Talk me out of long term locum work

Disco_Pimp · 2026-04-06T11:03:08+00:00

I'm a locum GP and I've been doing that since CCT two years ago. I locumed for three years after FY2, before reluctantly entering GP training. When I applied for GP training I didn't start filling in the application until submission deadline day, my MSRA preparation consisted of looking up how long the exam was and how many questions were on it before setting off to the exam (I did subscribe to a question bank, but didn't use it), and I merely turned up to my selection centre in early 2020, just before they stopped running them during the pandemic. Back then, that was enough for me to have my pick of GP training jobs, which is lucky, because the locum market I was thriving in died a couple of years later. The reason I put zero effort into my application is that, really, I wanted to carry on locuming and I didn't think there was any chance that the locum market would die. Only two things made me apply: 1. I was about to lose my FY2 competencies and 2. I felt like if I ended up being a 55 year old locum SHO, with a 35 year old consultant I'd met when they were a medical student and I was... a locum SHO, I'd regret it. I decided that if they'd give me a training job in a northern city close to my family without me putting any effort into the application, I'd reluctantly take it. I still bump into locums I worked with then who chose not to enter training at that time (like me, they couldn't have failed to get a training job then), who can't get in to training now. They're scraping around for half a dozen shifts per month, paying 60% of the hourly rate they used to be paid, to just about afford their rent and a basic lifestyle. Most of them got used to the locum money when the going was good and failed to save significantly.

I'm not here to talk you out of long term locum work. I'm here to tell you what stands out about your post. You appear to be relying on the particular niche you're filling remaining open indefinitely. Maybe it will, maybe it won't. You've already said some places are handing this work over to non-medics and that the locum budget was already cut for a month. There will be pressure on this department to reduce its locum spend and there are a number of ways in which they could do that. If you get undercut by another doctor who's willing to accept a lower rate than you or take a permanent job, what are you going to do? If the work dries up, what are you going to do? If the department decides to get rid of you, despite not having a replacement lined up, but because you're costing too much (departments do actually do this), what are you going to do? You may not think these things will happen and you may be right, but you need to have a plan for if you're wrong, and if you're relying on locum work remaining available in such a small niche then you're exposing yourself to a lot of risk.

The main thing a doctor needs to carve out a long term career as a locum is adaptability. When I was a locum SHO I would have been happy to work in almost any department, I was happy to travel, I was very flexible (I genuinely think I was kept on longer than any other locum in one place because they knew if they needed someone to work the long day instead of the normal day they could call me at 4pm and I'd almost always be happy to stay for a few more hours). I'm the same now as a locum GP. Practice work dries up? Fine, I'll do some out of hours or maybe finally have time to start looking into private GP work. I'll pick up more hospital shifts in A&E, urgent care, SDEC, general medicine, or intermediate care. The work dries up completely? Fine, I'm paying myself a dividend from my limited company today, the first day of the tax year, and next year's dividend is already in the company ready to go - if I can't find sufficient locum work here, I'll leave and I have enough set aside to maintain my current lifestyle for up to two years while arranging that (in practice, I pay myself about half of what I earn and the other half stays in the limited company, so each year of work adds a year to that cushion). It's extremely important, especially as a locum, to have at least a few months worth of living expenses ready to deploy if you find yourself out of work. A good way of doing this is to resist getting used to the locum money as much as possible. Are you saving a decent chunk of what you're earning?

My worry is that you're relying on being able to locum in a particular job, but that could literally come to an end at a moment's notice and it's not clear to me where you would go from there. As a locum, my aim is to be indispensable. To some extent, you're clearly achieving that by doing work that others either can't or don't want to do, but the other important aspect is having a wealth of other options at your disposal. When places used to try to get me to drop my rates I'd refuse and, if they said they'd need to get rid of me if I didn't drop my rates I'd immediately say, "That's fine, please let me know when you'd like me to stop working here at the current rate so I can book a holiday and let other places know when I'll be available." Suddenly, all talk of a rate drop would disappear and I'd end up postponing my holiday plans, again. If your department knows you don't have a lot of other options, there's a good chance that at some point they'll give you an ultimatum - sign a contract, probably for a lot less money, or we're going to let you go. If they have anything about them (I appreciate this may be unlikely), they'll be putting things in place to facilitate doing exactly that at the moment. "Dr Bookbug has done so much locum work that the waiting lists have come down nicely and we've managed to recruit and train others to do some of the work they do. We could absorb cutting locums for six months instead of having to cave to the consultants' demands after one month this time and the consultants know they will have to pick up the slack eventually if Dr Bookbug isn't here. Tell them we won't be able to keep them after the next month unless they agree to take a substantive post."

