NHS managers see GP maternity locum cover as a soft target, warns Dr Fiona Cornish.
Maternity locum reimbursement for GP partners is under serious threat now that primary care organisations have been allowed to allocate it on a discretionary basis. When there is no money in the kitty, maternity reimbursement is a horribly easy target. So, should GP partners be eligible – or will it inevitably fall victim to the cuts?
Hospital doctors and salaried GPs have well-organised maternity pay and there is no dispute over entitlement. But GP partners are in a different position as they are self-employed. Maternity reimbursement differs from sick pay in that it is not possible to take out an insurance scheme to cover the consequences of pregnancy.
Since the new 2004 contract, PCTs in England have had a legal requirement to reimburse maternity locum cover up to a maximum amount of £978.91 a week for the first two weeks, and £1,500 for a further 24 weeks.
But how much they choose to pay up to that amount is discretionary – and as Baroness Deech pointed out in her Women in Medicine report in October 2009, PCOs are using the recession as an excuse not to fund maternity locums to the maximum amount. Pulse's investigation last August revealed that 45% of PCOs are failing to pay full contributions.
Problems of fairness and a postcode lottery are already emerging. In Scotland, NHS Ayrshire and Arran tried to withdraw its scheme completely, but intervention by the LMC reversed that decision.
Bearing the cost
The crux of the matter is who bears the cost if the PCOs cannot. If it is the doctor herself, then she will take a big financial hit when she goes on maternity leave. If it is the partnership, it can lead to resentment from the other partners. The potential result, of course, is that no-one wants to take on a female partner of child-bearing age.
The arguments for and against protected maternity locum reimbursement both have their merits.
In favour, we must retain our female doctors in general practice – after all, soon they are going to be in the majority. If the system is too detrimental to women, they will drop out or decide not to become partners. Their training will become a wasted investment. This would be a great loss and one the profession cannot afford.
The main argument against protection of reimbursement is the one which says: ‘You can't have your cake and eat it.' Other small businesses do not benefit from a scheme of reimbursement. Add in the recession and there is a case to be made that there is simply no money available.
My solution for these cash-strapped times is one of compromise. All PCO funds, however discretionary, should go to the partnership. The partnership should then offer to fund the locum for an agreed time, say three months, and then the female partner would be responsible for covering any further maternity leave.
Ultimately this is everyone's concern. Don't think of the female partner as ‘that annoying partner who is on maternity leave' but as yourself or a family member. In the brave new world of GP consortia, perhaps a whole new scheme will be created: funds to cover maternity locum reimbursement in full, and also ‘parental leave', where the mother and father can share the leave entitlement.
If we don't look after our colleagues decently, how can they be expected to dispense care and goodwill to patients?
Dr Fiona Cornish is president-elect of the Medical Women's Federation and a GP in Cambridge.Dr Fiona Cornish