NHS, agency and private income
We separate NHS shift pay, agency remittances and private clinic fees, so every stream is reconciled and taxed correctly across your whole year.
Who we helpIndustry guide
The locum accountant who knows your shift pattern.
NHS shifts, agency work and private clinics, your tax return and your pension handled by a locum accountant who knows the rota.
You trained to treat patients, not to reconcile three agency remittances and an NHS Pension form. As a specialist locum accountant, we take Self Assessment, your pension paperwork and your year-end off your plate. A freelance GP doing surgery sessions, a junior covering trust shifts, or a consultant adding private clinics on top? We know how locum income works, how IR35 bites in the NHS, and we keep HMRC happy. Book a call with an accountant for locum doctors who actually understands the work, on one fixed monthly fee.
- 4.9 Google · 63 reviews
- ACCA-qualified
- 30-day money-back
The problem
Why a Generic Accountant Often Gets Locum Work Wrong
Most accountants have never seen an NHS Pension locum form or an inside-IR35 determination from a trust. They treat your locum work like any other freelance gig, and that is exactly where it goes wrong.
IR35 waved through unchecked. Pensionable sessions left unrecorded. Indemnity and royal college fees missed. Payments on account that arrive as a shock. So you overpay, or you lose pension you earned, and you are never quite sure where.
A specialist locum accountant works the other way round. We know how shift income is paid, where the allowable costs hide, and how the NHS Pension talks to your tax return. We do not just record your numbers. We make them make sense.
Tailored services
What We Handle, So You Can Stay on the Ward
01 02 Self-employed and limited company locums
Most freelance locums start self-employed. We handle your Self Assessment, expenses and payments on account, or run your company if incorporating wins.
03 NHS Pension paperwork
We complete your locum pension forms and reconcile pensionable pay, so your contributions are recorded and nothing pensionable is quietly lost.
04 Medical expenses claimed in full
GMC, BMA, indemnity and defence-union cover, royal college fees, CPD and travel between sites, all captured, including the costs a generalist tends to miss.
05 IR35 and contract reviews
We assess each trust and agency engagement for off-payroll status and keep the written evidence, so your position holds up if HMRC ever asks.
06 Tax return and year-end
Your tax return and accounts filed on time, with the bill and your payments on account flagged early, so January never catches you out.
IR35 in the NHS
Inside or Outside IR35? In Healthcare It Is Rarely Simple
IR35, the off-payroll working rules, decide whether HMRC sees a locum engagement as genuine self-employment or as employment dressed up through a company. In healthcare the answer leans one way more than most realise.
Since the off-payroll rules moved the decision onto the engager, many NHS trust and agency shifts have been determined inside IR35. When that happens, the agency or trust deducts tax and National Insurance at source, much like a normal payslip, before you ever see the money. Private clinic work and direct engagements with small employers can be a different story, where the call still rests with you.
Get this wrong and you either pay tax twice or carry a status you cannot defend. We read each contract, record the status determination, and reconcile any tax taken at source against your Self Assessment, so nothing is double-counted and nothing is missed.
NHS Pension Scheme
The NHS Pension for Locums, Without the Lost Sessions
The NHS Pension is one of the best parts of locum life, and one of the easiest to fumble. Only NHS-pensionable work counts, and it has to be processed correctly, with the right forms, for the contribution to land on your record.
For freelance GPs in particular, pensioning a session is time-limited: the locum forms confirming your pay have to reach the right place within a set window, or that pensionable contribution is gone for good. Miss a run of them and you quietly lose years of pension growth you actually earned.
There is also a structure trade-off most accountants skip. You cannot pension income invoiced through a limited company, so the route that saves tax can cost you employer pension contributions. We track every session, file your forms on time, and keep your bookkeeping, your tax return and your pension record telling the same story.
Allowable expenses
How Much Tax Do Locum Doctors Pay, and What Can You Claim?