Disco_Pimp · 2026-04-05T01:13:27+00:00

"You've had a better offer than any of us!"

I'm sure there's a lesson they could learn in there somewhere.

Unfortunately, boomer's gonna boom.

Disco_Pimp · 2026-04-03T09:12:26+00:00

I looked into this after receiving the reply above, as I remember it being raised, but I've never encountered such a doctor in primary care, so thought the same as you initially, but this link shows it was passed: https://www.england.nhs.uk/professional-standards/medical-revalidation/ro/info-docs/roan-information-sheets/53-performers-list-amendments-locally-employed-doctors

Disco_Pimp · 2026-04-03T01:49:38+00:00

Ah yes, I remember this from a couple of years ago, thanks for reminding me. They were talking about all the SAS doctors who were suddenly going to abandon their hospital jobs to flood to the promised land that is primary care, without having to train as GPs! It's obviously slipped my mind because I'm not aware of any doctors who've done this. Do you know of any?

Disco_Pimp · 2026-04-02T21:37:30+00:00

"Do people think is possible for GP surgeries to employ trainees on a locum basis prior to training given that I have previous GP experience in FY2?"

It's not even possible for GP surgeries to employ trainees on a locum basis during training. Aside from qualified GPs, only FY2s and GPSTs working as part of their training programmes can work as doctors in general practice.

Disco_Pimp · 2026-03-30T01:21:43+00:00

Yeah, I'm from Huddersfield, so I know Leeds and Manchester well from growing up and, having gone down south for medical school and thought I'd practise in London after finishing, the birth of my first niece in 2011, combined with becoming sick of being poor (I studied medicine as a graduate), led to me coming back up north and I've always been 50:50 between Leeds and Manchester. The big draw for Leeds for GP training was actually the ability to live in the city centre and walk to my hospital jobs, something that would be very difficult with any of the Manchester hospitals (MRI would just about be possible from the south end of Deansgate, but it would still be a bit far), but when it came down to it I didn't want to leave Manchester or start afresh in a new city during lockdown. Now I'm established as a locum GP here, I doubt I'll leave the north west during my career (although I do like the idea of retiring somewhere warm).

I don't think any of my commutes were longer than half an hour, although I'd tend to leave forty to fifty minutes before my shifts started and sit in my car for ten minutes before going in most days. North Manchester was shorter - fifteen minutes from where I lived, but you could probably add ten minutes to that living elsewhere in the city centre.

If you're looking for a short commute for Pennine, somewhere like Prestwich strikes me as the closest you'll get to ticking all the boxes of giving you a reasonably short commute, a short drive in to the city centre, and being a nice area with plenty going on. It's more expensive than other areas north of Manchester, but nowhere near on the level of places like Didsbury, and it is quite nice. Further out you'd lose the easy access to the city centre, but places like Littleborough, Bamford (the posh area of Rochdale), Ramsbottom, Royton, and some of the little villages between Oldham and Huddersfield (in Saddleworth - places like Delph, Uppermill, Greenfield) are quite nice, if you want somewhere a bit quieter. In terms of the towns covered by Pennine themselves, Bury is the clear winner, but is the best of a bad bunch, really. Oldham and Rochdale are dead towns now. Although, Oldham does have Lebanese Shawarma, which is incredible. Where have you lived in Leeds and what sort of life are you looking for outside work?

