Northern Ireland has five HSC Trusts, each with different hospitals, specialties, and locum opportunities. We compare Belfast, Northern, South Eastern, Western, and Southern trusts to help you find the right fit.
Northern Ireland's healthcare system is divided into five Health and Social Care (HSC) Trusts, each covering different regions with their own hospitals, specialties, and locum opportunities. Whether you're an experienced locum looking for your next placement or considering locum work for the first time, understanding the differences between these trusts can help you find the right fit.
In this guide, we break down each trust — covering the hospitals, in-demand specialties, typical pay rates, and what it's like to work there as a locum doctor.
Unlike England's fragmented trust system, Northern Ireland has just five trusts that together serve a population of 1.9 million. This makes the locum market more concentrated and easier to navigate. Each trust operates its own hospitals, community services, and mental health facilities.
All five trusts recruit locum doctors through a mix of direct engagement (PAYE) and agency bookings. The majority of locum shifts in Northern Ireland are filled through direct engagement, which affects how you're paid and taxed.
Region: Greater Belfast
Key Hospitals: Royal Victoria Hospital (RVH), Mater Infirmorum Hospital, Belfast City Hospital, Musgrave Park Hospital, Royal Belfast Hospital for Sick Children
Current Locum Jobs: 400+
Belfast Trust is by far the largest employer of locum doctors in Northern Ireland. As the region's major teaching trust, it covers the full spectrum of medical and surgical specialties.
In-Demand Specialties:
Typical Pay Rates: £50-110/hr depending on grade and specialty. Foundation Year doctors typically earn £50/hr, Specialty Doctors and Registrars £65/hr, and Consultants £110/hr.
What Locums Should Know: Belfast Trust offers the widest variety of specialties and the highest volume of shifts. The RVH Emergency Department is one of the busiest in Northern Ireland, so expect a fast-paced environment. The trust is well-connected by public transport and has extensive teaching opportunities alongside clinical work.
Region: County Antrim, parts of County Londonderry, and East Tyrone
Key Hospitals: Antrim Area Hospital, Causeway Hospital (Coleraine), Mid-Ulster Hospital (Magherafelt), Whiteabbey Hospital
Current Locum Jobs: 25+
Northern Trust covers a large geographical area with a mix of urban and rural populations. Antrim Area Hospital is the main acute site and a significant employer of locum doctors.
In-Demand Specialties:
Typical Pay Rates: £50-110/hr. Similar rate structure to Belfast Trust.
What Locums Should Know: If you prefer a less intense environment than Belfast's major hospitals, Northern Trust offers a good balance. Antrim Area Hospital handles a wide case mix as the main acute hospital for a large catchment area. The Causeway Hospital in Coleraine serves the North Coast — a beautiful part of Northern Ireland that appeals to locums who value quality of life alongside their work.
Region: Down, Lisburn, and Castlereagh
Key Hospitals: Ulster Hospital (Dundonald), Downe Hospital (Downpatrick), Lagan Valley Hospital (Lisburn), Ards Community Hospital
Current Locum Jobs: 15+
South Eastern Trust covers suburbs of Belfast and the County Down coastline. The Ulster Hospital is the main acute site and one of the busiest hospitals in Northern Ireland.
In-Demand Specialties:
Typical Pay Rates: £45-65/hr. Rates can be slightly lower than Belfast for some grades but remain competitive.
What Locums Should Know: The Ulster Hospital underwent a major redevelopment and is a modern, well-equipped facility. South Eastern Trust's proximity to Belfast means you can live in the city and commute to any of the trust's sites. Downpatrick and the Ards Peninsula offer scenic coastal locations for those looking to combine work with lifestyle.
Region: Counties Londonderry, Tyrone, and Fermanagh
Key Hospitals: Altnagelvin Hospital (Derry/Londonderry), South West Acute Hospital (Enniskillen), Tyrone County Hospital (Omagh)
Current Locum Jobs: 16+
Western Trust covers the western third of Northern Ireland. Altnagelvin Hospital is the major acute site and is particularly well-known for its Emergency Department locum opportunities.
In-Demand Specialties:
Typical Pay Rates: £50-110/hr. Competitive rates reflecting the difficulty of filling positions in a more remote location.
What Locums Should Know: Altnagelvin is a busy district general hospital serving the North West. Locum shifts here tend to be readily available due to the challenge of recruiting permanent staff to the area. For doctors willing to travel, this can mean more consistent work and greater flexibility in choosing shifts. Derry itself is a vibrant city with a lower cost of living than Belfast, and the Donegal coastline is just a short drive away.
Region: Counties Armagh, Down (south), and parts of Tyrone
Key Hospitals: Craigavon Area Hospital, Daisy Hill Hospital (Newry), South Tyrone Hospital (Dungannon)
Current Locum Jobs: Currently limited
Southern Trust covers the south and south-west of Northern Ireland. Craigavon Area Hospital is the main acute site.
In-Demand Specialties:
Typical Pay Rates: £50-65/hr for SHO/Registrar grades, £110/hr for Consultant grades.
What Locums Should Know: Southern Trust positions are less frequently advertised through agencies but can offer excellent opportunities when they arise. Craigavon is easily accessible from Belfast (30 minutes by car) and serves a large rural catchment area. Daisy Hill Hospital in Newry is close to the border with the Republic of Ireland.
When deciding where to work as a locum in Northern Ireland, consider:
At Grayscale Medical, we work with all five HSC Trusts to match locum doctors with the right opportunities. Browse our current vacancies across every trust and specialty, or register to get personalised job alerts delivered to your inbox.
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