Beginners guide to Locumming

Re: Beginners guide to Locumming

HMC — Tue, 06 Jul 2010 18:57:17 GMT

[quote user="Martin Atkinson"]However, I'm surprised there's locums still accepting £175-180 a day [/quote]

That was my rate over the winter period when there weren't as many jobs... and I was a naive 1st time locum.

Re: Beginners guide to Locumming

Martin Atkinson — Tue, 06 Jul 2010 18:13:49 GMT

[quote user="Hannah Chilton"]

[quote user="Clive Ansell"] I came across one recently that paid its locums £180-£200, whilst invoicing the practice £250-£260/day[/quote]

Ha, I can guess who you are talking aboot- I was working at £175/d and noticed paperwork at the practice said £250/d (though that may have included the B&B accommodation, I'm not sure).

I think I should set up my own agency and get that kind of commission.

[/quote]

Are we allowed to name and shame? If it is who I'm thinking about also then no, accomodation costs were not included and their matching employee to employer system is worse than a dodgy dating agency. When a perfectly good introductory agent charges £40 a week that commission seems a lot but to try to be fair they do take care of all the administration, its just not appropriate for my practice, so compared with other employment agencies in the real world it's probably not that OTT - I think I'm in the wrong profession when I hear from Mrs A. how much supply teachers are getting and how much she pays the agency. However, I'm surprised there's locums still accepting £175-180 a day - perhaps I should reduce my rates of pay or maybe they'd like to come and work for me!

Re: Beginners guide to Locumming

HMC — Tue, 06 Jul 2010 17:15:47 GMT

[quote user="Clive Ansell"] I came across one recently that paid its locums £180-£200, whilst invoicing the practice £250-£260/day[/quote]

Ha, I can guess who you are talking aboot- I was working at £175/d and noticed paperwork at the practice said £250/d (though that may have included the B&B accommodation, I'm not sure).

I think I should set up my own agency and get that kind of commission.

Re: Beginners guide to Locumming

bob lehner — Sun, 04 Jul 2010 10:32:09 GMT

With reference to VDS cover for locums, when I started a few years ago I spoke to David Mckeown, who is the membership services director of the VDS.

He told me I should def have my own cover. Although you will be covered for clinical issues under the VDS policy of the person whom you are replacing in the practice, you will not be covered for certain other things - in particular if you have the mis-fortune to be pulled up before the RCVS on a disciplinary charge. They will only help you in this situation if you have your own policy in place. There were a couple of other areas where you would not be covered unless you had your own policy - but I can't remember what they were. Give him a call to see if all this is still the same - he is v. helpful !

Also, if you ever have to argue the case with the Inland Revenue about being self-employed, showing that you provide your own professional indemnity insurance is likely to help.

You can of course off-set the premium against tax if you are self-employed, which makes it a little less expensive.

Re: Beginners guide to Locumming

Clive Ansell — Sat, 03 Jul 2010 13:32:49 GMT

I became a locum in 2001 following redundancy after my old boss sold his practice. Although I only intended to locum for 1-2 years, I am still at it 9 years later, suits me really well and makes for a far better work-life balance. It allows me to go off mountaineering and cycling as and when I want, and I don't have to be one of those 24/7/365 martyrs. Rather than being tired, stressed and resentful, I now really enjoy my job - works for me.

most, 75%, of my work is with a small core base of 5 practices that are all sole charge. It works very well, I know them, they know me, I know the staff and many of the clients, and have been with 3 of them since 2001.

I use agencies to find the remaining 25%, but I only use ones that act purely as an introductory service, then all discussion is directly with the practice and payment is direct. I avoid agencies that "employ" the locum. I came across one recently that paid its locums £180-£200, whilst invoicing the practice £250-£260/day. None of us want to give our hard earned over to an agency.

I prefer small private practices, and don't really like corporates or large groups, many have very little regard for people. I was recently dumped at 3-4 days notice by one of them with no reason or explanation being given whatsoever.

Always agree rates, terms and conditions and be clear what is expected of you. always discuss things like: hours worked, home visit policies, use of your own car, working after hours, OOH in patient care. Discuss accommodation - I once arrived at a practice for one week where accommodation was provided to find it was a vet bed on the floor in the lab (yes, it was in this century!), and there were no bath or shower facilities - I gave them the option of finding a B&B for 4 nights or I walk!

