My Business Instincts

My Business Instincts

Although I became a doctor and took fellowship in surgery, I always had an inclination for business. I wanted to take risk and explore possibilities in business. In 1990s, after moving to our first house in London, I was doing locum jobs in surgical specialities, especially in cardiothoracic surgery. The earnings through working as a locum was much higher than working permanently. The downside was lack of career progression, security and non provision  of paid holidays and sick leave. Finding the wages package, eaten away by tax, NI and huge commission to agents  I probed into working in hospitals directly. In this blog I shall give an insight into how I started the locum business and what made me to bib farewell to the business.


 A locum agency is a recruitment company that specialises in the placement of medical staff on a temporary basis. I thought, I better set up a locum agency so that I could get the whole pay without any deduction from the NHS hospital. These deductions include income tax, national insurance and superannuation. For running an agency, one need to have good contacts with hospitals, which I managed through working in various hospitals. I named my agency “Prompt Doctor Service” and printed all necessary forms and informed the tax authority, that I was setting up a business. Whilst running a locum business, tax authority consider the business as the ‘employer’ of the doctor,  I managed to get my first job for my agency Prompt Doctor Service in Harefield Hospital, London for myself, and received my whole payment as a sole trader.


I advertised in the locum medical section of British Medical Journal (BMJ) a standard media for advertisement for jobs related to medicine. Within a few weeks, I had a number of applications with enclosed Curriculum Vitae. They are from all grades and all specialities of doctors.  Mostly these General Medical Council (GMC) registered doctors were from abroad with resident permit to work in the UK. Those days in 1990s  communications were mainly through FAX, phone and post. I bought a Panasonic Fax machine with phone, which was a user friendly machine for sending and receiving curriculum Vitae (CV) and hospital correspondence.


 I set up files for each locum doctor, and each hospital in our small office room together with the FAX machine cum phone. It is the responsibility of the locum agency to enquire about the immigration status of the  doctor and to get references from consultants. These contacts had to be documented to cover the responsibility of the agency. Only with that documentation, a doctor would be considered for a  specific job. More and more doctors enrolled in my agency because I was giving them much better rate than established locum agency. This was helped by the lower overhead expenses to run the agency. My main expenses were advertisement, postage and office stationary cost.  Later I joined Federation of Recruitment and Employment Services (FRES),  anticipating help from the organization. There was no interface of bureaucracy between my agency and the locum doctor. However each doctor should sign for the terms of business, rates, send the CV with names of two referees.


Let me explain the step by step process of employing locum doctors in a hospital. The medical staffing contacts me by phone or by fax and informs me the list of doctors required in a particular speciality and grade. I go through the files of vetted doctors who are able to do the specific job. There might be a few doctors in my book. If none, I will immediately inform the medical staffing to approach other agencies. I match the requirements with the skill and qualification of the doctor. Once found, the doctor is contacted for his consent.  If the doctor agrees to the nature of the job and duration, I fax the CV and references to the hospital medical staffing. The medical staffing then forwards the CV and references to the concerned head of the speciality, and if the proposal is accepted, then medical staffing sends a confirmation letter by fax. I get back to the doctor and convey the message, and instruct him how to report to the medical staffing.

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Normally once locum doctors complete the job, they send a tabulated form with date, time and total number of hours worked. I work out the total pay, minus the tax and national insurance, raise a pay slip and  cheque and send them to the doctor by post .I document it in the HMRC deduction working sheet. I also raise an invoice to the hospital, and send it by FAX to the medical staffing. Usually it takes about three to four weeks to get the invoice paid. Invariably I will have to chase the medical staffing or finance department to enhance the process of sending a cheque. In a few instances I had to threaten them with legal action. Once I had to sue a hospital in London, got  county court default order and then only the invoice was paid.


I was also doing short term locum jobs while running the business. This time my wife was managing the running of the locum agency. While working in various hospitals, I seized the opportunity to promote my locum business. I pinned promotional brochures on the doctor’s mess notice board which helped me to  get more doctors registered with the agency. The networking with doctors, across the country, opened opportunity for standing as a candidate for the General Medical Council (GMC) council. Unfortunately, I could not get enough votes to become a council member.

By the end of every financial year, I need to submit end of year tax return to the HMRC and supply each doctor with P60, showing their income and tax paid. During summer months, hospitals used to have more vacancies and more doctors  arrived from overseas to earn extra money. Therefore, it was not possible for us to go for holidays when children got vacation. We continued to run the locum agency for  five years and once we moved into the current house in 1996, there was a dearth of locum work.


During 1996, there was an untoward incident, whereby, Wigan medical staffing directly employed one of our doctors from Bangladesh contrary to the terms of the business. The terms,  state that hospitals should not employ doctors introduced by locum agency.  I got exasperated when the Bangladesh doctor asked for P45 to work for Wigan Hospital, directly.  I left no stones unturned to settle the dispute through negotiation. As advised by a solicitor at Wigan, I sued the hospital for damages in Liverpool Crown Court. Unfortunately, the verdict was against me, and I was asked to pay the cost of the defendant’s solicitors.


In order to save huge locum expenses, the NHS started to employ more doctors in their pay roll who started to cover each others sick leave and holidays. I reckoned there would not be any mileage in running the show of locum agency. Therefore I wound up the business, and gave up my attitude of  ‘employments are for wimps’. To run a business, one ought to be disciplined, and sacrifice many of one’s comforts. The brighter side is that it provides Independence, a colourful life style, financial rewards, learning opportunities and personal satisfaction.


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This blog is about my experience as a doctor working in various countries in different clinical set up. This experience spans through 45 years, in which I acquired a lot of favourable contacts and unfavourable encounters. I shall dig deep into them and make it interesting to the readers. Unlike others in the profession, I worked as a community medical officer in a remote areas, prison medical officer, benefit service medical officer, in cardiac surgery in prestigious institutions and as a private doctor. I was managing my own businesses, and real estate in three continents. I hope the information I impart will be valuable to the like minded readers.

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