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Sick leave locum payments under the new contract

Certain areas are affected by new contract guidance, not dramatically but in a way that GPs still need to know about ­ Dr Bob Button looks at sickness leave

It is amazing how similar the new statement of financial entitlement (SFE) and the old Red Book (SFA) have turned out to be. But as from April 1 it is the SFE you will need to know about.

You will not find a great deal of difference when faced with locum reimbursement for the sickness absence of a person now termed a 'GP performer'. This term will apply to all those in the practice who have GP qualifications and are therefore on the GP performers list to be kept by the PCT.

The Red Book only applied to principals, and payments for locum absences were geared to them. Under SFE the GP concerned could be an employee of the practice (now referred to as 'the contractor') with any title, including retainer and flexible career scheme doctor as well as partners. All of these will now qualify for the scheme.

The capitation rules relating to the number of patients a doctor is expected to cope with without needing extra locum assistance remain unchanged from the old Red Book. This is disappointing since the figures were well out of date, based as they were on the practice of medicine in the early days of the NHS when the GP had only the reactive role of treating the sick. Capitation levels have become increasingly out of touch with the workload of the present-day GP practice and we had hoped for a radical revision.

Discretion is available in respect of locum provision for doctors returning from sickness leave but not yet ready to resume full-time duties ­ also for locum costs for GPs who might suffer health problems unless they receive support.

I see a role for the LMC here in making the case to the PCT.

Other discretionary areas are:

lwhere there is an unusually high rate of sickness in the locality

lin rural areas where the workload of a returning GP may involve excessive travel.

The relevant conditions that apply for PCT reimbursement of locum costs are:

mThe absence must be

greater than one week

mEither SSP or salary must be paid to the absent GP

mAny accident compensation must be offset against costs

mThe locum concerned must not be an employee or a partner unless it is a job-share situation

mPrior agreement must be obtained from the PCT; the PCT will need to be supplied with medical certificates and a written statement of the costs incurred providing the locum ­ also an undertaking to notify any changes in circumstances.

The PCT has the discretion to determine whether a locum should be provided at all. It does not need to pay if it prefers to provide a locum directly to the contractor. Obviously if the person on sickness absence has no job to return to for whatever reason, there will be no reimbursements payable.

But it is expected that all PCTs will provide locum payments in respect of singlehanded and job-share contractors.

The payments are fixed for this year (2004/5) at £948.33 per week for a full-time locum. These are payable for six months at the full rate and six months at a half rate.

Claims are required by the end of the month to which the claim refers.

A PCT is expected to have paid contractors the amounts owing with their global

sum monthly payment (GSMP) by the following month.

Bob Button is chief executive of Wessex LMCs

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