Locum Doctor Hourly Rates: Bank vs Agency Pay

Last updated: 28 September 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

Bank vs agency: how locum work works

When a rota gap needs covering, trusts fill it in a strict preference order: first their own staff bank (doctors registered to do extra shifts directly for the trust), then agency staff via commercial locum agencies. The two routes differ in almost every way that matters:

Most trainees start with bank shifts at their own trust — the admin is minimal, the systems are familiar, and the pension contributions keep building. Agency work becomes more attractive for F3 years, career breaks and anyone wanting to work across multiple trusts, where the higher rates compensate for the hassle.

Example bank rates (one trust's card)

To give a concrete sense of the numbers, here is a published local bank rate card — King's College Hospital's, published July 2026, rates including holiday pay. These are one trust's rates, not national figures. Your trust's card will differ.

Compare these with the salaried hourly equivalents: an FY1's basic works out at £19.82 an hour, but the bank pays £22.41 for a day shift — a 13% premium. For an ST3+, £40 against a £32.37 basic equivalent is a 24% premium. The premium is the market price of flexibility: the trust pays more per hour because it gets cover exactly when needed, without training or employment overheads.

What affects your locum rate

• Grade and specialty: the two biggest drivers. Higher grades and shortage specialties (emergency medicine, acute medicine, psychiatry) command the highest rates.
• Shift type: nights and weekends pay more than weekday days, everywhere.
• Urgency: a shift booked weeks ahead pays the card rate; a shift tonight that nobody wants can attract an uplift — sometimes substantial.
• Trust and region: London trusts often pay more in absolute terms, but so do remote trusts struggling to recruit. Each trust sets its own card.
• Bank vs agency: agency rates exceed bank rates for equivalent shifts, but the agency takes its margin and the work is not pensionable.
• Your experience: agencies and banks pay the grade rate, but sought-after locums with strong reputations get first refusal on the best shifts.

Agency rates and price caps

NHS England operates agency price caps — maximum hourly rates trusts should pay agencies — alongside rules requiring trusts to use approved frameworks and to prioritise bank staff. The policy intent is to control the enormous agency spend and push work back onto banks.

In practice, caps are frequently breached: when an emergency department is dangerously short-staffed at 9pm, the on-call manager authorises whatever rate secures a doctor. "Off-framework" agency use and cap breaches are persistent features of the system, particularly in shortage specialties and regions. For locum doctors, this means agency rates are negotiable in a way bank rates are not — especially at short notice. For the NHS, it means the agency bill remains one of the system's most stubborn costs.

If you work through an agency, use one on an approved framework, check exactly what the quoted rate includes (holiday pay? pension? travel?), and get payment terms in writing. Reputable agencies pay weekly or fortnightly; be wary of any arrangement that leaves you chasing money.

Tax, pension and IR35

Tax: all locum income is taxable. Bank shifts are taxed through PAYE on a (usually emergency or secondary) tax code — check your code, because emergency tax on a second job is a classic overpayment source, reclaimable from HMRC. Agency income may come via PAYE through an umbrella company or via self-assessment, depending on the arrangement.

Pension: bank shifts through the trust are usually pensionable — contributions are deducted at your tier and the pay counts towards your 1/54 accrual. Agency work is generally not pensionable in the NHS scheme. Over an F3 year of heavy agency locuming, the lost pension accrual is a real (if invisible) cost — worth weighing against the higher hourly rate.

IR35: the off-payroll working rules determine whether agency locums are taxed as employees or as genuinely self-employed. Most NHS agency engagements are deemed inside IR35 (taxed as employment); genuinely self-employed arrangements exist but need proper contracts and working practices. This is specialist territory — take professional advice rather than relying on the agency's assurances.

Working-time rules for locums

The 48-hour average weekly limit under the Working Time Regulations applies to all your work combined — training post plus locums. Trainees doing heavy locum rotas on top of full-time training can breach the limit without realising it, and breaches are a patient-safety issue as well as a contractual one. Some deaneries and trusts require trainees to declare locum work or restrict locuming in certain circumstances.

The practical advice: track your hours honestly, keep at least one full rest day a week genuinely free, and remember that fatigue-related errors fall on you professionally. The extra income is real — an FY2 doing two bank weekends a month can add £5,000+ a year — but it is not worth your training, your health or your registration.

Frequently asked questions

How much do locum doctors get paid per hour?

There is no national locum rate — each trust sets its own bank rates. As an illustration, one London trust's July 2026 bank card paid FY1 £22.41/hr (days), FY2 £30, ST1/2 £33, ST3+ £40, specialist doctors £45 and consultants £67.24, with higher rates for nights and weekends. Agency rates are higher.

What is the difference between bank and agency locum work?

Bank shifts are booked directly with the trust's staff bank — lower rates but simpler admin, and usually pensionable. Agency shifts go through a commercial agency — higher rates but the agency takes a margin, admin is heavier, and the work is usually not pensionable.

Are locum doctor rates capped?

NHS England operates agency price caps, and trusts are expected to use bank staff first. In practice, caps are frequently breached for hard-to-fill shifts, especially in emergency departments and at short notice.

Is locum work pensionable in the NHS pension?

Bank shifts done through the trust are usually pensionable — contributions are deducted and benefits accrue. Agency locum work is generally not pensionable in the NHS scheme.

Do locum doctors pay more tax?

Locum income is fully taxable. Bank shifts are taxed through PAYE; agency work may be taxed via PAYE or self-assessment depending on the arrangement, with IR35 rules determining employment status for tax.

Can trainee doctors do locum shifts?

Yes — it is common from FY1/FY2 onwards. But total hours including locums must stay within the 48-hour weekly average under the Working Time Regulations, and your training programme may have rules about locuming in your own specialty.

Sources and independence

Source: King's College Hospital NHS Foundation Trust — Doctors' Bank Rates, July 2026 (local rate card, illustrative only); BMA — Government offer to resident doctors in England (June 2026).

Locum rates are set locally by each trust and change frequently; the King's card is one trust's example, not a national scale. Agency rates are market-driven and uncapped in practice for hard-to-fill shifts.

This is an independent guide and is not affiliated with the NHS. Locum doctors work under medical and dental terms, not Agenda for Change. Always confirm rates with the relevant staff bank or agency.