Locum Work Across Republic & Northern Ireland: Key Differences Explained

Ireland’s shared border presents locum doctors with a unique opportunity, the chance to work across two healthcare systems within just a few hours’ travel. Whether you’re based in Dublin looking north or a Belfast-based doctor considering the Republic, cross-border locum work can offer both variety and financial reward.

However, there are clear differences between the Health Service Executive (HSE) in the Republic of Ireland and the National Health Service (NHS) in Northern Ireland. Understanding the practicalities of working in both jurisdictions is key to ensuring compliance and maximising opportunities.

Registration and Licensing: GMC vs IMC

The first step for any doctor considering cross-border work is registration.

• Republic of Ireland: Doctors must be registered with the Irish Medical Council (IMC). The process includes verification through EPIC (Electronic Portfolio of International Credentials), and depending on your qualifications, you may be eligible for general, supervised, or specialist registration.
• Northern Ireland: You’ll need registration with the General Medical Council (GMC) to practise under the NHS. Many Irish doctors already hold both registrations, which allows them to move fluidly between jurisdictions.

It’s also important to ensure your professional indemnity insurance covers both the HSE and NHS systems.

Employment Models and Pay Structures

One of the main differences between working in the Republic and Northern Ireland is how locum doctors are paid and contracted.

• HSE (Republic): Most locums work through agencies such as Locum Express and are paid as independent contractors. Hourly rates can vary widely depending on seniority and location, typically ranging from €65 to €120 per hour for hospital doctors. Payment is usually weekly, and doctors are responsible for their own tax, PRSI, and pension contributions.
• NHS (Northern Ireland): Locums are generally paid through PAYE by the NHS Trust or via an approved agency. Rates are quoted in pounds sterling, and taxes are deducted at source. Hourly rates tend to be slightly lower than in the Republic but can include NHS pension eligibility and other benefits.

For doctors crossing the border regularly, exchange rates and differing tax deductions can influence net income, so careful budgeting is recommended.

Taxation and Cross-Border Earnings

Working in both jurisdictions introduces complexity when it comes to tax.

Doctors living in the Republic but earning in Northern Ireland (or vice versa) are subject to double taxation agreements between Ireland and the UK, which ensure you won’t pay tax twice on the same income.

If you’re self-employed in Ireland and earning PAYE income from the NHS, it’s advisable to work with a cross-border tax specialist to manage filings correctly. Locum Express recommends that doctors maintain clear records of hours worked, pay slips, and invoices in both currencies to simplify end-of-year returns.

Work Environment and Patient Systems

Both healthcare systems offer rewarding experiences, but their administrative structures differ:

• Republic of Ireland (HSE): Many hospitals are smaller, with closer doctor-patient interaction. Electronic health records are expanding but not yet universal.
• Northern Ireland (NHS): Systems are more standardised, with widespread use of digital patient management tools and multidisciplinary team approaches.

For locum doctors, this means adjusting slightly between systems, particularly in charting, referral protocols, and reporting lines.

Opportunities and Demand

Demand for locum doctors remains high across both jurisdictions. In the Republic, rural hospitals and GP practices often experience shortages, particularly in emergency medicine, psychiatry, and general practice.

In Northern Ireland, high demand is seen in A&E, paediatrics, and mental health, especially in border counties like Fermanagh and Derry.

By registering in both regions, locum doctors can access a wider range of shifts, benefit from seasonal flexibility, and compare rate structures to find the best opportunities year-round.

Practical Tips for Cross-Border Locum Work

• Keep separate banking arrangements for euro and sterling payments.
• Track mileage and travel expenses for tax relief.
• Confirm indemnity and licensing before each assignment.
• Plan ahead for public holidays and rota differences, they don’t always align.
• Use a trusted locum agency that operates in both jurisdictions to streamline placement and compliance.

Final Thoughts

Working as a locum doctor across the Republic of Ireland and Northern Ireland can provide rich clinical variety, professional development, and financial flexibility. By understanding the nuances of both healthcare systems and maintaining up-to-date registrations, locums can confidently take advantage of opportunities on both sides of the border.

Get in touch with our dedicated team as we nurture a community in which locums can flourish and extend exceptional care to their patients. For more information on any of our roles contact a member of our Locum Express team on +353 (0)21 4297901 or email us at info@locumexpress.ie. You can also register online here.