GP Sickness Absence Funding and Locum Insurance
May 17, 2017
Following a recent update from NHS England, we are now able to provide, some answers to questions raised by the initial announcement made in February 2017 and helps clarify a little the position of whether to retain/apply for locum insurance.
One of the declared aims of the changes is to increase funding to general practice and, included in these measures is a change to the payments made to GP practices in respect of doctors illness to “reduce practice locum insurance cover expenses”.
Previously, GPs were eligible to receive from their Clinical Commissioning Group (CCG) a weekly payment (reimbursement) of £1,100 to cover locum costs if they were ill and could not work. This payment was based on list size, it was discretionary and, even then, was paid only if an external locum was brought in. As a result, many practices did not receive any payment. Those practices either met locum costs out of their own resources or they arranged insurance.
Under the terms of the new arrangement, a non-discretionary reimbursement will be paid by the CCG as follows:
- The lower of invoiced costs and £1734.18 per week, payable after 2 weeks of absence, for up to 26 weeks
- The lower of invoiced costs and £867.09 per week for the second 26 weeks of absence
- Covers all doctors regardless of pre-existing medical conditions
- Covers all doctors; partners and salaried (but not locums)
- Covers core hours only
- Is subject to aggregation meaning if a doctor has already been ill (and the practice claimed reimbursement) in the 52 weeks prior to making a new claim for reimbursement the previous claim will be taken into account. If say the claim was for £1200 a week in the first period so then the restricted payment would be £600 per week in the second period. All claims must be supported by invoices.
Does the Practice have to bring in a Locum?
No. The practice can claim reimbursement from the CCG if it uses a GP already working at the practice to provide cover, subject to the following restrictions:
- The GP(s) providing the cover must have been working at the practice prior to the sick GP’s period of absence and
- The GP(s) providing the cover must not already be working full time and when adding their existing commitment to the cover they are now providing, it cannot exceed a full time commitment
- They can only claim for providing “core hours” cover
How does the practice claim reimbursement?
The practice must send the CCG:
- An application for reimbursement, accompanied by invoices to support the amount claimed in line with maximum £1,734.18 per week in the first 6 months and £867.09 per week in the next six months and
- A fit note (otherwise known as a sick note) for the absent GP
- They will receive the lower of:
- Invoiced costs and
- The sums as shown above.
We have noted that as yet, no standard approach has emerged from GP practices and most appear to be sitting tight for the time being, until they see how the new sickness absence reimbursement provisions work in practice.
Probably the highest number of enquiries are from GP Practices requesting a staggered weekly sum insured eg Dr X wants insurance of;
- £750 per week for the first 6 months of absence
- £1000 per week for the next 6 months
- £2000 per week throughout for “extensions of cover” (ie jury service, compassionate leave, revalidation leave etc)
This approach gives the practice an element of control over the payments they would receive in the event of GP absence, brings down the cost of locum insurance and, should the NHS funding be restricted/withdrawn in future, ensures they have insurance in place.
Other Practices are choosing to ignore the new provisions entirely and to arrange insurance much as they would have done prior to the changes in funding.
There is not an endless pot to cover reimbursements and to date, NHS England have advised they will “monitor the ongoing spend”…..watch this space.