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GP maternity and sickness payments under threat as NHS England reviews all ‘discretionary’ funding

Exclusive GP practices face the loss of crucial funding for maternity leave and sickness locum cover after NHS England revealed that all discretionary payments formerly supplied by PCTs have been placed under review.

NHS England told Pulse it was looking at all payments for locum cover made to GP practices to provide for maternity, paternity and adoption leave, as well as sickness absence.

The move is part of a wider review into discretionary payments which Pulse revealed in February is targeting the occupational health services formerly provided by PCTs, and is also looking at locally run retainer and returner schemes.

Until April, payments to practices to provide locum cover for maternity leave and sickness were decided on a PCT-by-PCT basis. In London, some discretionary payments were stopped by the local area team in April, with Wandsworth LMC expressing particular concern over the loss of funding for maternity locum cover. But NHS England has since produced national advice to local area teams advising them to honour all legacy PCT-administered funding until at least September, when it hopes to announce an England-wide policy.

The delay has added to confusion in many areas, with Pulse reporting earlier this month that GPs across England were having to delay paying essential bills as a result of persistent problems with NHS England’s bookkeeping. LMCs conference delegates warned in May that some local area teams were now charging GPs for occupational health services, while elsewhere CCGs have been forced to step in to commission such services to ensure GPs can still access support.

NHS England said it had completed a fact-finding audit on a whole range of discretionary payments, including those for occupational health services.

A spokesperson said: ‘Work is now underway to analyse our findings and we hope to have draft proposals available by September. The other discretionary payments referred to relate to primary care organisation administered funds as referred to in the GMS contract. These include locum cover for sickness, maternity and paternity and retainer and returner schemes.’

She added that the work on the options for occupational health support would feed into the management of the national performers’ list.

She said: ‘We are consulting on a number of areas, which will impact on plans for the broader scope for occupational health service in primary care and hope to have draft proposals to area teams by September.’

NHS England said the intention behind the review was to develop a consistent policy across England that gives clarity to GPs about what they can expect in relation to discretionary support.  

But Wessex LMC chief executive Dr Nigel Watson said the review was worrying as the removal of the payments would have a significant effect on practices.

He said: ‘We are concerned because generally in these things people level down, they don’t level up.’

‘The area that I cover is generally less well-funded than other areas, where payments per patient were under the average, and therefore for some of these maternity and sick leave payments PCTs were giving a reasonable amount. There is concern everywhere that people will look at it, and then just level it down.’

Birmingham LMC executive secretary Dr Robert Morley said: ‘We have not heard anything yet regarding discretionary payment reviews but I have no doubt that will come soon. We have though had one victory over GP occupational health services, which have at least been rolled over for another year, but again I expect this to be reviewed for next year.’

Dr Michelle Drage, chief executive of Londonwide LMCs, said it was an ‘outrage’ that LMCs had not been consulted on the decision to review discretionary payments, or on the review itself.

‘We find it totally unacceptable that payments due to GPs under the Statement of Financial Entitlements are being held back,’ she said.

‘My teams at Londonwide LMCs is doing all they can to get this sorted. It feels as if every penny to do with GP payments are under intense scrutiny at every juncture, while hospitals remain immune.’