vacancy, absence or extra demand. This guide explains how locum work compares with permanent and bank work, how locums are paid, and how to get started, so you can decide whether it suits you.
By Tony Constantinides, Chief Executive Officer · LinkedIn
Updated 20 October 2026 · 6 min read
What a locum is
A locum is a qualified professional who temporarily fills a role: covering a vacancy, sickness, parental leave or a busy period. The word comes from the Latin locum tenens, "holding the place".
In healthcare, locums include physiotherapists, radiographers, biomedical scientists, pharmacists, social workers and many more; in nursing the same work is usually called agency work. You are booked through an agency for a set period, from a single shift to months at a time, work at the hospital, clinic or service that needs you, and are paid by the hour, usually weekly.
Locum vs permanent vs bank
There is no best option: each suits different people at different times. Many healthcare professionals mix them over a career, or at the same time.
| What | Permanent | Bank | Locum (agency) |
|---|---|---|---|
| Who you work for | The NHS trust or provider employs you | Your trust's own staff bank | An agency books you; you work at the trust or provider |
| Pay | A salary on your NHS band | Hourly, usually at your band rate | Hourly, usually higher than bank, paid weekly |
| Holiday, sick pay, pension | Paid leave, sick pay and the NHS Pension | Holiday pay; the NHS Pension is usually open to bank staff | Holiday pay depends on how you are paid; no NHS Pension |
| Flexibility | Set hours or a rota | Pick shifts at your own trust | Choose contracts, places and when you work |
| Security | The most secure; notice periods both ways | Shifts depend on demand | Contracts can end at short notice |
| Progression | Training, appraisals and promotion | Limited | Broad experience across services |
Bank and agency: how they fit together
Most NHS trusts fill extra shifts from their own staff bank first, often with their own permanent staff picking up extra hours. When the bank can't cover a shift, for example at short notice, for specialist skills or in hard-to-staff areas, trusts book agency staff through approved NHS frameworks and within NHS England's rules on agency pay.
Both keep services running and patients seen. Plenty of people do bank shifts at their own trust and agency work elsewhere. If you already work for a trust, its bank is often the easiest place to start.
Is locum work right for you?
Locum work could suit you if…
- you want a higher hourly rate, paid weekly
- you want to choose when and where you work
- you want broad experience across different services and teams
- you are between permanent roles, relocating or returning to work
- you want extra income alongside a permanent post
Permanent or bank could suit you better if…
- the NHS Pension, sick pay and paid leave matter most to you
- you want a steady income and the same team
- you are newly qualified and want structured training and supervision
- you are aiming for promotion within one organisation
Pure asks locums for post-qualification UK experience (for example 12 months for nurses and 6 to 12 months in health science), because locums need to settle into a new team quickly.
How locums are paid
Locums are paid by the hour for the hours worked, usually weekly after submitting a timesheet. There are three common ways to be paid:
- PAYE through the agency: the agency pays you and deducts tax and National Insurance, much like an employer.
- An umbrella company: the umbrella employs you, pays you through PAYE and charges a fee; holiday pay is usually included.
- Your own limited company: only possible for roles outside IR35. Since 2017 the NHS body decides, and most NHS locum roles are inside IR35, so this route is uncommon for NHS work.
Pure pays locums all three ways: PAYE through Pure, through an umbrella company, or through your own limited company where a role is outside IR35. Your consultant will tell you which apply to each role before you accept it.
General information, not tax advice. For the rules, see GOV.UK: IR35 and off-payroll working.
What locums earn with Pure, by profession
Hourly rates advertised on Pure's live jobs and past jobs from the last 12 months.
| Profession | Advertised rate | More |
|---|---|---|
| Physiotherapy (locum) | £22 to £44 an hour | View jobs |
| Occupational therapy (locum) | £22 to £38 an hour | View jobs |
| Speech & language therapy (locum) | £22 to £42 an hour | View jobs |
| Radiography (locum) | £28 to £36 an hour | View jobs |
| Psychology (locum) | £28 to £72 an hour | View jobs |
| Biomedical science (locum) | £24 to £44 an hour | View jobs |
Compare locum rates with NHS pay, band by band, in our salary guides: biomedical scientists, radiographers and occupational therapists, or see NHS pay bands vs locum rates.
Getting started
To work as a locum you'll need the same checks as any NHS role. Having them ready is the quickest way to your first shift:
- an up-to-date CV, with your last two years' references
- registration with your professional body (for example HCPC, NMC or Social Work England)
- an enhanced DBS check
- proof of your right to work in the UK
- occupational health clearance and immunisations
- mandatory training certificates
Register with Pure in 30 seconds and a specialist in your profession will call you to talk through jobs, rates and your checks. Pure's compliance team helps you get everything in place, and we're on call 24/7 while you're on placement.
Questions about locum work
What does locum mean?
A locum is a qualified professional who fills a role temporarily: covering a vacancy, sickness, parental leave or extra demand. The word comes from the Latin "locum tenens", meaning "holding the place". In healthcare, locums are usually booked through an agency and paid by the hour.
Do locums get holiday pay?
Locums are entitled to paid holiday like other workers, but how it is paid depends on how you are paid: through the agency or an umbrella company it is usually built up as you work, or added to your hourly rate. Ask your agency which applies before you start.
Can locums join the NHS Pension?
Agency locums generally cannot join the NHS Pension, because they are not employed by the NHS. Staff working on an NHS trust's own bank usually can. If the NHS Pension matters to you, that is a good reason to keep a permanent or bank post.
Can I do locum work alongside a permanent job?
Many people do, for example extra shifts on days off. Check your permanent contract first (some trusts ask you to tell them, and working time rules limit your total hours), and expect your main employer to come first.
How quickly can I start as a locum?
Once your documents and checks are in order, often within days. The checks take longest: registration, an enhanced DBS check, references, right to work and occupational health. Having these ready makes the biggest difference.
Is NHS locum work inside IR35?
Usually. Since 2017 the NHS body decides whether a role is inside or outside IR35, and most NHS locum roles are inside it, which means tax and National Insurance are deducted before you are paid (through PAYE or an umbrella company). This is general information, not tax advice.
Thinking about locum work?
Register in 30 seconds and a specialist will call you about jobs, rates and getting your checks in place.