Finally earning a wage for all your hard work is great, and locum work can be a great way to up your earnings, whilst gaining more clinical exposure and experience. It may not be long before you start receiving offers for extra shifts, but consider a few really important things before booking in for locum shifts:

Provisional GMC registration
As an F1 doctor, you have provisional registration and limitations on your practice. With regards to locum shifts, this essentially means that you not permitted to work outside of your ‘training post’ - you cannot work in another hospital, trust or speciality.
This acknowledged, internal locum shifts at F1 level are generally accepted throughout the UK, providing it is within an area of current or previous foundation rotation. For example, if you are an F1 in medicine, it would be considered appropriate for you to cover a medical F1 on-call shift in your hospital, because it is within your normal job role and you would be part of an appropriately supervised team (ie. on-call team with an SHO and registrar).

Personal responsibility
Extra cash is tempting, but it is your responsibility to consider whether you can safely carry out extra hours, in addition to your normal job. F1 is intense enough, so really think about your own health and well-being in relation to working hours. Is it worthwhile, and is it safe? The new BMA contract states no more than 48 hours/week of extra work is permitted, but realistically even one extra shift a week will have a considerable impact on your rest time.
Is the shift within your scope of practice? Be aware that sometimes administrative staff may not be fully aware of your current/prior experience and unwittingly just want to fill a gap. Don’t be tempted to volunteer to cover a shift in surgery, if you have not yet had a surgical job!
Never feel pressured to do extra work, you are not obliged to cover rota gaps and days off are entirely your own.
Locum work should be approached in the same style as regular on-call – be scrupulous when working with unfamiliar patients in different settings, document actions, write your bleep and name clearly - especially out-of-hours. Introduce yourself to unfamiliar team members, make sure you know who to contact if you need help. You still need breaks even when you are paid hourly.

Practical points
Each hospital has different procedures for offering internal locum shifts, so ask at your directorate office. Often emails are sent around listing shifts that need cover, but sometimes it could be at very short notice due to sickness, so it is worth making yourself known if you want extra hours.
Before accepting a shift confirm that it is for an F1, where/what it is (ward cover or assessment unit etc), start and finish time, who else is on that shift (will you be working alongside other doctors) and the hourly rate. A higher rate might be offered for if the shift is at short notice or important to fill. If you are negotiating for a higher rate, ensure you do this professionally and put patient safety first. F1 rates vary enormously but are generally around £30/hour.
Ensure you have a timesheet and have clarified exactly how you need to submit it to get paid! Check when you can expect to be paid, there is usually a cut-off date of the month which will determine this, and it can sometimes take a while.
It’s usually necessary to get a senior signature or authorisation to confirm you have completed the shift. Always get it done on the day, as it can be very difficult to track consultants down at a later date. Remember to get it done before an admissions post-take ward round that you are not involved in, or you could be hanging about!
Make sure you keep a copy of all your timesheets, so you can evidence your hours should there be an issue with payment.
Check how extra work will affect your tax – it can be hugely disappointing to realise all your hard-earned extra cash has actually been swallowed up in your monthly deductions. It isn't unusual for the tax office to think you have two jobs and overtax you - review your tax code.
There will be plenty of times to locum as an SHO, which is often easier, gives much higher rates and offers a better clinical experience.

Always weigh up whether the shift is really worth it for you, speak to your senior supervisors if you have questions, or contact the BMA/Medical Defence Organisation if you are unclear about whether your work is compliant or appropriate - and enjoy the extra pay!

Written by Dr Amy Nixon FY2