Post by Deborah Udy Okusaga Akanne (@deborah_udy_okusaga)
Locum vs Substantive NHS Work.
You have been told locum pays more.
That is sometimes true.
Here is what it costs you that nobody mentions.
Locum work means working through an agency or bank on a shift-by-shift or short-term basis. Substantive work means a permanent or fixed-term NHS contract of employment. The pay difference is real. Locum rates for doctors and some specialist nurses can be higher per shift. But that comparison only makes sense when you understand what substantive contracts include.
NHS substantive employees receive:
Employer pension contributions of approximately 20% into the NHS pension scheme — one of the most valuable benefits available in the UK.
Annual leave from 27 to 33 days plus bank holidays.
Sick pay protection from day one.
Maternity and paternity entitlements.
CPD funding and study leave access.
Locum workers through agencies receive their hourly rate. In most cases, that is it.
The tax situation matters too. Agency workers are often paid through umbrella companies. Some candidates have received unexpected tax bills because of how payments are structured through those arrangements.
The visa consideration that often gets missed: for a Health and Care Worker visa, your employment must be with an NHS body or a CQC-registered care employer in a contracted or substantive role. Purely agency-based arrangements can create complications with visa conditions. Always confirm with your employer and a qualified immigration adviser before assuming that locum work satisfies your visa requirement.
This is not a reason to avoid locum work entirely. But it is a reason to understand the full picture before you commit.
DM me LOCUM if you want to think this through for your specific situation.
Post 3 is at 11 am. The exact routes from Healthcare Assistant to Registered Nurse — including what the December 2026 deadline means for HCAs currently on sponsored visas.
#LocumNHS #SubstantiveNHS #NHSCareers2026 #NHSPension #InternationalNurses #IMGDoctor #healthandcarevisa #SovereignHealthcareAdvisoryGroup #NHSJobs2026 #NHSAgencyWork #UKHealthcareJobs #NHSRecruitment2026 #AHPsUK #InternationalHealthcareProfessionals #NHSContracts
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