Locum rates set to fall after state-backed indemnity kicks in

Locums could freeze or reduce the fees they charge after state-backed GP indemnity takes effect from April 2019.

Rates charged by locum GPs have increased over the past year, with many citing soaring indemnity costs as a reason for raising their fees.

However, locum rates could fall in 2019/20 if the much-anticipated state-backed GP indemnity scheme triggers a significant reduction in fees charged by medical defence organisations (MDOs), according to a leading sessional GP.

National Association of Sessional GPs (NASGP) chair Dr Richard Fieldhouse told GPonline that many locums had factored rising indemnity costs into their rates, with increases likely to have been around 1% or 2% this year. He said it would be 'reasonable' to expect locums to factor in any reduction in costs when setting their fees for 2019/20.

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The GPC said it could not confirm whether it will formally advise locums to lower their rates when the state-backed indemnity scheme starts, despite advising them in 2017 to raise fees to cover indemnity costs. GPC chair Dr Richard Vautrey said the issue was 'part of our ongoing negotiations with NHS England'.

The BMA advised locums to 'ensure their invoices/agreements with practices are uplifted appropriately' to claim their share of a £30m fund distributed to practices last year to cover rising indemnity costs in 2016/17 and a share of £60m distributed this year to cover rising costs in 2017/18.

Evidence suggests locum rates did increase last year - a survey by GPonline's sister publication Medeconomics in August found that daily rates charged by locums had increased by between 1% and 6.5% in different parts of England over the previous 12 months.

Dr Fieldhouse said: 'If locums put their costs up for this factor [indemnity] and this factor alone and their rates have been managed for other factors like inflation, it would be reasonable for locums to reduce their rates again.'

GP pay

He said partners had been criticised in the past for failing to pass on uplifts in GP pay, but it was important to 'do the right thing'.

In practice, the NASGP chair said, locums may simply 'freeze their rates for longer than they normally would' rather than reducing them, because other factors such as inflation could balance out indemnity gains.

Indemnity costs for all GPs rose by more than 50% between 2010 and 2016, the BMA estimates, and costs have continued to rise since then. Former health secretary Jeremy Hunt pledged in October 2017 to introduce state-backed indemnity from April 2019 - pointing to rising costs for GPs as a key factor driving a workforce crisis in general practice.

The government has yet to reveal in detail how the scheme will work, but BMA guidance makes clear that GPs working as 'partners, salaried, locum and out-of-hours will all be covered for all NHS commissioned work through all settings whether GMS, PMS, APMS or integrated urgent care providers providing commissioned NHS services'.

Medical indemnity

GPs will need to maintain cover with a medical indemnity organisation following the introduction of state-backed indemnity, to cover the cost of advice, representation at medical tribunal hearings, non-NHS work and other factors. But fees are expected to drop dramatically to reflect the government assuming responsibility for the cost of clinical negligence payouts, which have been the major driver behind sharp increases in the cost of medical indemnity for doctors.

GPonline revealed last month that GP leaders were negotiating with the government over how the state-backed scheme would be funded - and that part of the cost could be drawn from existing GP funding.

Dr Fieldhouse said he was confident that locums would be treated equally to other GPs under the state-backed indemnity scheme as promised, but warned that there was 'previous' when it came to unequal treatment - for example through entitlement to death-in-service payments.

He hit out at the long wait for detail of the indemnity scheme to emerge, warning that although older GPs were 'used to it', for younger GPs in particular the delay created another factor that made people 'question why they are doing general practice'. 'It's just another piece of free-floating anxiety,' he warned.

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