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GP sickness absence reimbursement

by in GPs, Insurance, Locums

GP sickness absence reimbursementAuthor: Lynda Cox

The new reimbursement provisions, announced in February and effective (in England) from 1st April 2017, mean that practices can claim up to £1734.18 pw for the first 26 weeks of a GP’s sickness absence, falling to half in the second 26 weeks of absence.

This doesn’t mean that practices can claim £1734 pw when a doctor goes off sick. Far from it.

It means you can claim for the cost of covering for that sick doctor, up to a maximum of £1734.18 pw.  You must submit invoices to the CCG along with a fit note. So, if your doctor’ sessions were covered by colleagues and the costs the practice incurred were £1200 a week, that is what you can claim.

This is a very important point, which becomes even more important if this doctor is off for a prolonged period.  We have had confirmation from the Senior Policy Officer at NHS England that, even if after, say, six months, you can no longer cover ‘in house’ for the sick GP and you have to bring in expensive locums, you can only claim at half the rate you claimed at previously – in this case £600 pw.

So the major features of the new reimbursement provisions are:

  • reimbursement requests must be supported by invoices
  • cover can be provided by doctors already at the practice as long as they are not already working full-time and as long as they were already working at the practice when the GP went off sick
  • the maximum payment is the lower of the invoiced cost and £1734 pw (after two weeks of absence and payable for up to 26 weeks) followed by half the rate paid in the first six months for the next 26 weeks
  • reimbursement covers core hours only
  • aggregation means the above periods are reduced if the practice has claimed for the doctor in the preceding 52 weeks

This latter point is often overlooked.  In summary, it means that if Dr X has already been off sick and you have claimed reimbursement for him/her in the past 52 weeks it eats into your ’26 weeks at the higher rate/26 weeks at the lower rate’ entitlement.

NHS England has told us: ‘it is quite complicated to make general assessments, and practices and commissioners will need to work through the rules to apply them on a case by case basis.’

Good luck with that!

Inevitably locum insurance is changing to meet the challenges that the new provisions create.  Our locum insurance can ‘plug the gaps’ by insuring GPs for a pre-agreed sum which is not based on invoiced costs, nor ‘eaten into’ by previous absences.  It can pay when a doctor is summoned for jury service, goes on compassionate leave, has to take revalidation leave and a whole host of other things not covered under the NHS sickness absence reimbursement.

It seems to me that practices have a choice.  They can either throw in their lot with the NHS scheme for which we have been told, in writing, that ‘There is no set amount to support these changes but NHS England will monitor ongoing spend.’ or they have insurance.

If they have insurance which, for argument’s sake, kicks in at week 13 of a GP’s absence they can claim from the CCG from week three, send them invoices and sick notes, and ‘move’ their claim to our policy from week 13.  This reduces the period for which they are ‘eating into’ the NHS reimbursement and gives them an unchallenged amount for the balance of that GP’s sickness, up to a maximum of 52 weeks.

Author: Lynda Cox, Practice Cover Limited

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.  

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12 Responses to “GP sickness absence reimbursement”
  1. Avatar
    Will Says:

    I still haven’t been able to confirm whether I can claim on both our locum policy and the government scheme at the same time… Does anyone know if there are rules on this?


    • Avatar
      Lindsey Says:

      I would say not to claim on both at the same time as that is fraud. You cant get reimbursed twice for something. The ‘rule’ on this will be in you insurance policy document and the NHS Financial rules.


    • Avatar
      Lynda Cox Says:

      This is not clear-cut. Insurance policies vary and some say that any payment from the policy will be reduced by the amount of reimbursement paid. Other policies (including ours) are unaffected by reimbursement. So you need to read your policy or ask your provider.
      As far as the ‘government scheme’ is concerned, NHS England have today confirmed as follows: “As far as the SFE is concerned practices are entitled to claim reimbursement from their commissioner – you are right to say there is no adjustment for whether or not a practice has a private insurance policy. ”
      It is my understanding that if a practice claims from both sources and profits from the GP’s absence, it will be taxed on the profit. But the practice should consult its tax advisers on this.
      A situation which could arise is that a practice claims reimbursement from week 3 for Dr X, then ceases claiming reimbursement at, say, week 12 when its locum insurance policy kicks in. Depending on the type of insurance policy you have, this can make sense because, if Dr X goes off sick again within the same 52 week period, ‘aggregation’ won’t have such a significant effect. (NHS England have confirmed they would have no objection to practices doing this.) Apologies for the lengthy response and please call me on 023 8051 3286 if you would like to discuss.


  2. Avatar
    Kat Says:

    I checked with locum insurer today, you can claim from NHS England and then just claim the top part from locum insurer to cover the deficit as 1700 isn’t going to go a long way and will probably cover 5 sessions ish..if your GPs work more than this a week you are going to need to cash in your locum policy to bridge the gap


    • Avatar
      Lynda Cox Says:

      Hi Kat, it does vary from insurer to insurer and yes, you’re right about ‘bridging the gap’. Also remember the gap caused by the fact that NHS England won’t be meeting locum costs if a GP goes on jury service or compassionate leave – which most insurance policies cover.


  3. Avatar
    Peter Says:

    No Will, it is one or the other. Either rely on and claim the reimbursement from NHSE, or keep your insurance in place.
    I would urge all to consider the scenario that this reimbursement will not be available for long though. Not once NHSE realise the checkmate position they have put themselves in.


  4. Avatar
    Naheed Sarfraz Says:

    Some of the information in this article is incorrect. NHS England process the claims for sick pay.


    • Avatar
      Lynda Cox Says:

      Thank you for pointing this out Naheed. The FAQs issued by NHS England say that claims are made to the CCG but, in light of your comments, we have queried this and the response today is: “I think it might vary from CCG to CCG what arrangements they have for payments, but I’m checking to see if we have got it wrong and it is NHS England local teams that make the payments. ” I will amend the blog, if necessary, once I have their response.


  5. Avatar
    Marsha Says:

    We have a gp off due to bereavement. Our insurance company will only pay 4 weeks and the gp is still off. Can we claim from week 4 through this scheme?


    • Avatar
      Lynda Cox Says:

      Hi Marsha, payments are for sickness absence only so, unless there is a fit note saying the GP is unfit to work, then you can’t claim.


  6. Avatar
    Nikki Long Says:

    What if the GP had a skiing accident and broke a leg would there be any sickness exclusions that the NHS wouldnt pay out for?


  7. Avatar
    Lynda Cox Says:

    Nikki, it is my understanding that there are no exclusions at all so a practice would be able to claim reimbursement for a GP certified as unable to work due to a skiing injury.


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