Although I agree T&C's, usually via email, I don't have a formally drafted contract. I find almost all practices and almost all colleagues are 100% fine. That said there are 1 or 2 shite houses out there. Of 225 locum positions over 9 years, I have had minor issues with just 5 which were, with the exception of one, all resolved one way or another.

I always ask for practice protocols and familiarise myself with them before I arrive. I try to be as flexible as I can - if someones does a thing differently, I try it and maybe learn from it. I make clear that I follow the rules regarding RCVS GtoPC, H&S, and cascade regs. I don't have my own VDS insurance, as all the practices I work I am covered on their policies for all work I do with them.

Payment: I am self - employed, and have been registered and accepted by HMRC as such since 2001. it has presented no problems for me at all. Other options are PAYE, but that makes no sense as both you and employer may more NI and you change jobs every time you change practices. You could become a limited company contractor - I'm afraid I don't know much about that, you would need professional advice really.

I am not VAT registered, but need to look at it. With the flat rate scheme you charge 17.5% on your invoices, then hand over 10% (9% in first year), thus keeping the difference.

Re: Beginners guide to Locumming

bob lehner — Sat, 03 Jul 2010 10:41:30 GMT

'it's more designed to protect me from old codgers locuming after retirement '

A tad patronising Mr A. - you appear to be not far off 'old codgerdem' yourself !

Anyway, as a moderately 'old codger', who retired a few years ago as senior partner of a busy, very well-equipped and go-ahead multi-vet hospital practice (even tho' I say it myself), I thought it would be interesting to see how other practices functioned and started doing s.a. locums.

OMG what an eye-opener .....We're not talking about the dark ages and the back of beyond, but an affluent part of SE England.

I came across a practice with no computer and all records on cards, writen in an illegible hand and with each family's multiple animals jumbled up on the same card - totally impossible to understand. The same guy, when asked where the price list was said 'Oh, just charge whatever you like !' Needless to say no lab facilities, crappy ancient x-ray machine, no other diagnostic toys.

Another one - arrived on day 1 - stuck in consulting room with computer that didn't work - in fact the whole practice computer system was archaic and kept crashing.

You should def. check out accommodation - sharing one's room with the gas boiler which explodes into life like an Icelandic volcano every 10 mins does not put one in a good frame of mind the next morning. Ditto mould-infested shower.

Above all else check that there are decent qualified nurses. Nothing more depressing than having as your sole helper a sullen, mono-syllabic teenage lump who would probably prefer to be stacking shelves at the Lidl store down the road. Avoid places where they expect you to consult from 9-12 without a break and an appt booked every 5 mins !

Moral - check everything out thoroughly first - visit the practice before committing yourself if poss. Look at their web-site if they have one. Needless to say I now confine myself to a small no. of practices where I go on a regular basis.

With reference to tax/self employed status etc. - v important that you do this right from day 1. There was a v. good article in 'In Practice' by Andy Moore (an accountant) - 'Taxing questions on locums' , 2006, vol 28, pp 412-415. Spells out everything you need to know and do.

Good luck !

Re: Beginners guide to Locumming

Martin Atkinson — Sat, 03 Jul 2010 10:19:21 GMT

Sorry but I've included answers to several of you in one post so be patient.

[quote user="Vikki Halliday"]

Emily was going to contact you via conversation but you have not enabled it for non-colleagues! Essential IMHO if you want some work!

[/quote]

Can't understand that, conversation tab is enabled for all users on my account. However, I can be contacted via my website or email at martin@gconnect.com.

Niall Taylor wrote: OK, I have to ask (as a vet of a certain age) - what are the problems you have had with "old codgers" and why do you hide the depot droids from them in particular while having them on the shelves for others to use.

Don't worry Niall, as another of a 'certain age' I don't have a problem with all old codgers but some of us have moved with the times. However I'm sure you're as aware as I am there is a 'certain generation' that views corticoids as a magic bullet. I have to say the Depomedrone gathers dust all year round and we are effectively a steroid-free zone anyway until all else fails.

