The Reimbursement Scheme For Private GP Practices

Back in Spring 2017, sickness payments and requirements were amended. Although the amendments were made, the entire process remains a complex situation for GP practices. In this post we will be looking closer at sickness leave for private GPs, and find out what can be claimed to make more sense of some common misconceptions.

In a long story short, if either a GP partner or employed/salaried GP happens to be off sick for a period longer than a fortnight, the practice itself can start claiming reimbursement of the financial implications to cover those missed GP sessions from the third week of sickness.

These reimbursements can be claimed where the cover is provided by a locum, a salaried GP on a fixed term contract, or a GP already working in the practice, who is not currently working full time (e.g. employed/salaried or a partner).

If you’re not sure whether your practice is eligible to make this claim, “full-time” is known as nine sessions of clinical work per working week and a “working week” is defined as a working day being during the period of 8am – 6:30pm, on any weekday, except Good Friday, Christmas Day or bank holidays.

There is a qualifying period of two weeks where you will receive no reimbursements of financial loss from sickness leave. However, after two weeks, if your claim is correct, reimbursements will begin, with the maximum amount payable is £1,751.52 per week up to 28 weeks.  After a 28 week period, the maximum amount payable is £875.76 per week up to 54 weeks.

It is important to understand that sickness leave payments will not be made on a pro-rata basis, having regard to the absent performer’s working pattern, and will be the lower of actual invoiced costs or maximum amount.

As an example of what you can expect from these reimbursement, if a practice contracts a locum to provide sickness cover and they charge £1,500 per week, then this is classed as the lower amount and it is this amount that will be reimbursed to your practice. Alternatively, if a locum charges £2,000 a week, the lower figure will result in a reimbursement of £1,751.52.

Although this is an extremely helpful scheme, it is not uncommon for GP partners or employed/salaried GPs to take one for the team, by increasing the number of sessions they work in order to provide sufficient cover upon the sickness leave. A very common misconception is that practices think that they can’t claim on these increased sessions in house, when in actual fact they can!

Practices must have a transparent process in place for calculating the value of rates per session and treading carefully when it comes to that the GP performer providing cover does not exceed the limit at full time for the nine clinical sessions per working week. The maximum of nine clinical sessions per week must include any existing / normal commitments when it comes to covering for another GP.

Retaining evidence of sessions worked for GP partners or employed/salaried GPs is good practice too and will make things much easier, is goes for the locum GPs too, as the commissioner may ask for evidence on how the sessional rates were calculated for your practice.

It is worth noting that there are also flexible arrangements for GP performers returning to work on phased returns. This applies if the Fit Note is continuing to declare sickness absence for the period, subject to and excluding any agreed working arrangements. An example of this could be, if a GP is advised that they may be fit to work 2 days out of 5 for two weeks – then the other three days in those weeks for the period remain as sickness absence.

Payment are in respect of necessary cover for this sickness absence under a Fit Note advising phased return or adjustment of hours may be mandatory or discretionary, subject to the requirements of the SFE being met.

Conclusively, although there is an element of complexity to the process, the new sickness leave reimbursement scheme has hugely benefited practices that have been struggling with sickness leave, and as a result provided some much needed support during difficult times.