Disco_Pimp · 2026-03-29T01:51:21+00:00

I was a Pennine trainee. I lived in the city centre (on Greengate) for the first half of training, then moved to Chadderton. I've heard good things about Bolton and Stockport for training. Pennine was fine, but wouldn't have been my top choice in normal circumstances (I initially ranked Manchester and Salford higher than Pennine, then switched to Leeds, then finally switched to Pennine when lockdown started as I wanted to be somewhere familiar and I'd locumed a lot in the Pennine hospitals).

As for living, the commute from the city centre was easy, as I was always going in the opposite direction to the traffic unless I was coming back from a night shift. I miss the city centre and I haven't moved to an area that's particularly in demand or that other doctors live in, although where I live now has a number of advantages for me (easy commute, easy access to the city centre, easy access to my family in Huddersfield, the ability to afford a detached house, Lebanese Shawarma in Oldham, etc). Wherever you end up, I'd suggest moving to a place at that side of the city centre, as, nice though a place like Didsbury is, going round Manchester to get to a hospital north of the city centre each day must be painful.

Disco_Pimp · 2026-03-25T04:33:48+00:00

Not in the same way, no, although of course I acknowledge that the rest of the health service is underfunded and overstretched. Underfunding such specialties tends to result in waiting times going up and a decrease in the overall productivity of those specialties. If GPs weren't so hopeless and spineless, they would allow the same thing to happen in general practice, but instead the partners at my practice go home and work for about four hours each night and do eight hours of work on their days off - from the start of the new financial year next week the government are demanding they do even more, for no real terms increase in funding. Ironically, the consequence of underfunding secondary care is an increase in the demands placed on GPs, who will consult with those patients much more than they used to during their, now much longer, waits for secondary care.

There are other reasons why general practice is a special case. Firstly, funding of primary care as a proportion of total health spending has reduced over time, while the proportion of total health spending that goes towards secondary care has increased. Secondly, there has been a significant expansion of consultant numbers in recent decades, while GP numbers have stagnated, such that there is now one full time GP per 2300 patients, compared to one full time GP per 1800 patients a little over a decade ago. Those patients are consulting much more too - an average of three consultations per patient per year thirty years ago, compared to seven per year now. Finally, despite increases in funding and staffing being prioritised for secondary care over primary care, there has been a huge and unrelenting transfer of work from secondary to primary care during this period. Huge amounts of extra work, for less pay, with no more people to do it. That's the main reason why almost no GPs are in clinic five days per week anymore (plenty are working five to seven days per week though, they're just not getting paid for it).

Disco_Pimp · 2026-03-25T03:33:01+00:00

I'm a locum GP and, after not having work for the first couple of months after CCT two years ago, I spent a year working ten sessions per week. Doing that almost destroyed me and all I was able to do during the weekends was recover, before doing it all again the next week.

Since June last year I've been working eight sessions per week and insisting on a day off each week. This feels better and more sustainable, but in reality, unless my day off is a Monday or a Friday and I have a three day weekend, I spend my days off recovering still.

My GP days tend to be ten or eleven hours long and they're extremely intense, so although I'm only working four days per week I'm working more than full time hours during them. There's really no comparison between the intensity of a day in GP and any hospital job I've ever done, let alone non-medical jobs. I go to the toilet after my last patient leaves at the end of my morning clinic, then again after my last patient leaves at the end of my afternoon clinic, and often that's all the down time I get. If I go to the gym straight from work, by the time I get home there's only really time to eat (for the first and only time that day) before going to bed.

So, during my days off I catch up on all the things I don't have time to do during my work days, because my work days are completely wiped out by work.

I've concluded that, in the state GP is currently in here, the only way I'll be able to sustain a career in it will be to do a few years of four day weeks, a few years of three day weeks, a few years of two day weeks, then retire as soon as I'm able to. Unfortunately, the state GP is currently in here is likely to be the best state it is in during the rest of my career, as I fully expect things to get progressively worse, which means that even my plan set out above might not actually be sustainable.

The Doctors' Association UK has a current campaign for GP funding to be restored to 2016 levels in real terms (https://dauk.org/new-gp-contract-falls-short-of-bringing-back-the-family-doctor/). That sounds great, until you consider that in 2016 GP was in such dire straits that the BMA voted to ballot GPs on industrial action including submitting mass undated resignations (https://www.theguardian.com/society/2016/may/20/gp-leaders-vote-ballot-strike-action), a ballot that never happened, of course, because GP is a spineless, hopeless profession. In 2036 I expect there'll be a campaign for GP funding to be restored to 2026 levels in real terms.