Finally, a word on what Cat said. As an employer I don't like dealing with umbrella companies and locum agencies who effectively lease out staff, their charges are inevitably higher, they are pushy and seem more intent on making a profit than marrying a locum to the right practice. IMO. I don't like paying PAYE either, otherwise I end up paying employer's NI contributions which I'd rather not and if don't have to I can then pay the locum more. I try to be very liberal and fair on this but in the end I have to look after my interests first and given two locums of equal merit I'd choose the one who was self employed. I've never had any problem with the taxman accepting my payments to self-employed locums (I've even had an 'in-depth' investigation) and so far as I'm aware they've never followed up any of them to see if the locum has indeed paid his/her own tax. I hadn't considered whether locums being self-employed or being a limited company would make any difference to me but VAT is not an issue as stated as I can easily claim it all back. One final tip for employers and employees: Simon at Dovetail is the best agency I've worked with and I think the locums find him fair as well.

Re: Beginners guide to Locumming

Niall Taylor — Sat, 03 Jul 2010 08:50:08 GMT

[quote user="Martin Atkinson"]I don't put restrictions on a locum's clinical freedom but we do have some basic ground rules which if you're a switched on young vet will probably fit with your ethos anyway, it's more designed to protect me from old codgers locuming after retirement (I hide the depot steroid bottles while I'm away)!![/quote]

OK, I have to ask (as a vet of a certain age) - what are the problems you have had with "old codgers" and why do you hide the depot droids from them in particular while having them on the shelves for others to use.

Break it to me gently .

Niall

Re: Beginners guide to Locumming

Cat Henstridge — Fri, 02 Jul 2010 22:48:52 GMT

Hi Emily,

I am a locum and have been for the past 18 months. If you are planning on doing it long term, then I would advise you set up a limited company. It is very easy, with the help of an accountant who you will need anyway, and means you can take jobs independent of agencies with no hassle at all. If you think you will only be doing it a short time, then going through the locum agencies is very simple. They have 'umbrella' companies who you can practice under and will sort out all your tax etc.

I am registered for VAT, but on a special scheme for people not over the threshold where I charge it at 17.5% (which is no barrier to work as all vets will be used to claiming tax back) but only pay it at 10%, thus pocketing more money!

I was advised by my accountant that being a limited company is better than being self employed and makes you more attractive to practices. Vets can't really be self employed (which is defined by stuff like choosing your own hours, using your own tools and delegating your work) and this can make your income time on dodgy ground for employers ( the tax man could ask them to pay it for you, even though you will have paid it yourself as well)

However you chose to do it, I would recommend it, I have had a lot of fun and enjoyed being in charge of my life! The agencies are helpful (I find flirting a bit down the phone goes a long way - with the boys anyway!) but don't let them bully you into taking jobs that aren't suitable. In my case I didn't want to work away from home and by sticking to my guns I have had loads of jobs and only spent 2or 3 nights away.

Good luck!

Cat

Re: Beginners guide to Locumming

Vikki Halliday LLB — Fri, 02 Jul 2010 22:06:43 GMT

Thanks Martin,

I also need a locum for week commencing Sept 13th, but thought it was really cheeky asking on the forum!

Emily was going to contact you via conversation but you have not enabled it for non-colleagues! Essential IMHO if you want some work!

Mine's in a new practice and you can play with my digital xray too. No website yet but Companion Care practices are all quite similar.

contact me if you are interested.

Re: Beginners guide to Locumming

Martin Atkinson — Fri, 02 Jul 2010 19:25:59 GMT

Emily, if you're interested I may need a locum this summer for a week, no set week at the moment, I tend to book around when I can get a locum in the summer rather than vice versa. It is sole charge but no out of hours, nice and quiet cutting edge small animal practice, friendly nurses, nice accomodation, very professional - as pointed out previously Go to my web site if you want to know more www.stmartinsvetclinic.com.

