Working as a locum doctor — whether you are an NHS locum GP, a locum consultant, or a private locum practitioner — puts you in charge of your own tax affairs. Unlike salaried colleagues whose tax is handled through PAYE, most self-employed locums must register with HMRC, file a Self Assessment tax return, and manage their own National Insurance.
This guide is the starting point for the 2026–27 tax year (6 April 2026 to 5 April 2027). It sets out how locum income is taxed, what changed this year, and the deadlines that apply — then points you to a detailed guide for each area.
This is information, not tax advice. Every locum’s circumstances are different. Nothing here constitutes personal tax advice, and you should seek guidance from a qualified tax adviser about your individual position.
Three changes matter more than the rest this year.
The mileage rate rose for the first time since 2011. HMRC increased the simplified mileage rate for cars and vans from 45p to 55p per mile for the first 10,000 business miles in the tax year. It was announced on 21 May 2026 and backdated to 6 April 2026. The rate above 10,000 miles remains 25p. If you set up your mileage claim before May, you are almost certainly still using the old figure — for a locum driving 8,000 miles between sites, that is a £4,400 deduction rather than £3,600.
Making Tax Digital for Income Tax began. From 6 April 2026 it applies where gross self-employment and/or property income exceeded £50,000 on your 2024–25 return.
Class 2 National Insurance works differently from how most guides describe it. It was not abolished. It became non-compulsory, and the distinction matters if your profits are low — see below.
Most locum doctors who take direct engagements — working for a GP surgery, hospital trust, or private clinic under a contract for services — are treated as self-employed for tax purposes. You are responsible for registering with HMRC, filing a Self Assessment return each year, and paying your own tax and National Insurance.
Income tax bands for 2026–27:
| Band | Taxable income | Rate |
|---|---|---|
| Personal allowance | Up to £12,570 | 0% |
| Basic rate | £12,571–£50,270 | 20% |
| Higher rate | £50,271–£125,140 | 40% |
| Additional rate | Above £125,140 | 45% |
National Insurance. Class 4 is charged at 6% on profits between £12,570 and £50,270, and 2% above £50,270.
Class 2 is no longer compulsory. Since April 2024, self-employed people with profits above the Small Profits Threshold — £7,105 for 2026–27 — are treated as having paid Class 2 without making a payment, and continue to build entitlement to the State Pension and other contributory benefits. If your profits are below £7,105, Class 2 is not charged automatically, but you may pay it voluntarily at £3.65 per week to protect your National Insurance record.
That matters for locums working reduced sessions, on parental leave, or taking a career break. A low-profit year can leave a gap in your contribution record unless you choose to pay.
If you are weighing up self-employment against incorporating, our guide to whether locum doctors should use a limited company in 2026 works through the comparison in detail.
As a self-employed locum you can deduct expenses incurred wholly and exclusively for your work. The most common categories are GMC registration, medical defence and indemnity, BMA membership, CPD that maintains existing clinical skills, professional subscriptions, travel between separate work sites, clinical equipment, and a proportion of home office costs.
Two rules catch people out. Travel from home to a single fixed regular place of work is not allowable, though travel between separate sites is. And costs of acquiring an initial qualification are not allowable, while costs of maintaining or updating existing skills generally are.
For the full category-by-category treatment, including the mileage and home-office methods, see our locum doctors allowable expenses guide for 2026/27. HMRC’s own guidance on self-employed expenses sets out the general principles, and the simplified expenses checker shows which method gives the better result.
The pension annual allowance for 2026–27 is £60,000. For NHS Pension Scheme members the figure that counts is not the cash deducted from your pay — it is the increase in the capital value of your defined benefit entitlement, known as the pension input amount.
A tapered allowance applies only where both threshold income exceeds £200,000 and adjusted income exceeds £260,000. Where both are exceeded, the £60,000 allowance reduces by £1 for every £2 of adjusted income above £260,000, down to a floor of £10,000 at £360,000. If threshold income is £200,000 or less, the taper does not apply however large your adjusted income. These limits have been unchanged since 6 April 2023.
Unused allowance from 2023–24, 2024–25 and 2025–26 can be carried forward, oldest first.
Our NHS pension annual allowance calculator works out your pension input amount and any tapered allowance. For how the scheme itself operates, see NHS pension explained for locum doctors; if you have exceeded the allowance, our guide to the annual allowance tax charge covers how the charge is calculated and paid. GOV.UK’s annual allowance guidance is the primary source.
Locum doctors in this band face an effective marginal rate of 60%. This is not a surcharge — it arises because the personal allowance is withdrawn by £1 for every £2 of income above £100,000. You pay 40p on the additional £2 of income, plus a further 20p on the £1 of allowance lost.
Pension contributions reduce adjusted net income, which is the figure used to assess the withdrawal. Our guide to the £100k doctor tax trap works through the interaction between this band and the pension annual allowance, which is where it gets genuinely complicated for NHS consultants.
Key dates for the 2026–27 tax year:
| Deadline | Date |
|---|---|
| Register for Self Assessment | 5 October 2027 |
| Paper return | 31 October 2027 |
| Online return | 31 January 2028 |
| Balancing payment, plus first payment on account for 2027–28 | 31 January 2028 |
| Second payment on account | 31 July 2028 |
Where your Self Assessment bill exceeds £1,000, HMRC usually requires two advance payments on account toward the following year’s liability, each set at 50% of the prior year’s bill. This is worth planning for in your first year of self-employment, because it brings part of the following year’s tax into the same January payment.