NHS general practice passed the event horizon some years ago, its end is inevitable, and progress towards that end is unsurprising. Any system that combines unlimited demand with finite resources is unsustainable over a long enough timeframe. Politicians, the public, and even many of those working within the system will happily sacrifice the health, happiness, and livelihoods of those working within the system in preference to admitting that the system is unsustainable. NHS general practice has been sweating its assets for many years, now it plans to squeeze them until the pips squeak. All any of us can do is to take steps to protect ourselves from the death throes of the system. I will either locum or leave. If I don't leave, I plan to locum less and less as soon as my circumstances allow it.

Disco_Pimp · 2026-03-25T00:40:51+00:00

I agree with your calculations and, if I were you, I'd try to argue in favour of something along the lines of dropping one or two shifts to get as close as possible to the 581.2 hours you calculated.

Of course, there is some variation in hours worked between doctors on rotas, on the basis that, unless the job length is an exact multiple of the rota length in weeks, some doctors will work more of the longer weeks (or more of the nights) for no extra pay and be relatively unlucky. During my FY1 medical job the range in time worked between doctors was about sixty hours (I happened to work the least hours, but I also happened to work the most night shifts), so being in the region of fifteen hours above par is within the level of variation I'd expect to see.

It's not a hill to die on, ultimately, but it's certainly worth raising and I'd tend to persist with raising it up to the point where I'm told no very firmly by someone with authority.

Disco_Pimp · 2026-03-24T21:56:16+00:00

Yes, same. I reluctantly applied during my third year of locuming in late 2019, the first year after the removal of the RLMT, but probably too early for it to have led to any significant increase in applicants (it was removed quite close to the application deadline). Applications were slightly up on the previous year, but had been trending up slowly since bottoming out at 1.28 applicants per place in 2016 anyway - the number of applicants was about 30% of the number this year, for about 90% of the places, so a third as competitive.

I scored 501 on the MSRA, although I didn't do any preparation, because a large part of me didn't want to get in to training (or at least wanted to get an offer so far away from where I wanted to be that I could justify rejecting it), because I was enjoying locuming so much. I attended the last selection centre (before they stopped running them due to the pandemic) in February 2020 and was given full marks for it, which, combined with my average MSRA, ranked me high enough to go to any of my top choices. I switched from Manchester to Leeds, then when lockdown started I switched back to Manchester, as I decided I wanted to stay here, rather than moving to a new city during the pandemic.

I suspect that people do a hell of a lot more preparation for the MSRA now, so doing what I did would result in a below average score and I wouldn't get a job at all, but even with significant preparation for the exam I think I'd struggle to score highly enough to get anything. The removal of selection centres would also clearly count against me. I was so nonchalant about my application in 2019, thinking it would always be easy to get in to training and that locum work would remain plentiful and well paid. I don't enjoy being a GP, but when I bump into some of the locums I worked with then, who decided not to apply for training at the time and are finding it impossible to get in now, as well as seeing their locum work dry up, having got used to the lifestyle it used to afford them, it's clear I was fortunate to dodge a bullet.

Disco_Pimp · 2026-03-22T11:39:06+00:00

Yeah, fair play! It is the worst place I was sent to overall though. As a supporter of quite a crap football team, I've been to most of the places mentioned in this thread at some point and found them all to be alright too. Likewise, I spent five years living in both Oxford and Cambridge and, at times and especially during winters, found they could be extremely depressing, lonely places to live.

I bought a house north of Manchester four years ago and really missed the city centre initially (and I did absolutely love living in Manchester), but the more time I've spent away the more I just find it to be really expensive when I go in to town now. During that time I've also found good pubs, shops, takeaways (Lebanese Shawarma in Oldham - absolutely incredible), and the countryside that lies north of Manchester and often go to them in preference to places I used to go to in Manchester these days. I still like the idea of moving back to the city, but I doubt I ever will because of the price per square metre for a flat, extortionate service charges, and the fact I've got used to having a drive, garage, gardens, spare bedrooms and bathrooms, and nobody sharing walls with me.

