Should I work through a limited company as a locum?

It depends on how much of your work falls inside the off-payroll rules, since a company adds cost and paperwork without adding much benefit if most engagements are treated as employment anyway. Send us the mix of clients you actually have and we will run both positions rather than answer it in the abstract.

I am already registered for Self Assessment. Am I automatically in Making Tax Digital?

Not automatically. It depends on your qualifying income from self-employment and property in the relevant tax year, which for the first tranche was 2024/25. Being over the threshold in one year and under it the next does not take you back out again straight away, so check rather than assume.

Can you deal with the NHS pension forms for my locum sessions?

We complete the locum forms from the records we already keep for you. What we cannot do is advise you on whether to pension the sessions at all, because that is regulated advice and we do not hold Financial Conduct Authority permission.

Locum Accountants

Written and reviewed by the Medical Accountants editorial team. Last reviewed 24 July 2026.

Locum work produces the messiest records in medicine. Three agencies paying on different cycles, a trust paying direct, a practice paying by bank transfer with no remittance, mileage between all of them, and a pension form for the sessions that were pensionable. None of it arrives in one place and none of it is designed to be reconciled.

We do the reconciling. You send the invoices and the bank statements, and you get back a set of figures that agrees to the bank, a return that matches it, and a running tax reserve so the January number is never a surprise.

Locum Bookkeeping and Returns

Records kept quarterly rather than in one panic at Christmas, income traced from invoice to bank so nothing is counted twice or missed, and the Self Assessment return prepared from the same figures. Where you are pensionable, we keep the sessions separate so the NHS forms can be completed from the same records rather than from memory.

If several years are outstanding, say so at the start. Bringing three years up to date is a different job from doing one, and it is much better quoted honestly at the beginning than discovered halfway through.

Quarterly Updates Under Making Tax Digital

Making Tax Digital for Income Tax started on 6 April 2026 for anyone whose qualifying income from self-employment or property was over £50,000 in 2024/25. A locum at that level is now sending quarterly updates from compatible software, on top of the return, with the first three due on 7 August, 7 November and 7 February.

This is the change most locums have not been told about, because the letters went out on the basis of a tax year that ended over a year ago. Our guide to Making Tax Digital for doctors sets out who is in, who comes in later, and what a quarterly update actually contains.

Agency Work, Companies and Status

Where you invoice through your own company and the client is an NHS trust, the trust decides your employment status, not you, because NHS bodies are public authorities for off-payroll purposes. Where the client is a small private company, the decision comes back to your own company. Which of those applies changes what lands in your bank and what has already been taxed before it gets there.

We check the determinations you have been given, tell you whether the deductions on your payslips or self-billing invoices are right, and reclaim where they are not. A wrong determination that nobody queries is money you will not see again.

Fees for Locum Work

A fixed annual figure covering the bookkeeping, the quarterly updates where you are in Making Tax Digital, and the return. Quoted before the work starts, based on the number of income sources and whether there is a company involved.

We do not charge per transaction and we do not add a fee for an email in October asking whether something is claimable. Ask the question when it happens, not in April when the answer is too late to be useful.