Self-employed vs PAYE for locums and healthcare professionals

Locum and healthcare professionals often work across multiple settings with different payment arrangements, and getting employment status right affects both tax and legal protections.

Why status isn't always a free choice

Whether you're genuinely self-employed for a particular engagement depends on the actual working relationship — control, substitution rights, and financial risk — not simply what you or the engaging organisation prefer to call it.

Mixed income is common

Many healthcare professionals have a mix of PAYE employment and genuine self-employed locum work, which means separate reporting for each and a Self-Assessment return covering the self-employed portion.

Pension considerations

For NHS-connected roles, self-employed locum work is typically outside the NHS Pension Scheme, which is worth factoring into overall retirement planning alongside any employed pension.

Our advice

We help healthcare professionals with mixed income structure their reporting correctly and understand the pension and tax implications of each income stream.