The new reimbursement provisions 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   -    £867.09 in the second 26 weeks of absence.

We have been told 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.

We have had confirmation from 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 (if the original claim was £1200). Not sure if many locums would work for £600 per week!

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

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.’ Which as an insurance provider gives us concern!

The main issues to consider here is the following:

  • Locum insurance policies cover more than just sickness such as Jury Service, Suspension Cover, Paternity, Maternity etc.
  • There is more flexibility with a private policy to cover absences internally.
  • Our limits are clearly displayed on the certificate of cover. What you pay for us is what you get with no ‘limit’
  • Any policy with ourselves can be tailored either to supplement or top up any payment from NHS England

We still have no confirmation how ‘quickly’ claims will be paid. A ‘case by case’ basis tells us this is not going to be a fast resolution for practices already struggling on a budget. That means ‘potentially’ covering any long term absence from practice funds.

As someone who has been in advising locum insurance for 10 years, you will remember that the PCT’s offered something very similar – until they went broke,  and insurance providers picked up the slack!

Personally, I would not discard your locum insurance plan quite yet until we see how this plays out or indeed if the ‘goal posts’ change!


Chris Dixon Dip PFS

Director of Approachable Finance (Medical).


(Please note all views expressed in this post are of Chris Dixon and this post is for information only and not intended to be financial advice.)


Approachable Finance (Medical) is a trading name of Approachable Finance LTD which is authorised and regulated by the Financial Conduct Authority.

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