A locum GP's guide to hiring an accountant — questions, red flags and MTD

At some point every locum asks the same question: do I really need an accountant?

If you’re a sole trader with simple income, you can file your own Self Assessment, and plenty of locums do. But once you add the NHS pension, mixed income (locum, salaried, out-of-hours, private), a possible limited company, or Making Tax Digital, a good accountant earns their fee and a bad one costs you far more than they charge.

We’re not going to name individual firms. We can’t vouch for them, and the right fit depends on your situation. What we can do is tell you what to look for. If you’d like the short version first, read finding an accountant who actually gets locum GP work.

Why a generic accountant may not be enough

Locum GP finances have quirks that a high-street accountant may not meet often:

• The NHS Pension Scheme for locums. Pension contributions are handled through Locum Forms A and B rather than payroll, and the contribution tier depends on your annualised pensionable income. An accountant who doesn’t know this can misjudge your cash flow and your tax position.
• Mixed income streams. Locum sessions, a salaried post, out-of-hours work and private work can all sit on one tax return, and are each treated differently for pension purposes.
• Pension tax. Higher earners can run into annual allowance issues. This is a specialist area where the wrong advice is expensive.
• Mileage and travel. Locums travel to a different site almost every day. Knowing what counts as an allowable journey (and what’s commuting) matters.
• IR35 and structure. If you’re thinking about a limited company, status, contracts and the effect on your NHS pension all need weighing up carefully.

Questions to ask before you hire

1. “How many locum GPs or doctors do you act for?” You want a confident answer, not a pause.
2. “Do you understand NHS pension Forms A and B and how my contributions interact with my tax?”
3. “Are you a member of a professional body, and do you hold professional indemnity insurance?” In the UK, the word “accountant” on its own isn’t a protected title. Look for membership of bodies such as ICAEW, ACCA, ICAS or CIMA for chartered or certified status, and confirm it on the body’s own register.
4. “Which software do you use, and is it compatible with Making Tax Digital?”
5. “What does your fee cover?” Ask for a fixed fee in writing, and find out whether it includes quarterly MTD updates, year-end accounts, the tax return, and queries throughout the year.
6. “Who will actually do my work?”
7. “How quickly do you respond?” If you can’t get an answer in January, you’ll struggle in July too.
8. “Will you advise me on sole trader versus limited company, and explain the trade-offs honestly?”

You should also expect an engagement letter setting out what they will and won’t do, and you should authorise them with HMRC as your agent properly rather than handing over your login.

Making Tax Digital: ask about it now

Making Tax Digital (MTD) for Income Tax replaces one annual return with quarterly updates plus a year-end final declaration, all through compatible software.

• Sole traders and landlords with qualifying income above £50,000 started from 6 April 2026.
• The threshold drops to £30,000 in April 2027 and £20,000 in April 2028.
• It’s based on gross income (turnover), not profit, taken from your tax return for an earlier year.
• Quarterly updates are due on 7 August, 7 November, 7 February and 7 May.
• HMRC has said there are no penalty points for late quarterly updates during the 2026/27 tax year, but penalties still apply to late returns and late payments, and points-based penalties start from 2027/28.

Check the HMRC website to see whether and when this applies to you. Then ask any prospective accountant exactly how they’ll handle it: do they file the quarterly updates, or do they expect you to? If you’ll be sending the numbers, make sure the software you use for records can feed into theirs.

Red flags

• Guaranteed refunds or “tax-free” schemes. If it sounds too good to be true, it is.
• No engagement letter or no written fee.
• They push a limited company without discussing the downsides, including how it affects your NHS pension and IR35.
• They’ve never heard of Forms A and B.
• They ask for your Government Gateway login instead of acting as an authorised agent.
• They can’t tell you who is responsible if something goes wrong.
• Vague answers about MTD.

How to find a good one

• Ask other locums. Your chambers, local sessional GP group or colleagues will have strong opinions, good and bad.
• Check with your LMC or a membership body such as the BMA or NASGP, which may know firms that work with doctors.
• Interview two or three. Most offer a free initial call. Use it.
• Look at fit, not just price. A cheap accountant who misses a pension issue is not cheap.

What to bring to the first meeting

• Your sessions: dates, sites, hours and fees
• Which invoices have been issued and which are paid
• Mileage and parking records
• Other expenses (indemnity, subscriptions, equipment, CPD, professional fees)
• Your NHS pension forms and contribution records
• Details of any other income

This is where a tracking app earns its keep. LocumBook keeps your sessions, mileage, invoices and expenses in one place and can export a self-assessment PDF and an MTD-style CSV that you can hand straight to your accountant. It doesn’t replace one, but it means they receive clean records instead of a shoebox of receipts.

Tax rules, thresholds and deadlines change, so check HMRC’s guidance and speak to a qualified accountant about your own situation. This is general information, not personal tax advice.