By Lynda Cox

Practice managers are, understandably, finding some elements of the GMS contract perplexing. The changes made in April have directed practices that they can claim for GPs’ sickness absence, but without paying close attention to the requirements of a claim you could be left at a dead end or, worse still, the wrong end of the law.

A great example of this is making a claim from the NHS under the GMS contract while making a claim on your locum insurance, too. Where do you stand?

At first sight it may appear that it is fine to do both. NHS Employers have confirmed to us that, if a practice claims from a locum insurance policy as well as from them, this will not affect the reimbursement the NHS makes.

But it’s important to give this perspective.

If you’re claiming reimbursement from the NHS and you’re also claiming from your locum insurance provider you could be committing fraud against one or both parties. In short, should you be paid twice for the same thing?  The clarity will be in terms of the locum insurance policy – and the type of policy you have. There are two types – an indemnity policy, and a benefit-driven policy. Let’s consider an example where a GP has fallen ill and is absent, and the practice needs £1200 a week for the costs of a GP locum.

Indemnity policy: If the NHS pays out the maximum of £1200, then the policy will pay nothing. Check your policy. If the insurance policy is worded such that any reimbursement is taken into account, you must declare this and the insurer will reduce their payment accordingly. So, even though you paid to insure your GP for £1200 a week, you will receive nothing during the first 28 weeks of absence.

Benefit-driven policy: Even if the NHS pays out £1200, the policy will happily pay whatever you had insured the doctor for (subject, of course, to the claim being valid).

The latter is clearly hugely beneficial for the practice:

• Policies like those from Practice Cover will not only pay the insured benefit, but also pay on a 4-weekly basis – so relatively quickly. This can really help cashflow.

• Your chosen locum insurance benefit could can be used to top up (or exceed) the maximum claim value imposed by the GMS contract of £1734.18 per week through the first 26 weeks of the claim.

For claims that run longer than 26 weeks, where the upper NHS claim value is reduced to a maximum of £867.09 per week, the locum insurance may be needed just to help you meet the GP locum’s costs.

• If you want to use an ANP to cover for some of the absent GP’s work, your locum insurance can meet the cost of this. The NHS will not allow you to claim from them in this situation.

A word of caution. It is worthwhile getting advice from your practice’s accountant on your tax situation. If the practice receives an ‘income’ which is over and above what it needs to meet the cost of the doctor’s absence, a tax charge may arise on the ‘profit’ so you should be clear on what impact this may have.

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Lynda Cox is founder and MD of Practice Cover.

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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