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.