Register as a Locum

Welcome to the Locum Connect Locum Registration Form.

Before you get started, here is a list of the information you will need to complete this form.

A scan of your eligbility to work in the UK e.g. Passport photo. This can be in an image format such as jpg or as PDF or Word Doc
A scan of your Liability Insurance Certificate . This can be in an image format such as jpg or as PDF or Word Doc
Your GPHC registration number

Title

- Please select your title

First Name

- Please enter a value

Surname

- Please enter a value

This will be your username for the site

- Please enter a value

- Please enter a valid email address

- Sorry, that address already exists - if you already have an account with us, please try using the remember password option

Password

- Please enter a value

Password

- Please enter a value

- Passwords do not match

Address and Contact Details

Postcode

- Please enter a value

Address

- Please enter a value

Address 2

Address 3

Town or City

- Please enter a value

County

- Please enter a value

Landline

Mobile

- Please enter a value

Registration Details

Please specify your primary job role

- Please select a value

PSNI/GPHC Registration Number

- Please enter a value

RPS Registration Number (if applicable)

- Please enter a value

Accreditations

Medicines Use Review Accreditation

CPPE Level 2 Safegaurding Accreditation

New Medicines Service Accreditation

DBS Check

Independent Prescriber

Flu Vaccination Accreditation

Dementia Friends Accreditation

Proof of right to work in Uk (e.g passport scan)

- Please upload proof that you are eligble to work in the UK

- Uploaded file must not have apostrophes or commas in file name

Indemnity Insurance Scan

- Please upload a copy of your current Indemnity Insurance

- Uploaded file must not have apostrophes or commas in file name

Which Pharmacy Systems are you familar with?

ProScript Link

Pharmacy Manager

NexPhase

Analyst PMR

Proscript

Other

Other System

- Please enter a value

Fitness to Practise

Do you confirm that you are currently registered with the General Pharmceutical Council (GPhC)?

- Please select a value

- You must be registered with the GPHC to continue on this site

Have you ever had a determination by the GPHC that affects your fitness to practise?

- Please select a value

Please give details of Fitness to Practise Issue

- Please specify details of the Fitness to Practise issue

Do you currently have any problems with your physical or mental health that may impair your ability to practise safely and effectively or which otherwise impairs your ability to carry out your duties in a safe and efficient manner?

- Please select a value

Please give details of any issue

- Please specify details of the health issue

Mailing Options

We can send you an email listing available shifts in your area. Please tick either of both of the options below if you would like to receive this.

Daily email with new shifts.

Yes please send.

Weekly email with new shifts.

Yes please send

Hide your contact phone and email from registerd pharmacies searching for locums.

Hide my details

Locum Connect Terms of Use

Do you agree to the terms of Locum Connect

- You must agree to the terms before continuing.

I agree to the terms of Locum Connect

Pharmacist Registration