Working as a self-employed locum for illness, holidays, peaks or a special need remains possible. A locum who works the same days in the same practice for years looks more and more like an employee. Then the practice owner and the locum both run a financial risk.
The LHV argues for a flexible pool for illness, peaks and special needs. At the same time the LHV sees regular locum work disappearing, with more GPs choosing employment or a partnership.
In short
- Since 2025 the Tax Administration has been enforcing again. In 2026 penalties for intent or gross negligence are possible and it can recover tax back to 1 January 2025. From 2027 the normal rules apply.
- The LHV model agreement for longer-term locum work can be used until the end of 2029, but itself advises an agreement of practice cooperation for regular locum work.
- Anyone who wants to work permanently in one practice can choose employment or a partnership. For salaried GPs there is a negotiated result for a new cao.
As at 1 November 2026. This article is about the form of working together, not about medical responsibility.
In this article
What risk do practice owner and regular locum run?
If the Tax Administration finds that the locum is in fact employed, the practice owner must pay payroll taxes. Since 1 January 2025 the Tax Administration no longer gives a warning first. It can impose correction obligations and additional assessments straight away, but not further back than 1 January 2025, except in cases of bad faith (Tax Administration, Employment relationships and enforcement).
In 2026 the Tax Administration does not yet impose penalties for administrative failures, but it does impose penalties for intent or gross negligence (Tax Administration, Employment relationships and enforcement). From 1 January 2027 that last part of the soft landing also ends (Tax Administration, Enforcement plan employment relationships 2026). As early as 2024 the LHV wrote that practice owner and locum GP both run a financial risk in case of false self-employment (LHV, de Dokter 5/2024).
For the locum it is about more than tax. Someone who is in fact an employee also has employee rights, such as protection against dismissal and continued pay during illness. How the Tax Administration and the courts assess this in general is explained in DBA Act and false self-employment: what to watch when hiring freelancers?
Does the model agreement for longer-term locum work help?
Yes, for temporary replacement. On 30 September 2021 the Tax Administration assessed the LHV model agreement for longer-term GP locum work. Working under that agreement does not lead to payroll taxes, because there is no relationship of authority. The client may only give instructions on what the locum does, not on how the locum does the work (Tax Administration, assessment 905-2021-82676-1-0).
The agreement is meant for a temporary replacement that lasts some time, such as a week, a month or a year. For regular locum work the agreement itself recommends a model agreement for practice cooperation (model agreement for longer-term GP locum work, explanatory note). The assessment also says nothing about your entrepreneurship for income tax.
The assessment was valid for five years, until 30 September 2026. Since 6 September 2024 the Tax Administration no longer assesses new model agreements. Agreements valid on that date may still be used until 31 December 2029, and you may ignore a different validity in the agreement (Tax Administration, No more new model agreements). The Tax Administration does warn that model agreements can create false certainty. You must also actually work as the agreement says.
- Record that you may be replaced by another qualified GP, and actually do so when needed.
- Agree your own rate and invoice from your own business.
- Work for more than one practice or service, and decide yourself which shifts you take.
- Conclude an agreement for each locum period with a start and an end, instead of one open-ended arrangement.
What do the courts say about locum work?
A subdistrict court ruled in 2023 that a locum GP at an out-of-hours service had no employment contract. For the locum shifts she concluded a separate agreement each time with the affiliated GP, agreed the rate herself and invoiced from her sole proprietorship (District Court Midden-Nederland, 15 November 2023, ECLI:NL:RBMNE:2023:6072).
For the supervisory shifts the court looked at all circumstances together, as the Supreme Court requires (Supreme Court, Deliveroo, ECLI:NL:HR:2023:443). The work was embedded in the service's organisation, which pointed to authority. But she was free to sign up or not, received a rate higher than the salary in employment and acted as an entrepreneur. Taken together there was no employment contract (ECLI:NL:RBMNE:2023:6072).
This is one ruling about separate shifts at an out-of-hours service, not a rule for the regular locum in a daytime practice. For a regular locum who works the same days for years with the practice's patients and team, the embedding weighs more heavily and the freedom less.
What changes on 31 December 2026?
