Locum vs Salaried GP: Which Career Path Is Right for You in 2025?

Whether you are finishing your CCT, returning to practice after a career break, or simply reassessing your working arrangements, the choice between locum and salaried general practice is one of the most consequential decisions a GP can make. There is no universally correct answer — the right path depends on where you are in your career, your financial situation, your appetite for administrative responsibility, and how you want to balance clinical work with personal life.

What Is a Locum GP?

A locum GP is a self-employed general practitioner who covers sessions at GP surgeries, out-of-hours services, urgent treatment centres, and other primary care settings on a temporary or sessional basis. Locum work can be arranged through a specialist agency like SHR Group, directly with practices, or via NHS staff banks. Sessions can range from a single morning to an extended three-month block covering long-term absence.

Most locum GPs work either as a sole trader (self-employed individual) or through a limited company. The correct structure depends on your individual circumstances — particularly whether you are primarily working in NHS settings, where IR35 rules may significantly affect the tax efficiency of operating through a company.

What Is a Salaried GP?

A salaried GP is employed directly by a GP practice, Primary Care Network (PCN), or NHS Trust under a contract of employment. They receive a fixed salary — often benchmarked against the BMA Salaried GPs Model Contract — and are entitled to annual leave, sick pay, and NHS pension contributions from their employer. Most salaried roles are between six and ten clinical sessions per week, with some flexibility built in depending on the practice.

Income: How Do the Two Compare?

On paper, locum GPs often earn more per session than their salaried counterparts. In 2025, experienced locum GPs in England typically command £85–£115 per hour for standard daytime GP surgery sessions, with OOH and urgent care rates often higher still. Salaried GP salaries typically range from £65,000 to £105,000 depending on experience, number of sessions, and location.

However, gross income is only part of the picture. Locum GPs must fund their own indemnity insurance (typically £3,000–£7,000 annually), do not receive employer pension contributions, must account for holiday and sick leave personally, and face greater administrative burden around invoicing, tax, and compliance. When all costs are factored in, the financial advantage of locum work narrows considerably for GPs who take regular breaks or who work fewer than eight sessions per week.

Side-by-Side Comparison

Flexibility: The Locum Advantage

For GPs who value control over their working life, locum work offers genuine flexibility. You can choose which practices you work at, set your availability, take extended leave without requiring employer approval, and vary your workload week to week. This is particularly attractive for GPs with caring responsibilities, those pursuing postgraduate study, or those who want to experience different practice environments before committing to a long-term role.

The downside is that this flexibility can feel illusory in practice. Practices often need GPs at short notice, and the most in-demand sessions tend to be the most pressured. Building a reliable locum diary takes time, and irregular income can make financial planning more challenging — particularly for those with fixed outgoings like mortgages.

IR35 and Tax: What Locum GPs Need to Know

Since April 2021, NHS organisations are responsible for assessing the IR35 status of contractors they engage. Most NHS locum engagements are assessed as inside IR35, meaning PAYE tax and National Insurance are deducted before payment — significantly reducing the tax efficiency of working through a limited company. Many GPs have since returned to sole trader status or accepted PAYE arrangements through agencies.

For non-NHS settings — private clinics, some urgent care providers — the rules may differ. Speaking to a specialist medical accountant before choosing your trading structure is strongly recommended.

NHS Pension: The Salaried Benefit That Often Tips the Balance

The NHS pension scheme is one of the most valuable employment benefits in UK public sector employment. Salaried GPs benefit from employer contributions of 23.68% on top of their salary. Over a full career, this can add hundreds of thousands of pounds in additional pension value — a benefit that locum GPs must actively and deliberately replicate through the GP SOLO arrangement, which many neglect to do consistently.

Career Development and Long-Term Satisfaction

Salaried positions typically offer more continuity — you develop relationships with patients, colleagues, and practice staff, participate in QOF and enhanced services, and have a clearer pathway to partnership or clinical leadership. Many GPs find the relational aspects of a regular practice environment professionally and personally fulfilling.

Locum GPs benefit from variety and freedom from management responsibilities, but some report reduced opportunities for clinical development, peer learning, and a sense of professional community.

The Portfolio Approach: Best of Both

Which Is Right for You?

Consider locum work if you value flexibility, want to maximise short-term income, are in a life stage where variable income is manageable, or want to experience different practice environments before committing to a salaried role.

Consider salaried work if you prioritise career development and continuity, want the security of a regular income and NHS pension contributions, have family commitments that benefit from predictable hours, or are interested in a pathway toward partnership or clinical leadership.

Whatever your preference, working with a specialist recruitment partner who understands both sides of the market — as SHR Group does — means you can explore all your options with expert guidance, without committing to anything prematurely.