What is the indemnity reimbursement?
As part of the 2017/18 GP contract negotiations, the Government agreed that £30m would be paid to practices to cover 2016/17 rises in indemnity insurance costs for all doctors delivering GMS work.
A similar funding arrangement has been confirmed for the 2018 contract.
GPC acknowledges that this falls significantly short of the actual cost. The amount was based on average rises in costs using figures received from surveyed GPs and medical indemnity organisations.
The first allocation has been paid to practices on a per patient basis, set out under the Statement of Financial Entitlements (SFE), and is not weighted by the Carr-Hill formula.
How much have practices received?
Practices should have now received a payment of 51.6p per patient based on their registered list as at December 2016. This funding was paid to practices in March 2017.
The extra funding for 2018 will again be calculated towards the end of this year and payments will be made to practices in March/April 2018 for rises in 2017/18.
Why can’t it be paid to individual GPs?
Because the practice is the ‘unit’ of care, commissioned to provide GMS services to patients. The payments are made to practices on the assumption that, where salaried GPs (and principals) are paying for part, or all, of their indemnity costs, the practice will reimburse to them an appropriate proportion of their premium.
The reimbursement amount should be based on the proportion of GMS services the GP is providing for the practice. It is recognised that every practice will have its own arrangements in place.
Each practice will need to allocate payment to its partners or salaried GPs that is equitable and proportional based on their circumstances. The conditions are set out in the revised SFE put in place from 1 April 2017.
I am a locum GP – what should I do?
The negotiated arrangement means only salaried and principal GPs can receive payment to cover the 2016/17 indemnity hikes retrospectively – locum GPs will receive it prospectively. So, if a practice does not engage any locum sessions in 2017/18, it will not be passing on the monies irrespective of their use in 2016/17. When the second part of funding is received in April 2018, this will again provide funding backdated for 2017/18.
As locums cannot backdate their indemnity uplift to practices they worked for in the previous financial year they may consider including a rise in their 2017/18 rates to compensate for the indemnity inflation in 2016/17.
However they should not use the indemnity inflation figure to calculate a new rate directly, but take their retrospective indemnity costs and apply this to their current sessional rate.
We are aware that some locum GPs have divided the number of sessions by the total indemnity fee creating a ‘fee per session’, after calculating their rise from 2016/17–2017/18. However, GPs must be mindful that the indemnity reimbursement only reflects the rise in core hours indemnity; the calculation must not conflate indemnity costs associated with work undertaken in the out-of-hours setting.
Some locum GPs may decide to incorporate the figure into their hourly rate charged. Either way, a separate line on how much of their fee is due to the indemnity calculation can be added on the invoice for transparency.
Ultimately it is up to the locum GP themselves to ensure that, as with all other business expenses, their charges reflect their costs and that this is negotiated with their engaging practices.
What if I am employed by more than one surgery, and do some out-of-hours work?
GPs who work in multiple settings will need to consider multiple approaches to different employers or engaging practices. Some employers will pay indemnity; some will have it inclusive or provided. Some will be NHS trusts with an arrangement through the NHS Litigation Authority. There is no ‘one size fits all’.
A key point again, however, is that the reimbursement is for core services only. No additional resource has been made available to out-of-hours organisations.
Where can I find out more information?
BMA members can follow BMA GPC Sessionals Subcommittee guidance.
NASGP (the National Association of Sessional GPs) has issued its own guidance and has a calculator which is available to NASGP members.
Dr Katie Bramall-Stainer is a sessional GP in Hertfordshire, GPC member and medical director at Londonwide LMCs