Locum and Bank Work in the NHS: How It Works and Who It Suits

Flexible shift work has always existed around the edges of the NHS, but it has become a much more visible and, for many clinicians, deliberate career choice rather than a stopgap between permanent jobs. The terms bank, agency and locum work all get used, sometimes loosely, to describe different arrangements, and understanding the actual differences matters if you are weighing up whether this kind of work suits you.

What bank, agency and locum actually mean

NHS staff bank refers to a pool of workers, often including staff who also hold a substantive contract elsewhere in the same trust, who pick up additional shifts directly through that trust's own booking system. Bank workers are typically paid at rates set by the trust and are treated, in most respects, as trust staff for the shifts they work.

Agency work involves being employed or engaged by an external staffing agency, which then places you in shifts at various NHS trusts or private healthcare providers. Agencies handle booking, and typically pay rates that reflect a commission or margin on top of what the trust pays, though NHS trusts operate under agency spending caps that shape how and when agency staff are used compared with bank staff.

Locum is a term most associated with doctors, and sometimes other regulated professionals, working flexible, temporary shifts, and can be arranged either through a trust's own bank or through an agency, depending on the individual's preference and the trust's policies. In practice, many trusts actively encourage doctors and other clinicians to register with their own bank first, since it is typically cheaper for the trust and often just as convenient for the clinician.

How bank work typically operates

Registering with an NHS trust's staff bank usually involves a similar recruitment process to a substantive post, including relevant checks, mandatory training and, depending on the role, an interview, even though you are not committing to fixed hours. Once registered, shifts are typically offered through an online or app-based system, and you choose which ones to accept based on your availability. Pay is usually processed through the trust's normal payroll, and shift rates are generally published and consistent, rather than individually negotiated.

Many bank workers hold a substantive part-time or full-time post at the same trust and use bank shifts to top up their hours or income, while others work exclusively via the bank, effectively building a flexible career without a single fixed contract.

How agency or locum work typically operates

Agency work involves registering with one or more staffing agencies, who handle compliance checks and then match you to available shifts, sometimes across multiple trusts or organisations. This can offer more variety in terms of settings and locations, and agencies often have visibility of shifts across a wider area than a single trust's bank. Because trusts operate under agency spending controls, agency shifts are not always as freely available as bank shifts, and trusts are generally required to try their own bank first before turning to agency staff.

Pay arrangements, notice periods and the exact relationship with the agency, including whether you are engaged as a worker, through an umbrella company, or in some other arrangement, vary and are worth understanding clearly before you commit, since these details affect both take-home pay and your employment rights.

Who this kind of work tends to suit

Flexible bank, agency or locum work suits different people for different reasons. Some are drawn to the control it offers over their own schedule, which can matter a great deal for parents, carers, or anyone managing a health condition or other commitment alongside work. Others use it to gain broad experience across different wards, specialties or organisations early in their career, before settling into a substantive post. Some experienced clinicians choose it deliberately as a long-term way of working, valuing the flexibility and variety over the structure of a single permanent contract, particularly later in their career or after retirement from a substantive post.

It tends to suit people less well if they strongly value predictability, continuity with a single team, or the fuller package of benefits and structured career development that often comes with a substantive contract, such as clear promotion routes, extensive training budgets or long-term pension planning built around continuous service.

Things to weigh up before committing

• Income predictability: bank and agency shifts are not guaranteed, so income can fluctuate more than in a substantive post, which matters for anyone budgeting around a fixed monthly figure.
• Continuity and team relationships: moving between different wards or organisations means less time to build deep working relationships with a single team.
• Career development: substantive posts often come with clearer access to structured training, mentoring and promotion routes, though many banks also offer some training access.
• Employment status and rights: bank, agency and umbrella company arrangements differ in terms of holiday pay, sick pay and other entitlements, so it is worth understanding exactly what you are agreeing to.
• Administrative overhead: working across multiple bookings, and potentially multiple agencies, requires more personal organisation than a single employer relationship.

A note on doctors and locum terminology

Although bank and agency arrangements exist across most healthcare professions, the term locum is used particularly often around medical staffing, covering doctors filling temporary gaps in a rota, whether for a single shift or a longer-term vacancy. Locum doctors can be booked through a trust's own medical staffing bank, through an agency, or in some cases directly by a department, and the same broad trade-offs around pay, continuity and administrative overhead apply as with nursing and other bank or agency work. Because medical rotas often carry particularly strict safe staffing requirements, locum doctor shifts can be in especially high demand at short notice, which shapes both availability and how quickly bookings are confirmed.

Tax and employment status are worth getting right

How you are engaged for flexible work, whether as a direct bank worker paid through payroll, as an agency worker, or through an umbrella company, affects your tax position and employment rights in ways that are easy to overlook when you are focused on simply picking up shifts. Rules around off-payroll working, sometimes referred to by the shorthand IR35, can affect how certain contracting arrangements are taxed, and requirements in this area have shifted over recent years. This is a genuinely technical area, and getting it wrong can be costly, so anyone doing significant amounts of agency or umbrella company work is generally well served by getting independent advice from an accountant or tax adviser familiar with healthcare contracting, rather than relying on informal guidance from colleagues.

Getting started

If you are interested in bank work, the most direct route is usually to contact the staff bank team at trusts you are interested in, since many accept registrations from suitably qualified and registered staff even if you do not currently hold a substantive post there. For agency work, researching a small number of reputable, well-established healthcare staffing agencies and comparing how they handle compliance, pay and shift availability is generally more useful than registering with as many as possible at once.

Whichever route you choose, keeping your professional registration, mandatory training and any required checks up to date in advance will make it far easier to start picking up shifts quickly once you decide to go ahead.

This article is general information, not legal, immigration or medical advice. Always confirm current requirements with the relevant official body.