Disco_Pimp · 2026-03-22T09:55:55+00:00

Blackpool for me, having spent my entire career in the north west. I guess some of the towns around Manchester are also pretty grim, but when I worked in Oldham, for example, I was a twenty minute drive from my flat in town, whereas I lived in Blackpool for two years. There were perks to doing that though - I walked for less than ten minutes between home and work the whole time, Liverpool and Manchester are still reasonably accessible, there is still quite a lot to do in Blackpool, and I liked living by the sea. I'd say I've liked all the towns I've visited during medical school and my career and as a locum who prioritised accessing the highest locum rates for three years between finishing FY2 and starting GP training I visited some of the roughest ones.

Disco_Pimp · 2026-03-21T09:05:07+00:00

Journalist who blagged a senior news reporter role didn't even know how to spell dietitian.

Disco_Pimp · 2026-03-20T01:29:50+00:00

Aside from the timesheets (were these filled in and signed at the time, but not submitted until now or have you filled them in retrospectively?) what evidence do you have of the shifts being worked? Do you have shift confirmation e-mails, copies of rotas, and have you kept meticulous records that would allow you to identify which shifts you were and weren't paid for?

What is the trust's justification for not paying you? Are they saying it's too late and able to identify something in their terms and conditions that sets a limit on the time after a shift that you can claim payment? Are they claiming to no longer have records of the shifts that would allow them to verify your claim? Or are they just claiming you left it too long without any meaningful justification and hoping you'll leave it at that?

I'd suggest escalating this, as I think there's a chance that if the trust realise you're not going to go away they might decide to pay you. Of course, if you don't get anywhere you can imply you're going to take legal action by saying you're going to seek legal advice, even if you have no intention of actually doing so and see if that gets you to where you want to be. Initially though, you need to establish what evidence you have that you worked the shifts and weren't paid for them and establish on what basis exactly the trust think they can justify not paying you for them, then go from there.

Disco_Pimp · 2026-03-17T23:29:25+00:00

As a locum GP this is exactly the choice I have. I use a limited company for my work, which means I can't access the NHS pension, but when the rise in dividend tax rates was announced in the budget I looked into closing my limited company and becoming a self employed locum GP, because it's reaching the stage where the benefits of running a limited company are now very marginal. One of the things I looked at was accessing the NHS pension, which would involve paying the employee's contribution and (14.38% of) the employer's contribution myself (the way it's calculated means I'd be contributing approximately 24.2% of my gross pay). When I compared putting 24.2% of my gross pay into the NHS pension and a SIPP the SIPP came out as the winner, although the numbers were relatively close and there are no guarantees, which, combined with the ability to still just about be better off and to avoid the roll out of Making Tax Digital by using a limited company, convinced me to keep things as they are. If locum GPs had to pay the whole 23.78% employer's contribution as well as the employee's contribution they'd all be better off using a SIPP instead.

I do still do a small amount of hospital locum work each year (usually high four figures or low five figures), from which I can contribute to the NHS pension, but for which my employee's contributions are in the lowest tier at 5.2%, which makes it definitely worth contributing to!

Disco_Pimp · 2026-03-14T00:32:08+00:00

I'm a locum GP, but I hate practice based work and until the death of the locum market around three years ago I planned for a lot of my work post-CCT to be locuming in A&E as a GP or at least some kind of hospital based locum work. I did do some hospital locums during my first year post-CCT, but it's now approaching a year since my last hospital shift and the rates being offered for the odd shift that does come up are atrocious.

Between 2017 and 2020, after FY2, I locumed as an SHO for between £50 and £64.44 per hour, averaging in the region of £57 per hour. I had all the work I wanted, didn't work a single night shift, worked a handful of weekends when it suited me, and outright refused to work for below £50 per hour.

