Two years on from the NHS England’s surprise announcement that it would pay towards the costs of covering for a sick GP locum, many practices report mixed outcomes.
The new rules, effective from April 2017, took away the discretionary element of funding and stated that, from April 2017 onwards, the NHS would reimburse an element of a practices’ locum costs in respect of GP performers signed off sick for more than 2 weeks.
This was excellent news for hard-pressed practices meaning that they had a right to funding that, until that point, was discretionary.
Scotland and Wales followed suit, with Northern Ireland catching up in March 2018.
The reimbursement amounts vary slightly, depending on where the practice is located:
| Location | Reimbursement from CCG/Health Board | ||
|---|---|---|---|
| Waiting period | First 26 weeks of sickness absence (after waiting period) | Next 26 weeks of sickness absence | |
| England | 2 weeks | £1,751.52 per.wk | £875.76 per.wk |
| Scotland | 2 weeks | £1,734.18 per.wk | £867.09 per.wk |
| Wales | 2 weeks | £1,734.18 per.wk | £867.09 per.wk |
| Northern Ireland | 4 weeks | £1,734.18 per.wk | £867.09 per.wk |
NHS England has confirmed the above amounts for 2019/20; confirmation is awaited for Scotland/Wales. Northern Ireland is expected to remain unchanged.
This is the maximum reimbursement so, if a practice incurs costs of, say, £1,000 per.wk in covering for a sick GP, that is all the practice can claim.
Once the GP has been off sick for 28 weeks, the maximum that can be claimed falls to half the amount previously paid. So, if £1,000 per.wk is paid in the initial 26 weeks, only £500 per.wk can be paid in the second 26 week period, not £875 (or £867) per.wk – even if the practice continues to incur costs of £1,000 per.wk.
There are a few other rules around aggregation (i.e. taking previous sick leave into account) and not being able to claim if a GP’s sessions are covered by a nurse. However, all the while, it’s pretty straightforward.
Despite this, practice managers’ experiences when making a claim, seems to vary wildly.
On the plus side, CCGs (Clinical Commissioning Groups) and Boards which understand the rules, apply them correctly and pay up promptly.
On the other side of the coin are those which don’t, for a variety of reasons:
1. Some CCGs/health boards continue to treat the reimbursement as discretionary and refuse to pay because the practice doesn’t meet outdated criteria (e.g. list size).
2. Some CCGs/health boards misinterpret the rules and refuse to pay if the practice has any locum insurance. We have explicit confirmation from NHS Employers that any locum insurance must not be taken into account when calculating the reimbursement due.
3. Administrative errors: lost paperwork, requiring the Practice Manager to re-submit locum invoices, GP sick notes and so on.
4. Delays in paying agreed amounts, with budgetary constraints being cited.
Practice managers may not know how their CCG/health board will perform if they need to make a claim but, forewarned is forearmed, so make sure your Practice Manager knows the rules so your practice isn’t left under-funded if you or one of your colleagues is off sick.
Do you work in a practice where it’s been difficult to claim your reimbursement? Lets us know by leaving a comment below
This article was written by Lynda Cox, Director of Practice Cover, specialists in locum insurance.
The opinions presented in this blog are solely those of the author on behalf of Practice Cover Limited and they do not constitute individual advice. Practice Cover is a trading name of Practice Cover Limited and is authorised and regulated by the Financial Conduct Authority. * First Practice Management