Locum Occupational Therapist Work: How It Works, Pros and Cons

Locum occupational therapy work means filling a temporary post to cover a vacancy, sickness, parental leave or a backlog. It is usually arranged through an agency. You work as an OT in the normal way, on the organisation's caseload and under its policies, but you are not its permanent employee. Contracts can last a few weeks or well over a year, and many get extended.

The honest summary is this. Locuming gives you more control over where and when you work, and usually a higher hourly rate than the equivalent permanent post. In exchange you give up most of the security: occupational sick pay, the NHS Pension Scheme, protected CPD time, a clear route to promotion. You also take on admin and tax questions that permanent staff never think about. Whether that trade is worth it depends on your stage of career, your finances and how much you enjoy walking into a new team every few months.

What locum OT work actually looks like

Most locum OT posts are in the NHS and social care: acute wards, community rehab, council adult social care, mental health, paediatrics, wheelchair and equipment services. Others come from private hospitals, care providers, schools and case management firms.

The pattern is fairly consistent. A team has a gap and sends a request out to agencies. The agencies put candidates forward. You may get a short phone or video call with the team lead, sometimes nothing more. Once your compliance checks clear, you start, occasionally within days.

You will be expected to be useful almost immediately. Induction is often short, and you learn the local recording system, referral criteria, equipment service and housing processes as you go. Locums are frequently brought in because a team is stretched, so you may inherit a long waiting list, half-finished notes or a caseload nobody has had time to triage. Good locums are valued precisely because they get on with it without needing much hand-holding.

That is also why many agencies and teams prefer some post-qualifying experience. If you are newly qualified, ask yourself whether you would get the supervision and preceptorship you need. Often the answer is no, and that matters more than the rate.

Agencies or going direct

Working through an agency

Most locum OT work runs through recruitment agencies. NHS trusts generally book temporary staff through agencies on approved procurement frameworks, and NHS England sets rules on agency spending, so for NHS locum work an agency is often the only way in. The agency finds the post, handles compliance, collects your timesheets and pays you, or pays your umbrella company or limited company.

Agencies vary a great deal. A good consultant tells you the truth about a post, chases late payments and does not push you into the wrong role. Before you accept anything, ask:

• What exactly is the post, the setting and the size and type of caseload?
• Who will be my line manager, and is clinical supervision available?
• How will I be paid (PAYE, umbrella or limited company), and has the client made an IR35 status determination?
• How often am I paid, and what happens if a timesheet is signed late?
• What notice period applies on both sides?
• Who provides indemnity cover while I am on this placement?

Registering with more than one agency is normal. Just keep track of who has submitted your CV where. Two agencies putting you forward for the same post annoys clients and can cause disputes about who placed you.

Going direct

Some temporary work is booked directly: private providers, case managers, solicitors, schools, care homes or families wanting an independent OT. This is closer to running a private practice than to locuming. You agree your own terms, invoice for your own work and carry all the responsibility. Check any agency contract you have signed for clauses restricting direct work with clients they introduced you to. These are common and can be enforceable for a period after a placement ends.

IR35 and employment status, in plain terms

This is the part that worries most people, and it is worth paying for proper advice rather than relying on forum threads. What follows is general, not tax advice.

How you are paid depends on your employment status for tax. There are three common routes:

• PAYE through the agency. The agency pays you much like an employee, deducting tax and National Insurance. Simple, with no company to run.
• Through an umbrella company. You become an employee of the umbrella company, which invoices the agency and pays you through PAYE after its deductions. Read every payslip. The headline rate you were quoted is often before costs such as employer's National Insurance and the umbrella's own margin come out.
• Through your own limited company. Your company contracts with the agency. This only makes sense if a role is genuinely outside IR35, and it brings company accounts, filing and responsibilities of its own.

IR35, also called the off-payroll working rules, exists to stop people who work like employees from paying less tax by working through their own company. In the public sector, and for medium and large private organisations, it is the client (for example the NHS trust or council) that decides whether a role is inside or outside the rules, and it should give you a status determination statement explaining why. Most clinical locum roles involve working under the organisation's direction and control, so in practice many are treated as inside IR35. If a role is inside, tax and National Insurance are deducted much as they would be for an employee.

HMRC publishes guidance on GOV.UK and an online tool called Check Employment Status for Tax. Read both, and speak to an accountant who works with contractors before setting up a company or signing up to any arrangement. Be very wary of anyone promising you can keep far more of your pay than seems reasonable. HMRC has repeatedly warned about tax avoidance schemes aimed at contractors, and when they unravel it is usually the worker who gets the bill.

If you work through an agency, you may also have rights under the Agency Workers Regulations, including equal treatment on certain pay and conditions once you have done 12 weeks in the same role with the same client. Acas explains these rights, and how they apply depends on your arrangement.

How locum pay is structured

We do not quote rates, because they move with demand, region, specialty and band, and any figure would date quickly. What helps more is understanding how the money works.

• Charge rate and pay rate. The client pays the agency a charge rate. The agency keeps a margin and passes on a pay rate. For NHS work, charge rates are constrained by national rules, which limits how much there is to negotiate.
• Hours, not a salary. You are paid for hours worked and signed off. Bank holidays, service closures and short-notice cancellations all come straight out of your income.
• Holiday pay. Agency and umbrella workers are entitled to paid holiday. It may build up and be paid when you take leave, or be included in your hourly rate. Find out which, and budget for unpaid weeks off.
• Sick pay. Usually statutory sick pay at most, if you qualify. No occupational sick pay.
• Pension. You will normally be auto-enrolled into a workplace pension through the agency or umbrella. It is not the NHS Pension Scheme, and many locums underestimate what that difference is worth over a career.
• Mileage and expenses. Community posts mean driving. Check how mileage is reimbursed before you start. Tax relief on travel to temporary workplaces is restricted for many workers inside IR35 or under supervision, direction or control, so do not assume you can claim it.