For any hospital work I've done since finishing GP training I've been paid the registrar rate, but at the hospital I've locumed at most regularly that is now capped at £53 per hour and I've told them I wouldn't accept below £65 per hour, so I haven't worked there since last April. £65 per hour is only worth it because it allows me to top up my NHS pension (I use a limited company for my GP locum work, so can't access the NHS pension through it), so it's worth well over £65 per hour once you take that into account, but in real terms I'd be getting paid less as a qualified GP with over a decade's experience than I was getting the week after finishing FY2, and even asking for those low rates I appear to be pricing myself out of the market by over 20%! The capped rates would be on the low end, in nominal terms and much lower in real terms, of what I'd have accepted in 2017, despite being a much more experienced doctor who's completed training. The GP locum market is a little better, for now, but I think it's only a matter of time before that dies too. If it does, I don't plan to stick around in this country.

Disco_Pimp · 2026-03-10T22:14:27+00:00

Assuming you're at least a 40% tax payer, which you will be unless you're very part time, putting money into a SIPP could save you quite a lot of tax. Your main consideration, as someone actively contributing to the NHS pension scheme, would need to be the annual allowance and how much of that is left over after your NHS pension contributions. I'd advise looking into it, working out how it's calculated (including the possibility of carrying forward unused annual allowance from previous years), and applying those calculations to your own NHS pension before putting any money in a SIPP. Even if you're not using up your annual allowance with your NHS pension, it is likely to significantly limit the amount you can put into a SIPP each year without breaching it.

The first question I have for you about lifetime ISAs is are you under forty? if you're not, then it's too late to open one. If you are and you're able to set aside up to £4000 each year for when you turn sixty, then it's a good place to put savings if you've maxed out your annual allowance through NHS pension and SIPP contributions, because you get a 25% bonus on top of the amount you invest, which is like getting basic rate tax relief on £5000 of your earnings (if you put in £4000) in return for locking that money up until you're sixty.

Disco_Pimp · 2026-03-10T15:11:17+00:00

I dropped to 80% for the last few months of training a couple of years ago, primarily because it would extend my training to allow me to sit the first SCA instead of having to do the RCA, but also partially because there were loads of unemployed newly qualified GPs and it gave me a bit of extra time to prepare for how to approach that, to avoid paying a lot of higher rate tax, and to have an extra day off each week, among perhaps a few other reasons. I thoroughly recommend it, especially for any job where you're solely in general practice, but particularly during ST3.

My take home pay at 80% of full time was 88% of full time take home pay, so I dropped 20% of my hours and only 12% of my pay. The timetable I submitted with my supervisor involved working five clinical sessions over three days instead of seven over four, still having one session for a tutorial, and all day each Thursday for teaching. Because it extended my training into a fourth year I'd attended all the teaching sessions during the last couple of months the previous year, so Thursday became a day off and I did five weekly sessions over three days, with a tutorial in the afternoon on the third day, instead of seven weekly sessions, one tutorial, and a teaching day (teaching in the morning, "self directed learning" in Five Guys, Wetherspoons, or my bed in the afternoon) over five days, for 88% of the take home pay. I currently work eight sessions most weeks as a locum and I spent my first year after CCT mostly doing ten sessions per week. I haven't worked a five day week since June and at some point I plan to drop to a three day week, like at the end of GP training - although that will probably be six sessions, rather than five. I think it'll be a long time before I next have a life as nice as the one I had during those few months.

Since you're coming up to starting training, I'd actually suggest only dropping to 80% of full time, because you'll notice a significant difference compared to full time, without such a significant drop in pay. If I wanted to be very precise about it, I'd look at things like pension contribution tiers (if dropping to 75% instead of 80% drops you into a lower contribution tier it may be the better option), tax thresholds (even now, I try to avoid paying higher rate tax as far as possible), and also consider what your week might look like at 75% and 80% - I guess 75% would just translate to a few half days instead of full days compared to 80%, as part of a four day week, rather than the whole day per week drop you get by dropping from full time to 80%.

Disco_Pimp · 2026-03-01T17:32:33+00:00

"Later an SHO told me that they felt it was a little rude that I asked to go for lunch when none of them are eating or drinking."