If you worked through several agencies, all locum earnings go on a single return. You will need remittance advices from each agency plus records of any directly invoiced work. Our guide to common tax mistakes made by doctors covers the errors that most often surface at this stage.
You can register on GOV.UK.
MTD for Income Tax is being phased in by income level. The test uses gross self-employment and/or property income — turnover, not profit — as reported on an earlier tax return:
| You must use it from | If qualifying income was over | On this return |
|---|---|---|
| 6 April 2026 | £50,000 | 2024–25 |
| 6 April 2027 | £30,000 | 2025–26 |
| 6 April 2028 | £20,000 | 2026–27 |
The gross basis catches locums out. A doctor invoicing £55,000 across several agencies is in scope from April 2026 even if profit after expenses is well under £50,000.
In practice it means three things: income and expenses held digitally in compatible software throughout the year, four quarterly summaries submitted to HMRC, and a final declaration after the year end in place of the usual return. Working across multiple agencies makes accurate capture of each income source more important, not less.
HMRC’s check when you need to use MTD for Income Tax tool confirms your position, and the compatible software list covers the software requirement.
If you supply services through a personal service company, or via an agency that treats you as a contractor, the off-payroll working rules may apply. The assessment turns on control, substitution rights and mutuality of obligation. Locum doctors employed directly by an umbrella company fall outside the rules, because they are employees of that company.
Our guide to IR35 for locum doctors sets out how status is assessed and what evidence supports a determination.
| Locum (self-employed) | Salaried (employed) | |
|---|---|---|
| National Insurance | Class 4 at 6% / 2%; Class 2 treated as paid above the £7,105 threshold; no employer NI | Employee Class 1 at 8% above £12,570; employer Class 1 at 15% above £5,000, paid by the practice or trust |
| Expense deductibility | Broad range of allowable business expenses | Stricter “wholly, exclusively and necessarily” test; fewer expenses allowable |
| Pension | Can contribute to a personal pension alongside NHS scheme membership | NHS pension contributions via employer |
| Self Assessment | Always required | Only where income exceeds PAYE thresholds or there is additional income |
| MTD for Income Tax | Applies where gross income exceeded £50,000 on the 2024–25 return | Does not apply to PAYE income |
AccTek is an AI-native accountancy practice built around professionals who manage variable income. Our locum doctor accountancy service covers Self Assessment preparation and filing, expense reviews, NHS pension input calculations, and MTD for Income Tax set-up around a clinical schedule.
To find out more, visit our locum accountancy page or get an instant quote.
Class 2 is no longer compulsory. Since April 2024, self-employed people with profits above the Small Profits Threshold — £7,105 for 2026–27 — are treated as having paid it without making a payment, and continue to build State Pension entitlement. Below £7,105 you can pay voluntarily at £3.65 per week to keep your record complete. Class 4 still applies at 6% on profits between £12,570 and £50,270, and 2% above £50,270.
55p per mile for the first 10,000 business miles in the tax year, and 25p per mile thereafter, for cars and vans. The 55p rate was announced on 21 May 2026 and backdated to 6 April 2026 — the first increase since 2011–12. Travel between separate work sites qualifies; travel from home to a single fixed regular place of work does not. The current rates are on GOV.UK’s travel, mileage and fuel rates page.
Yes. NHS pension accrual is measured as a pension input amount and counts toward the £60,000 annual allowance for 2026–27. It is based on the increase in the capital value of your defined benefit entitlement, not your cash contributions. Unused allowance from the three prior tax years can be carried forward.
It depends on your engagement structure. If you supply services through a personal service company, or via an agency that treats you as a contractor, the off-payroll working rules may apply. Doctors employed directly by an umbrella company fall outside them. Speak to an accountant about your specific arrangements.
It depends on your gross self-employment and property income — turnover before expenses — on an earlier return. Over £50,000 on your 2024–25 return means you are in scope from 6 April 2026. Over £30,000 on your 2025–26 return brings you in from 6 April 2027, and over £20,000 on your 2026–27 return from 6 April 2028.
At least five years after the 31 January online filing deadline for the relevant tax year. Keep agency pay statements and remittance advices, records of directly invoiced engagements, receipts for claimed expenses, a mileage log, and NHS pension correspondence relating to annual allowance. See HMRC’s record-keeping guidance.
For the underlying rules, see HMRC and GOV.UK directly: expenses if you’re self-employed, register for Self Assessment, self-employed record keeping, pension annual allowance, travel, mileage and fuel rates and when you need to use MTD for Income Tax.
AccTek Ltd is independent and is not affiliated with HMRC or GOV.UK.
This article provides general information about the UK tax system as it applies to locum doctors for the 2026–27 tax year (6 April 2026 to 5 April 2027). It does not constitute personal tax advice. AccTek Ltd is a qualified accountancy practice, a member of the ICPA, and supervised by HMRC for anti-money laundering purposes. Tax rules change; always verify current figures at GOV.UK and seek professional guidance on your individual circumstances.
Kishan Kedia ICAI, CAMS is a specialist accountant at AccTek with 20+ years of experience in locum doctor tax, NHS pension annual allowance, landlord tax, Section 24 planning and Making Tax Digital for Income Tax. He holds the ICAI qualification and is a Certified Anti-Money Laundering Specialist (CAMS).
AccTek is a member firm of the Institute of Certified Practising Accountants (ICPA). Our accountants have a wide range of qualifications and accreditations from trusted professional bodies such as the AAT, ICPA, and ACCA.