Your tax bill is not your day rate times a percentage. It is worked out on your profit, what is left after every legitimate cost, and locum work carries plenty.
- GMC registration and your annual retention fee
- Medical indemnity and defence-union cover (MDU, MPS, MDDUS)
- BMA membership and royal college fees
- CPD courses, conferences and clinical exams that maintain your skills
- Professional journals and subscriptions
- Equipment, scrubs and consumables you buy yourself
- Mileage and travel between different work sites
- A reasonable share of phone and home admin
Courses that maintain your existing skills are usually allowable; those that lead to an entirely new qualification often are not, and that line catches doctors out. We keep a locum-specific expense checklist and get your VAT position right if your fee income takes you over the registration threshold.
Business structure
Sole Trader vs Limited Company for Locum Doctors
Most locums start as a sole trader. You pay Income Tax and National Insurance through Self Assessment, usually with payments on account, and the admin is light.
As private and agency income grows, a limited company can keep more in your pocket. You pay Corporation Tax on profits, then take a salary and dividends. But company income cannot be pensioned into the NHS scheme, and inside-IR35 shifts blunt the benefit, so the saving is rarely as clean as it looks.
A company also means more obligations: annual accounts at Companies House and tighter monthly accounting. It is not automatically better, and for many locums it is not worth it.
The right answer depends on your shift mix, your private income and how much you value the pension. We run your real numbers and tell you which structure leaves you better off.
Cash flow
Payments on Account, Forecast Before They Bite
The first big self-employed tax bill is a double hit. Alongside the tax you owe, HMRC asks for payments on account, advance instalments toward next year, which can land as a much larger figure than locums expect.
It catches people in their first or second year especially, when income has jumped but the cash has already been spent. We forecast the whole bill from day one and tell you what to set aside each month.
That way your 31 January never blindsides you, and we flag early if your income drops enough to reduce the instalments rather than overpay.
Simple, fixed fees
Fixed Monthly Pricing & Packages for Locum Doctors
Most self-employed locums pay between £99 and £199 a month. For doctors running a company with several income streams it depends on the volume of work.
No hourly rates. No surprise bills. One fixed fee, a named, qualified accountant who understands locum income, and a 30-day money-back guarantee.
Essentials
Startups and small companies that need essential compliance and year-end support without VAT or payroll.
£99/month- Preparation of Company Year-End Financial Statements
- Year End Corporation Tax Computation
- Submission of CT600 to HMRC
- Statement of Account submissions to Companies House
Premium Plus
Growing businesses that need complete accounting services, VAT return management, and payroll handling.
£199/month- Everything in Essentials
- Quarterly VAT return calculation and submission
- Payroll and benefits management
Enterprise
Established businesses that want strategic mentoring, business planning, and a part-time finance director driving growth.
£499/month- Everything in Premium Plus
- Business mentoring
- Part-time finance director
- Business plan
Trusted by clinicians
What Our Clients Say.
I’ve used several accountants in the past, but hands down there is no one better than Harvey at Zmartly. He really understands exactly what advice you’re looking for and explains everything clearly and professionally. Nothing ever feels rushed…
HeenaVerified Google review · 4 months agoI’ve had an excellent experience working with Zmartly. Harvey and the team are professional, responsive, and genuinely supportive. They explain things clearly, stay on top of deadlines, and always look for practical ways to save tax and improve…
land4 success (chill feel good)Verified Google review · 5 months agoI started working with Zmartly Accountants after having serious issues with my previous accounting firm. They were missing deadlines, incorrectly calculating VAT, constantly late, and extremely difficult and frustrating to communicate with. Switching to Zmartly was a huge…
Jorge Carballo GomezVerified Google review · 5 months agoGreat proactive service always up to date regarding accounting legislation. Harvey and Team will be always helping you with advise how to make your books look good. Already over 4 years using their service very happy.
