If you're locuming, you're probably registered with multiple agencies. You're also probably unclear on exactly how much each one takes, what their cancellation terms are, and whether you're getting a fair deal. That ambiguity isn't accidental — it's the business model.
Here's what you need to know.
How locum agencies work
Agencies act as intermediaries between practices seeking temporary GP cover and GPs available to provide it. The practice pays the agency a rate (e.g., £1,100/session). The agency pays you a rate (e.g., £850/session). The difference is the agency's margin — typically 15–25% of the practice-facing rate.
You never see the practice-facing rate unless you ask. Most agencies don't volunteer this information.
The major agencies
The UK GP locum market has several large players and dozens of smaller ones. The major agencies include:
National agencies: Lantum, Patchwork Health, BDI Resourcing, Medical Staffing (MSI), TTM Healthcare Solutions, and ID Medical operate nationally with large databases of practices and clinicians.
Regional/boutique agencies: Smaller agencies often offer more personal service and sometimes better rates (lower margin) but fewer available shifts.
NHS-run staff banks: Some ICBs and trusts operate their own internal locum banks, cutting out agency margins entirely. If your local area has one, it's usually the best deal financially.
What to compare
Commission rate. The agency's cut as a percentage of what the practice pays. Lower is better for you. Some agencies are transparent about this; others aren't. Ask directly: "What is the practice paying for this session?" If they won't tell you, that tells you something.
Payment terms. How quickly do you get paid after working a shift? Standard is 7–14 days from invoice. Some agencies pay faster (weekly); some pay slower (30 days). Cash flow matters when you're self-employed.
Cancellation policy. What happens when a practice cancels your shift? The best agencies pay you a cancellation fee (typically 50–100% of the session rate depending on notice given). The worst agencies pay you nothing and offer you a different shift instead. Get the cancellation terms in writing before accepting bookings.
Indemnity. Does the agency arrange or contribute to indemnity, or are you entirely responsible? Most agencies expect you to hold your own indemnity. A few offer group schemes. Check before assuming.
Compliance burden. Every agency requires you to submit credentials: GMC registration, DBS check, indemnity certificate, mandatory training evidence, appraisal documentation, references. Maintaining compliance across multiple agencies is time-consuming. Some agencies have streamlined digital onboarding; others still require faxed forms.
Should you use agencies at all?
Direct booking — where you work directly with a practice without an agency intermediary — pays more because there's no margin. If you've built relationships with practices that know and trust you, direct booking is always the better financial option.
The practical barrier: finding shifts. Agencies solve the discovery problem — they know which practices need cover and when. Building a direct booking network takes time and requires you to market yourself.
The hybrid approach: Use agencies for shift discovery and new practice relationships. Once you've worked at a practice and they're happy with you, offer to book directly for future sessions. Most practices prefer this too — they pay less. Everyone wins except the agency.
Rates in 2026
GP locum rates in 2026 (what you receive, after agency margin):
Standard sessions (Mon–Fri daytime): £800–£950/session in most of England. London and South East: £850–£1,000. Rural/hard-to-fill: £900–£1,100+.
OOH/urgent care: £90–£130/hour. Weekend mornings and bank holidays command premiums.
Direct booking premium: Add 15–25% to agency rates (because the agency margin goes to you instead).
If you're consistently being offered below £800/session through an agency, either the agency's margin is too high or the market has shifted — check with peers.
The one rule
Never accept the first rate offered. Agencies negotiate, practices negotiate, and the gap between the initial offer and the final rate is often 10–15%. State your rate clearly and be willing to walk away from sessions priced below your floor.
iatroX is built by a GP who understands the locum life. AI clinical search that works wherever you're working this week.