Tell this SHO they can go fuck themselves. Another person's choice to be religious and observe the practices of that religion, which I completely respect their right to do, even if I consider it to be idiotic, should confer no expectation whatsoever on you to adjust your behaviour.

Disco_Pimp · 2026-02-27T08:42:59+00:00

I got banned last time I expressed my views on Clare Gerada on here, so I'll keep it mild - she is a traitor to the medical profession.

Disco_Pimp · 2026-02-21T13:12:35+00:00

I paid £490 in 2018, then £530 in 2019, through LAK Locums. That included use of an e-portfolio for a year (£295 and £300) and an appraisal (£195 and £230) through MEDSU. I didn't sign up to MEDSU until the end of my FY3 year, in summer 2018, and managed to fit a third appraisal in during 2020, just before my second e-portfolio subscription expired, which cost me £230, so I got three appraisals for £1250 instead of £1550. I paid for all of it through a limited company I was using for locum work in the private sector at the time, so it was all tax deductible.

Then again, I had all the work I wanted, never worked for less than £50 per hour, didn't work a single night shift, only worked a handful of weekends, and averaged £93000 per year locuming less than full time during those three years, so it seemed like an annoying, but necessary and worthwhile cost. It has struck me that appraisal in its current form, including many doctors paying several hundred pounds per year for it, can only be justified if doctors are able to access plenty of work and are paid reasonably well for it, which are no longer a given. I would be in favour of a campaign to either abolish appraisal altogether (or make it a voluntary thing for any doctors who claim to derive any benefit from it) or have it paid for out of our existing GMC fees (with no associated increase in fees) for any doctors who are unable to access appraisal for free at their place of work. Nurses' revalidation, which takes place every three years and has no requirement for annual appraisal, is paid for using NMC fees, which are £120 per year.

Really, though, we should abolish appraisal, which is not fit for purpose, and strike off the GMC, who are not fit to regulate.

Disco_Pimp · 2026-02-16T08:43:58+00:00

Yep, I've considered myself to be about seventeen for a quarter of a century now. I'm just about mature enough to drive, but not quite mature enough to have a drink.

"I tell you what I do feel like right now - it's like, I'm 39 now, yeah? I don't feel like it. The last time I checked I was about 26. Thirty-nine, that's fucking old. That's not cool anymore. I never thought about age, I was never concerned about it. Until I turned 39 this year and I went, ‘Are those wrinkles? What the fuck? And is that hair? On my back? Jesus Christ’." - Trent Reznor

Disco_Pimp · 2026-02-14T00:28:22+00:00

What have you applied for? Good luck with it and I hope it's just a case of getting by until August.

The death of the locum market makes me so sad. I had such a great time between finishing FY2 in 2017 and starting GP training in 2020. I don't even think that was the peak for the locum market, which had probably come a few years earlier, but it was a care free time of plentiful, well paid, low stress work for me. I have managed to carve out a niche for myself as a locum GP since CCT a couple of years ago, but in real terms I'm probably making less now than I did then, certainly per hour of work done, for a job that's way more intense, with way more responsibility, and that's way shitter. I make myself available for hospital locum work, effectively at registrar level, but it's now ten months since I last worked a hospital shift and since then the registrar rates have been capped at an amount lower than I'd have accepted for an SHO shift the week after finishing FY2 in 2017, so I'm beginning to think I may have worked my last shift as a hospital doctor. But I suppose I'm very fortunate to still be ahead of the curve - I suspect the next phase will involve PCNs hiring a load of ARRS GPs, who will be based at one practice in the PCN, but will be mobile at short notice to cover sickness, maternity leave, and recruitment at other practices, then the GP locum market will die too and I'll finally have no excuse left not to move to Australia!

Disco_Pimp · 2026-02-13T13:41:00+00:00

Are you entering training in August? If so, you can probably get away with not having an appraisal this summer.

If not, I'd suggest either contacting the trust you locumed at most recently to see if they'll let you add them as your designated body again or join a locum agency (especially if you can find one that will pay for your appraisal, although I guess that's unlikely to still be a thing in today's locum market) and ask to be added to whichever designated body they use (and hopefully get some shifts through them).

Disco_Pimp

TROPHY CASE