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Category: Contractual issues



NHS England short contract form


NHS England publish a shorter-form version of the NHS Contract, for use in defined circumstances. These include:  non-inpatient mental health and learning disability services; any community services, including those provided by general practices, pharmacies, optometrists and voluntary sector bodies; hospice care / end of life care services outside acute hospitals; care provided in residential and nursing homes; non-inpatient diagnostic, screening and pathology services and patient transport services.  The shorter-form contract may not be used for any service for which the National Tariff guidance sets a mandatory national price (whether or not that mandatory national price is to be the subject of a Local Variation or Local Modification).The relevant documentation is available here:

CSG presentation to LMC

Please find attached a Powerpoint presentation for Cost-sharing from CSG to the LMC. Document is here 

Contract Changes 2019-2020

A summary of the changes to the Contract for 2019-20 is here.

State-funded indemnity scheme

The MDOs are in the later stages of pricing their post-April product.  GPs should remain members of one of the MDOs to ensure they have cover for GMC, criminal/coroners cases, private reports/HGV medicals etc.  There will be a competitive market for this cover after April and this is likely to influence pricing decisions.  In the meantime, all indications suggest the market rate for this cover is likely to be broadly in the £800 - £1,200 range.  Renewals falling due before April 1st are likely to be in line with current costs.

For GPs working in community hospitals the intention behind the agreement with NHS England is that all roles will be covered by state indemnity.  There will be two sorts of state indemnity: the Clinical Negligence Scheme for Trusts (CNST - currently and loosely referred to as Crown Indemnity) and the Clinical Negligence Scheme for GPs (CNSGP).  Both of these are or will be administered by NHS Resolution (NHSR).  People working in these settings will need to be aware of which arm of NHS Resolution will be providing their cover, but GPC has been assured that there will be no gaps between CNST and CNSGP.  However, the detail of whether the GP is to be covered by CNST or the new CNSGP is not yet settled. 

Currently GPs working in community hospitals, A&E and urgent care centres may be doing so under a number of arrangements, the most common being either direct employment by the trust of the GP or a sub-contracting arrangement from the Trust to a practice or other provider (with whom the GP may be a partner or salaried). It appears that to date both of these arrangements have generally seen GPs being indemnified through their own MDO, although not in all circumstances.  In general, where the engagement is direct along the lines of an employment/locum basis then these arrangements would ordinarily need to be covered under CNST.  This may represent a change for some trusts who may not have been offering this to date.

All trainees will be covered for clinical negligence under the CNSGP scheme.  DHSC has assured the GPC that no doctor will be out of pocket as a result of the introduction of the scheme. There is a patchwork of arrangements in operation by different deaneries with some buying block products for their trainees.

The NHSR webpage on CNSGP has gone live and includes advice on scope:

There is also an email address for queries of all types including scope:

GDPR requests - what is 'excessive'?

As you can imagine, there has been much thought going into this question, with no clear answer in the absence of a court decision.  However, the practice is the data controller and can decide on a case by case basis whether the request is excessive.  The sort of factors to be considered might include:

  • The time it takes a member of staff to copy the notes. (Perhaps more than 15 minutes would be excessive?)
  • Postal costs.  (e.g. Would it be more than the standard recorded delivery postal charge for one A4 sized envelope?)
  • The medical time taken to read records and redact third party information. (Again, 15 minutes is probably a good limit beyond which it becomes excessive.)

If a requestor complains then do come back to us.

Winter indemnity scheme

NHS England has announced that it is again running a winter indemnity scheme this year to support GPs who wish to offer additional extended access and/or out of hours sessions over the winter season. The scheme, running from 1 October to 31 March next year, will be used to provide indemnity for the extra services provided by GPs, giving them the freedom to work extra sessions securely and without the worry of additional costs.  

Practice locum reimbursement for phased return to work

GPC England has been made aware that a number of local commissioners have refused locum reimbursement following GP partners returning to work from sickness absence on reduced hours (phased return). GPC has challenged these decisions with NHS England nationally, as a clear breach of the GMS Statement of Financial Entitlements.

This intervention has resulted in NHS England conceding GPC's position that when GP partners return from sick leave on phased return certified by Med3, the SFE mandates that practice must be reimbursed the cost of their cover in exactly the same was as if the partner was still completely off sick.

Furthermore, whilst there are some circumstances where a practice may not automatically be entitled under the SFE to locum reimbursement when a salaried GP is on phased return from sick leave, NHS England nationally has made it clear to all local commissioners that, to avoid discrimination, salaried GPs' absence during phased return will also be reimbursed on a discretionary basis.

An updated SFE will be published shortly and NHS England will also imminently be publishing a new protocol dealing with the correct interpretation of the SFE in respect of various issues related to practice locum reimbursement entitlement for parental and sick leave, on all of which GPC has successfully challenged local commissioning decisions where reimbursement had been inappropriately denied.

In the meantime, in respect of the specific issue of phased return from sickness, a guidance document has just been published on the NHS Employers website, available at this link:




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