Then the presumption of employment comes into force. Anyone who works for another for at most € 36 an hour is presumed to do so under an employment contract (Bulletin of Acts 2026, 158, article 7:610aa Civil Code). The government mentions € 38, because the amount moves with the minimum wage (Ondernemersplein, Low hourly rate of a freelancer can lead to an employment contract). The amount as of 31 December 2026 will follow in a ministerial regulation.
The presumption only works in civil law and only applies below that threshold. If your rate is above it, nothing changes on this point and the ordinary test of all circumstances continues to apply.
What are the alternatives to regular locum work?
Employment or a place in a partnership. LHV board member Hilly ter Veer said in May 2026: "My impression is that more GPs are choosing employment or a partnership. Regular locum work is disappearing." The LHV is developing a checking tool, a questionnaire to assess in advance whether an assignment can be done as a freelance assignment (LHV, de Dokter 2/2026).
For salaried GPs, LAD, LHV and InEen reached a negotiated result on 3 July 2026 for a cao from 1 October 2025 to 31 December 2027. Wages rise by 3.5% on 1 August 2026 and by 4% on 1 January 2027. The pension schemes with SPH and PFZW continue (LHV, Negotiated result cao for salaried GPs). Whether that result is now final we have not confirmed in an official source.
| Form | Suits | Watch out for |
|---|---|---|
| Locum as freelancer | Illness, peaks and special needs, changing practices | Replacement, own rate, several clients |
| Salaried GP | Steady work in one practice without business risk | Cao and pension, less freedom |
| Partner or practice owner | Own patients and control | Goodwill, investment, accountability report |
For the practice owner one more thing counts. A sole proprietorship that uses a locum, even briefly, must submit an annual accountability report by 31 May each year (Annual accountability care, Sole proprietorship). Almost every GP builds up a pension compulsorily with Huisarts & Pensioen, except among others those already building up compulsorily with ABP or PFZW (Huisarts & Pensioen, Compulsory participation).
The LHV wants as many regular GPs as possible with a regular group of patients. There is research behind that too: a systematic review found in 18 of 22 studies that more continuity of care by doctors went together with lower mortality. The research was observational, so it shows association, not proven cause (Pereira Gray et al., 2018).
Sources
- Tax Administration, Employment relationships and enforcement (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Tax Administration, Enforcement plan employment relationships 2026, version 2.0 (in Dutch). belastingdienst.nl
- Tax Administration, No more new model agreements (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Tax Administration, LHV model agreement for longer-term GP locum work, assessment 905-2021-82676-1-0, 30 September 2021 (in Dutch). belastingdienst.nl
- District Court Midden-Nederland, 15 November 2023, ECLI:NL:RBMNE:2023:6072 (in Dutch). uitspraken.rechtspraak.nl
- Supreme Court, 24 March 2023, ECLI:NL:HR:2023:443 (Deliveroo) (in Dutch). uitspraken.rechtspraak.nl
- Act of 2026 amending Book 7 of the Civil Code (presumption of employment based on hourly rate), Bulletin of Acts 2026, 158 (in Dutch). officielebekendmakingen.nl
- Ondernemersplein, Low hourly rate of a freelancer can lead to an employment contract (in Dutch), accessed 1 November 2026. ondernemersplein.overheid.nl
- LHV, de Dokter 2/2026, Self-Employed Act gives more room, but lobbying remains necessary, interview with Hilly ter Veer, May 2026 (in Dutch). lhv.nl
- LHV, de Dokter 5/2024, Practice owner also runs financial risk under DBA enforcement (in Dutch). lhv.nl
- LAD, LHV and InEen, Negotiated result cao for salaried GPs 1 October 2025 to 31 December 2027, July 2026 (in Dutch). lhv.nl
- CIBG, Annual accountability care, Sole proprietorship (in Dutch), accessed 1 November 2026. jaarverantwoordingzorg.nl
- Huisarts & Pensioen, Compulsory participation (in Dutch), accessed 1 November 2026. huisartsenpensioen.nl
- Pereira Gray, D.J., Sidaway-Lee, K., White, E., Thorne, A. & Evans, P.H. (2018). Continuity of care with doctors, a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open, 8(6), e021161. doi.org