How to become a locum or agency nurse in the UK
How to become an agency or locum nurse in the UK: NMC registration, DBS, revalidation, joining a framework agency vs NHS bank, and how self-employed nurses are paid.
A locum or agency nurse covers clinical work on a session-by-session basis for the organisations that need them, as a self-employed professional rather than a salaried employee. This guide walks through everything you need to do to start, in order, and the common pitfalls that catch people in their first year.
Step by step.
6 steps- 01
Current NMC PIN and revalidation
You need a current NMC registration and must complete revalidation every three years: 450 practice hours, 35 hours CPD, reflective accounts, and confirmation. Agencies ask for evidence of your next revalidation date before placing you.
- 02
Choose bank, agency, or direct
NHS Professionals and individual trust banks handle most NHS locum nursing on PAYE. Agency nursing runs through framework-compliant agencies at capped rates. A small amount of direct private-sector locum nursing exists (insurance medicals, occupational health, specialist clinics).
- 03
Understand the rate cap
NHS England caps framework agency nurse rates. Off-framework rates are higher but most trusts decline these. Expect Band 5 standard shifts at £22–£25/hr + unsocial hours uplifts (weekends, nights, bank holidays).
- 04
Enhanced DBS + training compliance
You’ll need a recent enhanced DBS, Basic Life Support, Moving and Handling, and Safeguarding (level 2 or 3 depending on role). Most agencies provide mandatory training modules; budget 2–3 days every three years.
- 05
Track your hours for revalidation
NMC practice hours are tracked by revalidation year, not tax year. Keep a simple spreadsheet or use Sessional to log every shift with date, hours, and workplace. Missing the 450-hour minimum can mean a lapsed registration.
- 06
Decide tax status
Most agency nursing is PAYE through the agency or umbrella. No self-assessment needed. If you work directly and invoice private clients, you’re self-employed and need a tax return. IR35 doesn’t usually bite unless you’ve set up a limited company.
Documents to have ready.
- 01NMC registration certificate
- 02Revalidation confirmation
- 03Enhanced DBS certificate (renewed every 3 years)
- 04Mandatory training certificates (BLS, M&H, Safeguarding)
- 05Immunisation evidence (Hep B, MMR, varicella, TB)
- 06Right to work documentation
Sessional sends reminders 30 days before each expiry.
First-year pitfalls.
- !Missing revalidation deadlines. Practice hours are cumulative over 3 years, not per year
- !Working below the NMC’s scope of practice on a locum shift because the ward was desperate
- !Accepting unsocial-hours bookings that don’t include the uplift in the headline rate
- !Not realising an agency umbrella is different from direct PAYE. Umbrella fees can quietly eat 5% of gross
Run your locum work like a business, from day one.
Sessional tracks every session, invoice, expense, and document, so you spend evenings with family, not spreadsheets. Free to start.
Related
Last reviewed April 2026. Rates and regulator details change. If something looks off, let us know.