The short answer: what a locum doctor pays for an accountant
A UK locum doctor pays roughly £95 to £250 a month for an accountant in 2026/27, and where you land inside that range comes down to how you trade and how much paperwork you generate. A locum working as a sole trader with one income stream can be looked after from £695 a year for the Self-Assessment tax return. A locum running a limited company, which most agencies still call a personal service company or PSC, starts from £1,200 a year for the annual accounts and Corporation Tax return, then adds director payroll and a personal return on top.
Three things push the fee up or down. The first is your structure: a company costs more to run than a sole trade because there are two sets of filings, not one. The second is volume: a locum with a single monthly agency remittance is cheap to process, while someone juggling NHS trust shifts, private clinic sessions and an appraisal-year expense pile takes more work. The third is scope: bookkeeping, VAT (rare for clinicians, but it happens with cosmetic or medico-legal work), payroll and pension advice all stack onto the base fee.
LOYALS works with GPs, hospital doctors, dentists and consultants through our clinician accountants service, and the honest headline is that the fee is almost never the thing that decides whether the relationship pays for itself. That is your IR35 status and your expenses, which we come to below. For the full menu, you can see our full price list.
What sits inside a locum doctor's accountant fee
The fee is a bundle of separate jobs, and understanding the parts is the quickest way to see why two locums get quoted very different numbers. For a sole trader locum on a simple year, the whole job is one Self-Assessment return, so the price is low. For a limited company locum, the fee builds up across several tasks that each carry their own cost.
Start with the base. A set of annual company accounts and a Corporation Tax return (the CT600) starts from £1,200 a year. Onto that you add running the director payroll through Real Time Information, from about £35 a month, because a PSC locum almost always takes a small salary. Then there is the director's personal Self-Assessment, from around £300, and light monthly bookkeeping to keep records tidy for those quarterly filings, from around £125 a month if you want it managed. The chart below shows how that stacks into a typical all-in year for a limited company locum.
Two locums on identical day rates can still be quoted differently. Someone who sends a clean spreadsheet and works through one agency is quick. Someone with three agencies, a private clinic, medico-legal reports and a shoebox of receipts takes longer, so the bookkeeping line rises. That is worth knowing before you assume the cheapest quote is the best value, because a fixed low fee often means the expenses and IR35 review that actually save you money are not in scope.
Sole trader, limited company or umbrella: the setup that decides your fee
Your trading structure is the single biggest driver of both the fee and the tax, so it is worth getting right before you worry about the monthly price. There are three routes a UK locum typically uses, and they cost very different amounts to run.
Sole trader is the simplest and cheapest to account for. You register with HMRC, keep records, and file one Self-Assessment return a year, from £695 with us. There is no company, no Companies House, no payroll. The catch arrives at scale: once your gross self-employment income passes £50,000, you are pulled into Making Tax Digital for Income Tax from April 2026, which means digital records and four quarterly updates plus a final declaration, not one annual return. That threshold falls to £30,000 from April 2027 and £20,000 from April 2028, so more locums get caught each year.
Limited company, the personal service company route, costs more to run (from £1,200 a year plus payroll) but can be more tax efficient for genuinely outside-IR35 work at higher income. You take a small salary and draw the rest as dividends, taxed at 10.75 percent in the basic band and 35.75 percent in the higher band for 2026/27 after the April 2026 rise. One quiet cost trap: a single-director company cannot claim the £10,500 Employment Allowance against employer National Insurance, so the payroll maths is not quite as clean as a two-employee business. Companies are not caught by Making Tax Digital for Income Tax, which is a genuine simplification some locums value.
Umbrella is not really a structure you account for at all. The umbrella company employs you, runs PAYE, and there is no return for us to file, so there is no accountant fee. It is common for inside-IR35 agency work. The trade-off is that you keep the least of your money and can claim almost nothing. If most of your work is inside IR35, umbrella often makes more sense than paying to run a company that gives you no tax advantage.
Where the maths tips from sole trader to company is rarely below £50,000 to £60,000 of outside-IR35 profit. For the deeper comparison with worked numbers, our guide on where the sole trader versus limited company maths actually tips walks through the mechanics, and the take-home effect of a small director salary is easy to model with our take-home pay calculator.
Why IR35 status changes everything for a locum doctor
IR35 decides how much of your day rate you actually keep, and it swamps the accountant fee, which is exactly why paying for someone who understands it is rarely a false economy. IR35, the off-payroll working rules, is the test of whether you are genuinely self-employed for a given engagement or effectively an employee wearing a company hat. Get placed inside when you should be outside and you can lose £8,000 to £18,000 a year in take-home.