Auris Property AcademyVerified Google review · 8 months agoI've had a terrible experience with multiple accountants. Zmartly have been incredible. If you do ecommerce / Amazon FBA you definitely need to go with someone who understands the complexities with it. Thanks to Harvey and his amazing…
Sean BarringtonVerified Google review · 5 months agoI’ve used several accountants in the past, but hands down there is no one better than Harvey at Zmartly. He really understands exactly what advice you’re looking for and explains everything clearly and professionally. Nothing ever feels rushed…
HeenaVerified Google review · 4 months agoI’ve had an excellent experience working with Zmartly. Harvey and the team are professional, responsive, and genuinely supportive. They explain things clearly, stay on top of deadlines, and always look for practical ways to save tax and improve…
land4 success (chill feel good)Verified Google review · 5 months agoI started working with Zmartly Accountants after having serious issues with my previous accounting firm. They were missing deadlines, incorrectly calculating VAT, constantly late, and extremely difficult and frustrating to communicate with. Switching to Zmartly was a huge…
Jorge Carballo GomezVerified Google review · 5 months agoGreat proactive service always up to date regarding accounting legislation. Harvey and Team will be always helping you with advise how to make your books look good. Already over 4 years using their service very happy.
Auris Property AcademyVerified Google review · 8 months agoI've had a terrible experience with multiple accountants. Zmartly have been incredible. If you do ecommerce / Amazon FBA you definitely need to go with someone who understands the complexities with it. Thanks to Harvey and his amazing…
Sean BarringtonVerified Google review · 5 months ago
4.9
Google · based on 63 reviewsCommon questions
Frequently Asked Questions
It depends on your shift mix. A limited company can be tax-efficient at higher profits, but you cannot pension company income in the NHS Pension Scheme, and public-sector trust shifts are frequently caught by IR35, which removes most of the advantage. Many GP locums stay self-employed precisely to keep building NHS pension. We model both on your real figures before you decide.
Yes, if you do freelance GP locum work for a practice or ICB on a self-employed basis and aren't engaged through an agency. You complete Locum Form A and Form B (or SOLO forms for ICB work), and only 90% of your earnings are pensionable, the other 10% is a fixed expenses allowance. Crucially, forms must reach PCSE within 10 weeks of the work or that period can't be pensioned.
The Type 2 Medical Practitioner self-assessment confirms your tiered NHS pension contributions for salaried or solo GP sessions. If you are solely a freelance locum you generally don't need it, your Locum A and B forms cover you. If you mix salaried and locum work, you do. We confirm which applies and complete it before the annual deadline.
GMC registration, medical indemnity (MDU, MPS or MDDUS), BMA and Royal College subscriptions, exam and CPD course fees, medical equipment, professional journals, business mileage between sites, and a reasonable share of phone and home-admin costs. We make sure each is claimed correctly, generalist accountants often miss indemnity and CPD.
Self-employed locums pay through payments on account: your first Self Assessment bill includes the tax owed plus a 50% advance payment towards next year, then another 50% in July, so the initial demand can feel like 150% of the tax. We forecast it from your first invoices and tell you exactly what to set aside, so it's never a shock.
Usually not. Most medical services provided by a registered doctor for the protection of health are VAT-exempt, so locum clinical income typically doesn't count towards the £90,000 VAT registration threshold. Some non-clinical work (certain medico-legal reports or expert witness work) can be standard-rated, we check the mix and advise.
Fixed monthly pricing at £99, £199 or £499 depending on whether you're self-employed or running a limited company, with a named qualified accountant, replies within 72 hours, a 30-day money-back guarantee and rolling monthly terms. We work in Xero, QuickBooks, FreeAgent or Sage.
Guides for locum doctors
Plain-English explainers, kept current with the latest HMRC rules.
Stop guessing. Stop overpaying. Let's sort your tax once and for all.
Zmartly Ltd · 20–22 Wenlock Road, London N1 7GU · 020 8175 5145 · info@zmartly.co.uk
ICAEW, ACCA and AAT qualified accountants.
Further reading