If your practice relies on NHS reimbursement for sickness or accident cover, the rules have changed.
For many GP practices, managing sickness or accident absence has always involved a bit of practical juggling. Someone picks up an extra session. An ANP stretches their week slightly. A partner absorbs the pressure for a short spell. It’s never ideal, but it’s often been workable.
That’s why the recent changes to the NHS reimbursement arrangements have caught the attention of practices and accountants across the country.
Following the 30 April update to the Statement of Financial Entitlements, reimbursement claims now require much clearer evidence of actual financial loss. In practical terms, that means practices can no longer rely on internal cover arrangements in the same way they may have done previously. Evidence such as locum GP invoices is now becoming central to successful claims.
According to Association of Independent Specialist Medical Accountants, the updated scheme could create particular pressure for smaller, rural and coastal practices already struggling with GP recruitment and locum availability.
That point matters more than it might first appear.
It’s no longer just about having cover, it’s about proving the cost
Historically, some practices could demonstrate operational disruption without necessarily bringing in external locum support. If an Advanced Nurse Practitioner worked additional hours, or existing clinical staff absorbed workload internally, there was at least some flexibility around how practices approached reimbursement claims.
The updated framework appears far stricter.
Now, practices are expected to evidence a direct financial loss linked to the absence itself. In many cases, that means external locum expenditure supported by invoices and clear audit trails. On paper, that sounds straightforward enough.
But here’s the thing, what happens if you physically can’t source a locum GP?
Practices in remote or under-served areas already know the answer. Locum availability can be patchy at best. Some areas see inflated rates, others simply have nobody available. So, practices are left in an awkward position:
- They may still face operational strain
- Existing staff may still be covering the workload
- Patient demand doesn’t magically reduce
- Yet reimbursement could become harder to evidence
That’s a difficult gap to navigate.
Rural and smaller practices could feel this most
Andy Pow warned that some deprived, rural and coastal communities could lose out under the revised reimbursement structure because additional staffing simply isn’t easy to secure. And there’s a wider concern sitting quietly underneath all this.
Many practices already operate with very little slack in the system. When sickness hits unexpectedly, the response often depends on goodwill, flexibility and internal resilience. That resilience is admirable, but under the revised rules, goodwill alone may not support a reimbursement claim.
It creates a slightly uncomfortable contradiction. The practices most likely to struggle sourcing external cover may now face the biggest challenge evidencing financial loss.
So, what should practices be doing now?
This isn’t necessarily about panic or wholesale change. But it probably is time for a proper review.
Practices should be asking themselves a few fairly direct questions:
- How would you currently demonstrate a financial loss following GP sickness or accident absence?
- Are your evidence and record-keeping processes robust enough?
- If you needed emergency locum cover tomorrow, could you realistically source it?
- Does your existing locum insurance arrangement still reflect operational reality?
- Have reimbursement assumptions quietly become outdated?
Sometimes these issues only become visible when a claim needs to be made and by then, options can narrow quickly.
Locum insurance arrangements may need a second look
For practices that rely heavily on internal flexibility rather than external locum capacity, these changes may expose a mismatch between policy expectations and day-to-day operational reality.
That doesn’t automatically mean current arrangements are wrong. But it does mean they deserve another look.
At Practice Cover, we’re already speaking with practices reviewing whether their sickness and accident cover still fits the revised NHS reimbursement landscape.
Policies aren’t really tested when everything runs smoothly. They’re tested on the chaotic Tuesday morning when a GP is suddenly off for six weeks and the rota starts wobbling before 9am. That’s the real-world version.
If you’d like to discuss how these changes could affect your practice, or whether your current locum insurance arrangements remain fit for purpose, feel free to get in touch.
You can also read the original AISMA commentary here: AISMA article on GP reimbursement scheme changes