The rules have not changed for 2026/27, but the practical position for locums is worth stating plainly. Since April 2017 in the public sector, and April 2021 for medium and large private clients, the end client decides your status, not you, and issues a Status Determination Statement. NHS trusts and health boards are public sector, so for trust shifts the trust (or the agency that pays you in the chain) makes the call and, if it decides inside IR35, deducts tax and National Insurance before you are paid. You can read the current rules in HMRC's off-payroll working guidance.
There is one important exception that catches out both locums and their generalist accountants. If your end client is a small company, broadly a business meeting the Companies Act small-company test, the responsibility for deciding status reverts to your own limited company. Plenty of small private GP practices and private clinics sit here. So the same locum can be inside IR35 on a trust contract in the morning and responsible for their own outside-IR35 assessment for a small private clinic in the afternoon. Handling that split correctly is specialist work, and it is where the take-home is won or lost.
Expenses follow status. Outside IR35, a locum can claim genuine business costs: professional indemnity insurance, GMC registration, Royal College and defence body fees, mandatory training and courses, business mileage at the new 55p rate for the first 10,000 miles from April 2026, and the accountant fee itself. Inside IR35, those claims largely disappear. We break the status tests down further in our practical guide to IR35 for locum doctors and dentists.
Is a specialist accountant worth it for a locum doctor?
For most locums earning a professional income, yes, because the fee is small next to the tax at stake, but the value comes from specialism rather than the filing itself. Anyone can submit a return. The difference a healthcare specialist makes is in the decisions around it: the IR35 status on each contract, the expenses a generalist never asks about, the sole trader versus company call, and the NHS Pension interaction that quietly catches high-earning doctors.
That last point is a genuine trap. Doctors in the NHS Pension Scheme can breach the annual allowance and face an unexpected tax charge running to thousands, often without realising until it is too late to use a Scheme Pays election cleanly. We cover the mechanics in our guide to the NHS Pension annual allowance taper. A generalist high-street accountant who mostly does builders and cafes will not spot it. A specialist plans for it.
Put the numbers side by side and the case is straightforward. A specialist fee of £150 a month is £1,800 a year. A single wrong IR35 call, a missed year of professional expenses, or an unmanaged pension charge can each cost more than that on its own. You can check your agency's or clinic's position in a free call with LOYALS, and the point of that call is to price your actual situation, not to sell you a return you could file yourself.
How the options compare on cost and what you actually get
Here is how the common ways a locum doctor handles the books actually compare, because the sticker price only tells part of the story.
The cheapest option on paper is rarely the one that keeps the most in your pocket:
| What you need | DIY / umbrella | Generic accountant | LOYALS specialist |
|---|---|---|---|
| Files the return correctly | ● If you get the figures right | ✓ | ✓ |
| Reviews IR35 status per contract | ✗ Left to you or the agency | ● If asked | ✓ Built into onboarding |
| Claims all clinician expenses (indemnity, GMC, courses) | ✗ | ● Common ones only | ✓ Full review |
| Handles the NHS Pension annual allowance | ✗ | ✗ | ✓ Planned for |
| Advises sole trader vs company at your income | ✗ | ● | ✓ Modelled yearly |
| Open Mon to Sat for urgent contract questions | ✗ | ✗ Mon to Fri 9 to 5 | ✓ 10am to 7pm Mon to Sat |
| Fixed monthly fee, no surprise invoices | ✓ | ● Hourly billing common | ✓ Fixed monthly |
This is why most locum doctors who work across NHS and private settings move from a generic accountant or a filing app to a healthcare specialist.
What this means for you: choosing and what to do next
If you are weighing up the cost, the practical steps are simple and most of them save you more than the fee.
- Work out your real structure first. Mostly inside-IR35 trust work usually points to umbrella or a simple sole trade. A meaningful block of outside-IR35 private work at higher income is where a company can earn its keep.
- Check your gross income against £50,000. A sole trader locum above that is in Making Tax Digital for Income Tax from April 2026, which changes the scope and the fee, so factor it in now rather than in a panic next spring.
- List the expenses you have not been claiming. Indemnity, GMC, Royal College and defence body fees, courses, exam costs and business mileage add up fast and are routinely missed.
- Ask any accountant how they handle IR35 and the NHS Pension. If the answer is vague, the low fee is not the bargain it looks like.
- Get the quote in writing with the scope spelled out. A £40 monthly app that only submits numbers is not the same product as a £150 monthly plan that reviews status, expenses and structure.
None of this is exotic planning. It is matching the setup to how you actually work, then pricing the accountant to the scope you genuinely need. Done well, the fee is comfortably the smallest number on the page.