Re: Beginners guide to Locumming

Emily Nightingale — Fri, 02 Jul 2010 14:22:13 GMT

Thank you all very much. It is very very much appreciated!!!! =D

Emily

Re: Beginners guide to Locumming

Nixthevet — Fri, 02 Jul 2010 10:21:25 GMT

[quote user="Martin Atkinson"] Last but by no means least, even though in my practice you are covered by my professional negligence indemnity because you are replacing me or my assistant get your own, you are not covered from the moment you walk out the door at the end of the week, so if that op that didn't go right comes back in 6 months it may also come back to haunt you.[/quote]

Martin's post is excellent- I wish the practices I locumed for ( very briefly) were so orgasnised and professional.

On VDS cover- definately get your own- it's a must these days as the theory of 'replacement cover' no longer really applies as the vet who is away is then also not covered for anything that occurs whilst you're in their shoes!

I'm sure they'd be really happy to tell you more if you give them a call.

Also there a some companies who will not employ locums unless they are self-employed- as otherwise they take on all the repsonsibilities that come with PAYE.

Re: Beginners guide to Locumming

Martin Atkinson — Fri, 02 Jul 2010 09:54:51 GMT

I thought it may be useful to have the viewpoint of the employer. Personally I prefer locums who are self employed and are not VAT registered, it makes life a lot more simple for me, but I understand that for some being on PAYE is better and being VAT registered makes sense so you can claim it back on equipment you purchase. I prefer to pay the locum directly, not through an agency. I don't put restrictions on a locum's clinical freedom but we do have some basic ground rules which if you're a switched on young vet will probably fit with your ethos anyway, it's more designed to protect me from old codgers locuming after retirement (I hide the depot steroid bottles while I'm away)!! I don't want you to suddenly change the treatment for a case I've been trying to stabilise for the past 6 months unless there is very good reason and I don't want you to order a bottle of an expensive drug that I will never use again, unless it is critical to the treatment. I will send a practice protocol on things like vaccination schedules, anaesthetic protocols, nurses rotas, the computer etc etc and a fact sheet on basic amenities, what the flat is like etc and terms and conditions in advance and if the vet you're going to locum for doesn't, then ask. I will follow up your references (I don't rely on the agency's) and if I don't have your most recent one or if there is a gap I will want to know why. I like to meet you before I employ you and I want to show you my practice and the accomodation - I'm proud of it and have nothing to hide and neither should you so unless it is totally impractical, if the practice doesn't invite you then ask, but don't worry if you can't as its not critical, but if they don't want you to visit then ask yourself why. Buy your own protective clothing: consulting tunic, scrubs etc unless the practice insists on you using theirs with the corporate logo or you may end up with something 2 sizes too small or large with holes in it! Get your own stethoscope especially if you're into cardiology, don't expect the practice to have a good one and you also then only have your own ear wax to contend with!, and if you have a favourite instrument especially needle holders (critical if you're left handed) bring your own. Obvious things like: are you in sole charge, are you on call, is there a car if the accomodation isn't next door, are not always admitted so ask. Last but by no means least, even though in my practice you are covered by my professional negligence indemnity because you are replacing me or my assistant get your own, you are not covered from the moment you walk out the door at the end of the week, so if that op that didn't go right comes back in 6 months it may also come back to haunt you.

Re: Beginners guide to Locumming

Vikki Halliday LLB — Fri, 02 Jul 2010 08:59:02 GMT

Emily,

You have three months to register as self employed, and this can be done online at the direct.gov website, but if you work for an agency this may not be necessary if you use one of their contractor payment schemes. Just beware as although they pay your tax and NI at source, they frequently get it wrong, and you will still have to check it at the end of the year when you submit a tax return. My advice would be get an accountant to do it, and get advice from them as to what tax allowances you can make best use of.

Also it may be a good idea to start locumming for an agency first unless you have any specific practices which are willing to contract you on a regular basis, as that way you can build up a portfolio of work, a locum "CV", and you will get yourself known.

I wouldn't worry about VAT registration, it's not compulsory unless you are turning over more than a certain amount, which is quite high, but you can voluntarily register if you want. This means that you will invariably need an accountant to do your VAT return as well unless you are particularly accountancy minded.

One other thing, you may find after practice it is incredibly frustrating not being able to carry out treatments the way you want to or are used to, and also not getting to follow up cases, but if you want freedom to work when and where you choose then it's not a bad life, I did it for about 5 years before a yearning for my own practice got the better of me!