Locum and sessional pay works differently from salaried NHS pay in ways that genuinely affect your real take-home — worth understanding before assuming a headline day rate tells the whole story.
No automatic pension
Unlike salaried NHS staff, locums aren’t automatically enrolled in the NHS Pension Scheme for every engagement — you typically need to actively opt in per assignment, and many locums don’t, which changes the real comparison against an equivalent salaried role.
Tax treatment depends on how you’re engaged
If you work through an agency as employed, PAYE applies as normal. If you invoice as self-employed or through your own limited company, tax works completely differently — Self Assessment and possibly IR35 considerations come into play.
The day rate isn’t the whole picture
No paid holiday, no sick pay, and gaps between bookings all mean a locum day rate needs to be meaningfully higher than an equivalent salaried daily rate to actually come out ahead once averaged across the year.
Work out your own locum take-home with the Payslp Locum calculator.
What “sessional” actually means in practice
A session typically refers to a defined block of time (commonly around four hours), rather than a full day — worth clarifying exactly how many sessions make up a full working day when comparing rates between different practices or agencies, since this isn’t always standardised.
Frequently asked questions
Do I need my own indemnity insurance as a locum?
In most cases yes — this is a genuine additional cost that should factor into how you assess whether a given rate is actually competitive once compared with salaried roles.
Can I claim tax relief on locum-specific costs?
Often yes, if you’re genuinely self-employed — professional indemnity insurance, professional subscriptions, and travel between assignments are commonly allowable expenses, though it’s worth confirming your specific situation with an accountant.