When comparing a locum rate with a permanent job, put a value on everything you are giving up, not just the hourly figure. Our guide to OT salaries, NHS bands and private earnings sets out the permanent side of the comparison.

Compliance checks: what to have ready

Every agency and client will check you before you start. Having your file complete is the single most effective way to get placed quickly, because good posts often go to whoever can start first.

• HCPC registration. Occupational therapist is a protected title, and you must be on the register to practise. Agencies will check the online register. Keep your CPD records up to date in case you are selected for audit at renewal. Our guide to HCPC registration for occupational therapists covers the detail.
• DBS check. Usually an enhanced check with barred list checks for adults, children or both, depending on the work. Subscribing to the DBS Update Service lets agencies and employers check your certificate online with your permission, which saves repeated applications. There is a time limit for joining after a certificate is issued, so check the details on GOV.UK when you apply.
• References. Usually two recent clinical references, often including your most recent line manager. Ask referees in advance and keep their contact details current.
• Statutory and mandatory training. Typically basic life support, safeguarding adults and children at the right level, moving and handling, infection prevention and control, information governance, fire safety, and equality and diversity. Keep certificates in date and in one place. If an agency offers training, check the client will accept it.
• Occupational health clearance. A health questionnaire and, for clinical settings, evidence of immunisations.
• Right to work and identity documents.
• A clear CV. Dates, settings, gaps explained, and the specific skills a team will look for: discharge planning, moving and handling assessments, equipment prescription, adaptations and grant work, standardised assessments, sensory work, report writing.
• Driving licence and business use car insurance for any community post.

Insurance

The HCPC requires you to have a professional indemnity arrangement in place as a condition of registration. As a locum, that cover can come from different places, and it is your job to know which applies.

Work done for an NHS trust or a council is often covered by the organisation's own arrangements, and some agencies provide cover too. Professional body membership may include professional liability insurance, but check the scope, the limits and whether it extends to independent or private work. If you take any direct work, from a single private assessment to regular case management referrals, you will almost certainly need your own professional indemnity and public liability insurance. A limited company may need its own policies as well. Get the answer in writing before you start, not after something goes wrong.

The pros and cons, honestly

What locums tend to like

• Choice over where, when and how much you work.
• A higher hourly rate than many permanent posts.
• Broad experience across settings and specialties, quickly.
• Distance from internal politics and restructures.
• The ability to take longer breaks between contracts.

What locums tend to find hard

• No guaranteed work. Contracts can end at short notice.
• No occupational sick pay or NHS pension, and holidays are unpaid in practice unless you budget for them.
• Constantly learning new systems, forms and referral pathways.
• Often given the hardest caseloads with limited support.
• Less access to supervision, training and career progression.
• Tax and admin, especially if you work through a company.

Where locum work fits: locum, NHS bank and private practice compared

These three often get lumped together, but they are quite different.

Locum agency work is temporary cover arranged through an agency, usually full-time or close to it for a fixed period, paid by the agency or through an umbrella or company. It suits people who want a block of well-paid work and are comfortable moving on.

NHS bank work means joining a trust's own staff bank, or a bank run on its behalf, and picking up shifts or short assignments. You are paid through the trust's payroll, often on rates linked to NHS pay bands, and bank staff can usually access the NHS Pension Scheme. Bank work is often done alongside a permanent post or while keeping a foot in a familiar service. Availability for OTs varies a lot between trusts.

Independent private practice means building your own caseload: setting your own prices, finding your own clients, keeping your own records and carrying the full clinical and business responsibility. Typical work includes home assessments, equipment and adaptation advice, and functional assessments and reports. It is slower to build than locum income but gives far more control over the work itself. Our practical guide to going private as an occupational therapist covers registration, insurance, data protection and finding clients.

Many OTs combine them. A part-time permanent post with bank shifts. A run of locum contracts to build savings before launching a private practice. Private work alongside a locum post, where your contract allows it. There is no single right answer, only the mix that suits your life at the moment.

Frequently asked questions

Can I work as a locum OT straight after qualifying?

It is possible, but many agencies and teams want some post-qualifying experience, and for good reason. Locum posts rarely offer structured preceptorship, and you may be given a complex caseload with little supervision. Most newly qualified OTs are better served by a permanent post for their first year or two.

Do I need a limited company to locum?

No. Many locums are paid through PAYE or an umbrella company, and because most clinical NHS roles are treated as inside IR35, a limited company often brings extra admin without much benefit. Check the GOV.UK guidance and speak to a contractor accountant before deciding.

How long do locum OT contracts usually last?

It varies with the reason for the post. Cover for leave or a vacancy might be a few months, while some posts are extended repeatedly. Treat every end date as real, and do not rely on an extension until it is confirmed in writing.

Can I do locum or bank work alongside a permanent job?

Often, yes, but check your employment contract first. Some employers require you to declare secondary work, and you need to think about working time limits, rest between shifts and any conflict of interest. Your registration and professional standards apply equally in every role.

Does locum work count for HCPC renewal?

The HCPC does not set a minimum number of hours. It requires you to meet its CPD standards and keep a record of your learning and how it benefits your practice. Locum work can provide plenty of material, but you have to organise and record it yourself, as nobody will remind you.

Can I leave a locum placement early?

Usually, if you give the notice set out in your agency terms. Leaving with no notice can damage your relationship with the agency and the team, and abandoning a caseload without a proper handover raises professional concerns. If a post is unsafe, raise it with the agency and the team lead in writing.

Next steps

If you are thinking about adding independent work to locum or bank shifts, see the kind of work private OTs offer on our home assessment page, find out about listing your practice, and choose an area below to see who is already working near you.