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The 2017-18 changes to the GMC contract in England were announced this week. Generally, contract negotiations and changes are aimed at partners, and sometimes we, as salaried and locum GPs, struggle to see the relevance. However, there is a key area in this year’s contract that we all need to be aware of - and that is the funding for indemnity increases.
This was part of the GP Forward View, but the funding didn't reach practices until this year.
NHS England have committed funding for the expected INCREASE in indemnity costs, for all GPs.
A few important points:
Time to dig out your renewal notice for your MDO and do some maths. If you are a whizz with maths and spreadsheets, then I apologise if this is simple and laughable. Maybe skip to the other blogs...
GPs who only locum - you are self-employed. Your MDO indemnity costs are a tax-deductible business expense. The advice from the sessional subcommittee and GPC is that you do as you’d normally do every year and include any indemnity increase in your overall locum fees in order to cover your expenses in general. HMRC have been very clear with NHSE that they want to see this passed on to all GPs, Speak to your accountant about the best way to highlight this.
You may have other increases in expenses that will be causing a change in your fees this year; these should be highlighted separately.
For salaried GPs, it gets a bit more complicated.
Some salaried GPs have their indemnity paid, or fully reimbursed by their practice. If this is the case, there will be no change as the practice gets the funding, and will pay the full amount.
If you don't have your indemnity reimbursed, or work in other roles that affect your indemnity and cost more, it will be a bit more complex. However, HMRC will be expecting to see this money passed on to salaried GPs, and practices are aware of their obligation to do so. It is helpful, if you don't already have one, to ask your MDO for a breakdown of your indemnity costs. Some companies give this automatically, so you can see how much of the total you are paying for standard GP work, and how much for another role e.g. out of hours/prison work.
Once you have this breakdown, we suggest you put the indemnity increase for the last year in writing to your practice, and discuss when and how that will be paid.
The contract roadshows that have taken place recently, and all the guidance from NHSE and HMRC have been absolutely clear that salaried GPs must have this funding passed on to them. The advice here is being shared with practices by GPC, and with LMCs, to try and ensure a consistent approach.
If you as a sessional GP have questions, please feel free to contact myself or any other member of the sessional subcommittee. The link to your regional reps is here, and most of us are also active on social media. Your LMC will also have our contact details.
Zoe Norris is chair of the sessional GP subcommittee
Please can I recommend the NASGP advice on this - it's perhaps a little bit clearer and even gives an online calculator.
I'm not sure why you advise locums to highlight the increase in fees due to increased indemnity costs separately from increases in fees due to increases in other costs. No other professionals that I currently pay - vet, dentist, accountant, or lawyer - do so. My fee increase incorporates the rise in the cost of indemnity, the rise in some other costs, and a rise in income to cover general inflation. It doesn't need to be itemised.
Hi Anonymous 1 hour ago. If you separate out the actual cost of the extra cost of your indemnity it could help GPC to monitor that the sum the MDOs said would be needed ( £30 million) was the actual cost . If GPC gets feedback from practices that the amount is insufficient ( likely I suspect) then they can challenge to have the difference as well as next years extra costs reimbursed directly.
salaried GPs are NHS employees, they should have parity with their secondary care colleagues= they shouldn't have to pay their own indemnity,nor should it be a 'benefit' - incurring tax. With static pay for the last 8 yrs, it's time we had some more realistic assessment of what is happening. We are being treated differently when our roles are the same in so far as I'm an NHS doctor. My hospital colleague pays no indemnity as it's covered by crown indemnity.
in the 16 17 uplift, 33 million was paid to English practices to cover for increase in indemnity in 15/16 year. This is well docmented in GP forward view, NHS england docuemnt on indemnity and have received the same from BMA advisors. However not a penny has been paid to me by my practice as they have "spent the money on other costs". My contract does not enforce them to pay this money and neither does the contract the practice has with NHS England. So I would hold fire on your calculators just yet, if practices want to keep the funds for their own profit there is nothing to stop them from doing so. The BMA has failed to negotiate a contract that requires salaried GP get their share of indemnity in 2016 and and no reason to think that it will work this coming year after April 2017. Come on BMA do better for Salaried GPs, we want to be treated equally for indemnity support. We should be paid directly by NHS England.
Why does this not cover out of hours? Surely this is where the indemnity rise and GP shortage hits hardest...?
I fail to see how your masterclass works!
The practices will receive a fee based on the registered population, that then has to be shared across the partners, salaried GPs and locums.
1. For which year does this fee relate - 16/17 or current year 17/18?
2. If 16/17 - will the fee be paid in one lump sum in April?
3. The amount available with differ from practice to practice and the number of sessions needing to be paid will be variable depending on staffing levels and the use of locums.
4. Your guidance and the online calculator simply encourage locums to build in their additional costs, and salaried GPs to invoice their practice for the uplift - not receive a reimbursement!
I would be stunned if the amount paid to practices more than covered the increase in indemnity fees, your current train of thought is likely to leave partnerships even further out of pocket!
I've asked one of the Bristol practices I work for whether they are receiving any money themselves as part of the this scheme... they're not, so I've left it that I'll talk to them once they know how much they are going to get... but I'm not exactly holding my breath...
This may have been touched on on other comments but this whole process seems to completely circumvent the fat cat insurance companies who we should be forcing to reduce costs. If insurance companies are continuing to make high profits then surely the government could impose a windfall tax. It is obscene amount that we are forced to pay, come on BMA this is a workaround solution at best.
This is typical. They throw some money in without thinking. Why is the increase in indemnity fees? Due to increased claims in OOH? Who works in OOH? Mainly locum GPs? Can they set their rates? No, they have to take what the OOH providers pay. What is going to happen? The already stretched service is going to be stretched even more as it soon will not be worth working in OOH. Well done again, government! http://rooftopsnipersgame.com/ free for everyone.
Thank you for all your comments.
This is not a solution to indemnity. At all. It isn't even a sticking plaster. The agreement on this indemnity uplift was part of the GPFV - our job as the sessional subcommittee representing salaried and locum GPs is to ensure that the (insufficient) funding gets shared equitably to all GPs. Particularly because NHSE has decided it should be paid to practices.
The solution to the whole indemnity situation is for NHSE to agree funding on behalf of all GPs and directly reimburse or pay this in full. The fact OOH GPs haven't even been covered, with no commitment to extend the winter indemnity scheme suggests a deliberate neglect of this already struggling area.
Is this enough? No.
Does this mean we won't be asking for more? Absolutely not.
Am I happy about this personally as a locum GP? No. It's not even a drop in the ocean.
But it is our job to tell you how to access this funding - however paltry it may be.
NHSE will be issuing their own guidance shortly which may (or may not) clarify further.