Expenses failing to add up for practices

Lynda Cox, principal at Practice Cover Limited, discusses the implications of the latest NHS England and BMA GP funding announcement and the minefield that is GP practice expenses 

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One of the key aims of the recent finance announcement by NHS England and the BMA was to, ‘…secure much needed funding to address GP practice expenses’. It strikes me that to ‘secure funding’ you need to know how much funding you need to secure. In the publications released to date I can see a re-allocation of £156.7m for AUA DES, £5m added to help practices work out which patients don’t have an EHIC, £1.5m for the workforce census, £58.9m to cover population growth and so on.

As with any form of budgeting, it’s always useful to have some numbers. When it comes to indemnity insurance, something which has been of concern to many GPs due to rising costs over the past few years, £30m has been allocated to practices to offset their increased costs. This will be handed to practices on a ‘per patient’ basis and the practice will spread this around the partners and salaried doctors in an ‘appropriate’ way. The cost of this latter exercise has been ring-fenced at the £30m figure.

Financial arrangements to ‘end up in tears’

Then we come to GP sickness cover. What we appear to have is a non-discretionary payment of £1,734.18 pw (for the first 6 months of absence, starting at week two) which, they state, will be ‘a very significant benefit to GPs with long-term conditions …”.

For me this raises a warning flag. The payment is non-discretionary and will be made with ‘no medical exclusion criteria’.  In my world, this means that ‘with their hands tied behind their back’, NHSE will take on the cost of GPs’ sickness whatever that cost may ultimately be to the public purse.

No matter how many times I read the guidance I cannot find any ring-fencing of cost, any overall funding limit, guesstimate, or per doctor or per practice cost.

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After a lifetime in financial services this sits very uncomfortably with me as I struggle to find a context in which an open-ended commitment made by an organisation not known for being awash with cash can fail to end up in tears. Probably too late now but, if the model of ‘hand money to the practices and let them divvy it up’, was thought to be a good idea for indemnity insurance, why isn’t it just as good for sickness insurance?

Flawed logic?

I also have a concern around locum cover for GPs, around which there seems to have been no consultation with insurers. Already I’m seeing GP practices thinking it is straightforward to reduce their locum insurance by £1,734.18 pw because it will be paid to them by their CCG. But this logic is flawed.

The payment isn’t going to cover the entire cost of a GP’s absence, especially in areas where locums charge £600 to £1000 a day. Reimbursement halves after 6 months’ sickness absence, and £867 doesn’t make a big dent in locum costs to cover for a full-time GP either. What’s more, reimbursement covers the  sickness absence of doctors only; the new proposals provide no cover for staff.

Similarly, this payment doesn’t cover jury service, suspension from practice, revalidation leave, or compassionate leave. It doesn’t meet funeral costs after accidental death. It doesn’t meet private physiotherapy costs and a whole host of other things which typically fall within today’s locum insurance policies. Ultimately, GPs will still be left putting their hands in their pockets, so how far does this really go to addressing ‘GP practice expenses’?

The opinions presented in this blog are solely those of the author on behalf of Practice Cover Limited and they do not constitute individual advice. Practice Cover is a trading name of Practice Cover Limited and is authorised and regulated by the Financial Conduct Authority.