UK Locum Healthcare Pay Rates Guide (2026/27)

This guide compares indicative locum healthcare pay by profession and engagement route. Actual rates depend on each client and assignment, and umbrella, PAYE and Direct Engagement figures are not interchangeable.

All pay rates are subject to assignment and client commissioning terms. The figures in this guide are largely based on National Health Service framework data and market benchmarks, and are provided for illustration only. At Actionus, we always endeavour to achieve more for our healthcare professionals based on experience, clinical demand and shift requirements.

Final gross rates depend on the trust, procurement framework caps, geographical location, shift pattern and engagement model (Direct Engagement, PAYE or approved umbrella). All rates exceed the National Living Wage, with statutory 12.07% Working Time Regulations holiday pay either accrued on top or itemised separately on your payslip.

Indicative hourly rates by profession

Umbrella, PAYE and Direct Engagement explained

Umbrella: the headline assignment rate is paid to an umbrella employer, which deducts employer's National Insurance, the apprenticeship levy and holiday pay before paying you. Available only where the client's terms permit it.

PAYE: you are paid directly through payroll. The hourly figure is lower than an umbrella headline but is not reduced by umbrella employer costs.

Direct Engagement (DE): many NHS trusts engage locums directly on PAYE to reduce VAT costs. Where a client uses DE, umbrella payment is normally not an option.

What affects your rate

• Region and demand: London weighting and hard-to-fill areas often attract higher rates.
• Unsocial hours: nights, weekends and bank holidays usually carry enhancements.
• Specialism: CT/MRI, vascular sonography, histology dissection and critical care command premiums.
• Compliance readiness: complete HCPC/NMC, DBS and mandatory training records mean faster starts.

Pensions: NHS Pension, auto-enrolment and opting in or out

Umbrella and agency PAYE locums: if you earn over the auto-enrolment threshold, you are put into a workplace pension by default. Your employer must contribute at least 3% of qualifying earnings and you contribute 5%, unless you choose to opt out. You can opt out within the first month for a full refund, or later for a pro-rata refund, and you can opt back in afterwards. Agency locums generally cannot join the NHS Pension Scheme through an agency or umbrella company.

Direct Engagement (DE): because the trust pays you directly, some DE arrangements allow you to join the NHS Pension Scheme. Whether this is available depends entirely on the trust's terms, so ask your Actionus consultant before the placement is confirmed if NHS Pension membership matters to you.

Permanent NHS staff: Agenda for Change employees are automatically enrolled into the NHS Pension Scheme, where employer contributions exceed 20% of pensionable pay. You can opt out by leaving the scheme through NHS Pensions, though your own contributions stop and your take-home pay rises by only part of what the employer was putting in. You can apply to rejoin later, subject to scheme rules.

Locum vs permanent

Locum work offers higher hourly pay and control over where and when you work. Permanent Agenda for Change roles include NHS pension, contractual sick pay and annual leave. Many clinicians combine both, using locum placements to gain experience across different services before settling into a specialist role.

Frequently asked questions

What is the difference between an umbrella rate and a PAYE rate?

An umbrella or assignment rate is the gross figure paid to an umbrella company, which then deducts employer costs such as employer's National Insurance, the apprenticeship levy and holiday pay before paying you. A PAYE rate is your gross hourly pay before your own tax and NI. That is why a PAYE rate looks roughly 15–25% lower for the same assignment.

What is Direct Engagement (DE)?

Under Direct Engagement the hiring trust engages the clinician directly, usually on a PAYE basis, with the agency supplying and supporting the placement. Trusts use it to reduce VAT costs. Where a client uses DE, umbrella payment is normally not available for that assignment.

Can I always choose umbrella or PAYE?

No. The payment route depends on the client's procurement terms. Some clients mandate PAYE or Direct Engagement and do not permit umbrella engagement. Your Actionus consultant confirms the available options and rate before you accept a shift.

Do locum healthcare workers get holiday pay?

Yes. Workers are entitled to 5.6 weeks of statutory holiday under the Working Time Regulations, equivalent to 12.07% of hours worked. Depending on the engagement model, holiday pay is either accrued and paid when leave is taken, or shown as a separate 12.07% uplift on top of the basic hourly rate. Where a rate is quoted including holiday pay, the basic rate plus the 12.07% element is itemised on your payslip. All Actionus rates are quoted so that the basic rate never falls below the National Living Wage once holiday pay is separated out.

Do nights, weekends and bank holidays pay more?

Usually. Many clients apply enhancements for unsocial hours, weekends and bank holidays on top of the standard weekday rate. Enhancement levels vary by client and framework.

How are Actionus locum workers paid?

Hours are submitted through Actionus online timesheets and authorised by the client before payroll is processed.

Do locum healthcare workers get a pension?

Yes, but which pension depends on the engagement model. If you are paid through an umbrella company or agency PAYE, you are automatically enrolled into a workplace pension once you earn over the auto-enrolment threshold, and your employer must contribute at least 3% of qualifying earnings. You can opt out of this pension and opt back in at any time. Agency locums generally cannot join the NHS Pension Scheme through an agency or umbrella company; NHS Pension membership requires an eligible arrangement with an NHS employer, such as some Direct Engagement placements, where it depends on the trust's terms. Permanent Agenda for Change staff are automatically enrolled into the NHS Pension Scheme, where employer contributions exceed 20% of pensionable pay, and can choose to opt out and later rejoin.

Can I opt in or out of my pension as a locum?

Yes. Under auto-enrolment you are put into a workplace pension by default and can opt out within the first month for a full refund of your contributions, or opt out at any point afterwards with a pro-rata refund. You can also opt back in, usually no more than once every 12 months if you have previously opted out and your earnings stay below the threshold. If a Direct Engagement placement offers NHS Pension membership, joining is by choice: you opt in to contribute, and you can opt out (leave the scheme) and reapply to rejoin later. Opting out of the NHS Pension Scheme is a formal process with the NHS Pensions organisation, not something an agency can do on your behalf.

Final pay rates and payment routes are subject to client commissioning terms, framework caps, location and engagement model (Direct Engagement, PAYE or approved umbrella). Your Actionus consultant confirms the exact rate before any shift is confirmed. Figures are indicative and not an offer of work.