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Gold, incentives and meh

GP maternity and sickness cover ­ even negotiators are mystified

The new contract's provision for maternity and sickness absence is still extremely vague and even the negotiators are unable to provide GPs with chapter and verse ­ Dr Bob Button attempts to clear up some of the confusion

A problem with the contract is the delay in finding out the actual terms and conditions that will apply under the new primary care legislation.

Maternity and sick leave provision for principals is one of the things that needs urgent clarification. The negotiators have told Pulse: 'The future arrangements will be no worse than those that apply at present, though there will have to be changes because the list-size criteria will no longer be able to be applied.'

But they have not said what the arrangements will be.

At present a practice employing a locum is eligible for reimbursement after the first week of employment. This set-up should continue. But it is limited at the moment by capitation rules and may change in future.

Reimbursement is limited to cases where an actual locum is employed, and the amount is based on the concept of a full-time locum. Reimbursements are reduced in proportion where a locum does less than full-time. These rules are applied through the Red Book, which of course will end as soon as the new legislation takes effect, expected to be from April 1, 2004.

Again, it is known that under the proposed new arrangements any funds available to practices for reimbursement of actual locum expenses will be made at the discretion of the PCO. But we do not know the source of these funds. It is expected that locums, as at present, will have to be employed before reimbursement claims can be considered.

As for time limits on how long such sickness payments will be available, we can only work on the present arrangements which do not usually exceed one year.

Maternity arrangements will be governed by national legislation and it will be discriminatory to have different conditions for principal practitioners who are pregnant when comparing them with other women in the country. I'm sure the conditions will form part of the agreement the practice has, as embodied in a partnership contract. Just as now however, discrimination against women on maternity leave offered much less favourable terms than would apply to a man who was forced to be absent from the practice is illegal.

At present any locum for a doctor absent on maternity leave may not be reimbursed if they are an existing partner in the practice doing the absent partner's job, unless that partner is a job sharer with the doctor on maternity leave. It is unclear whether or not this requirement will change in the future, but it is hoped that with the concept of the practice rather than the doctor being the provider there will be greater freedom for practices to fill the locum post in any way they find convenient.

Whenever a practice seeks reimbursement for absent doctors there is always the risk that the PCO will consider part of the work at least could be done by someone other than a GP. And it may take this into account when determining whether a locum allowance should be paid.

Salaried doctors will be working to a contract based at least in part on a hospital contract which will need a little tweaking to make it appropriate for general practice. The essential point is that the salaried doctor will be a member of staff like any other. As such there is no guarantee the PCO will be able to provide allowances or locum cover costs for any salaried practitioner who may be off sick.

I would expect a different attitude to apply when it comes to maternity absences, but there is again no guarantee. Payments of this nature are entirely at the discretion of the PCO, and PCOs will no doubt base their policy on the amount of money they have available.

I foresee real problems for practices that employ salaried doctors. It will be much more expensive than before as the provisions of the proposed contract refer to Whitley Council terms and conditions which are relatively generous.

It will be very important for these conditions in the contract to be agreed between the practice and salaried doctor right from the start.

Should the practice be successful in obtaining reimbursement from the PCO for salaried doctors I am sure these payments will be based upon the normal time commitment the salaried doctor has to the practice.

We must remember that PCOs themselves will be employing salaried doctors and they will have nothing but their own funds to provide sick pay or locum arrangements for employees off sick or on maternity leave.

We are waiting with bated breath to see the detail of the new legislation, but I am led to believe this will not be until next month at the earliest. In the meantime all the negotiators can say is: 'We know the arrangements will be no worse than at present, and we would hope they will be a great deal better.'

So there really are an awful lot of factors up in the air at the moment.

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