How do you take a sabbatical in general practice?

With difficulty, but Terry Kemple has been trying (without much success) to coordinate the Deanery and the locals PCTs to produce a fair system.

‘Taking a sabbatical in general practice’ was published in the BMJ’s career focus in 1998. The details about prolonged study leave allowance for GPs are out of date, but its a good place to start your planning process. The BMJ link is HERE.

With the new GP contract in 2004 the NHS process for claiming Prolonged Study Allowance (PSL) changed. At that time each PCT had funds (roughly £20-40k) allocated in it budget each year to fund GP sabbaticals. The money was placed into the PCTs budget along with maternity, retained doctors, and sick leave payments. The money has no ring fencing and its use is at the discretion of the PCT. The deanery can only recommend approval of PSL but the PCT has the final say, unlike Retained Doctors where the PCT must pay if the Deanery, Practice and Retainee agree on an appointment. Applications for PSL have fallen to roughly 20% from previous years. The system is no longer working. In the first 9 months since April 2004 there were only 30 submissions to the national panel when previously the number would be around 105. There was a proposal that PCTs should agree to pool the funding with the Health Authority or a lead PCT to work with the deanery and allow the GP director to distribute the fund equitably to develop the workforce. Directors and the lead PCT would produce an annual report on how the funds have been dispersed and the national panel will remain to advise on applications. This proposal got nowhere.

Whilst the money may be cash limited and difficult to access it is important that it is not lost completely and we should ensure there is a fair process for applying for funding. At present (11/07) you must get the forms from your PCT to submit an outline of your plans. If the PCT gives outline approval you submit a full application including your educational plan to Bill Irish head of the GP school of the Severn Deanery. If your application is approved a letter is then sent to support it while at the same time local negotiations occur with the PCT on funding.

For GMS practices, please refer to the Statement of Financial Entitlements section 12 (see below) For PMS practices, it depends on the local agreement/contract and it would be worthwhile checking that your new PMS contract includes the same entitlement as the new GMS contract.

Avon LMC can help clarify the process of approval and budgets of PSL, and in addition each of the local PCTs has been asked 'What are the PCT budget and approval arrangements for GP Prolonged Study leave allowance?' The PCTs answers are recorded on this webpage. I must declare an interest because I am asking Bristol PCT for PSL in 2008/9. A diary of my progress will be attached later.

Specific information about who to contact in the PCTs has been added when it is available. The Strategic Health Authority has been asked what budget each PCT receives for PSL funding each year:

• Bath & North east Somerset PCT No reply to enquiries.
• Bristol PCT You should contact Jessica Wilson at Bristol PCT.
• North Somerset PCT No reply to enquiries.
• South Gloucestershire PCT There is no definitive budget set up, but GPs may apply through Lynda Dando, Director of Primary Care.

New GMS Contract

12. Payments in respect of Prolonged Study Leave

12.1 GP performers may be entitled to take Prolonged Study Leave, and in these circumstances, the contractor for whom they have been providing services under its GMS contract may be entitled to two payments–

1. an educational allowance, to be forwarded to the GP performer taking Prolonged Study Leave; and
2. the cost of, or a contribution towards the cost of, locum cover.

Types of study in respect of which prolonged study leave may be taken

12.2 Payments may only be made under this Section in respect of Prolonged Study Leave taken by a GP performer where–

1. the study leave is for at least 10 weeks but not more than 12 months;
2. the educational aspects of the study leave have been approved by the local Director of Postgraduate GP Education, having regard to any guidance on Prolonged Study Leave that Directors of Postgraduate GP Education have agreed nationally; and
3. the PCT has determined that the payments to the contractor under this Section in respect of the Prolonged Study Leave are affordable, having regard to the budgetary targets it has set for itself for the financial year 2004 to 2005.

The educational allowance payment

12.3 Where the criteria set out in paragraph 12.2 are met, in respect of each week for which the GP performer is on Prolonged Study Leave, the PCT must pay the contractor an Educational Allowance Payment of £129.50 per week, subject to the condition that where the contractor is aware of any change in circumstances that may affect its entitlement to the Educational Allowance Payment, it notifies the PCT of that change in circumstances.

12.4 If the contractor breaches the condition set out in paragraph 12.3, the PCT may, in appropriate circumstances, withhold payment of any or any part of an Educational Allowance Payment that is otherwise payable.

Locum cover in respect of doctors on Prolonged Study Leave

12.5 In any case where a contractor actually and necessarily engages a locum (or more than one such person) to cover for the absence of a GP performer on Prolonged Study Leave, then subject to the following provisions of this Section, the PCT must provide financial assistance to the contractor under its GMS contract in respect of the cost of engaging that locum (which may or may not be the maximum amount payable, as set out in paragraph 12.7).

12.6 It is for the PCT to determine whether or not it was in fact necessary to engage the locum, or to continue to engage the locum, but it is to have regard to the following principles–

1. it should not normally be considered necessary to employ a locum if the PCT has offered to provide the locum cover itself and the contractor has refused that offer without good reason;
2. it should not normally be considered necessary to employ a locum if the performer on leave had a right to return but that right has been extinguished; and
3. it should not normally be considered necessary to employ a locum if the contractor has engaged a new employee or partner to perform the duties of the performer on leave and it is not carrying a vacancy in respect of another position which the performer on leave will fill on his return.

12.7 The maximum amount payable under this Section by the PCT in respect of locum cover for a GP performer is £948.33 per week.

Payment arrangements

12.8 The contractor is to submit to the PCT claims for costs actually incurred during a month at the end of that month, and any amount payable is to fall due on the day of the following month that the contractor’s Payable GSMP falls due.

Conditions attached to the amounts payable

12.9 Payments in respect of locum cover under this Section, or any part thereof, are only payable if the following conditions are satisfied–

1. the contractor must obtain the prior agreement of the PCT to the engagement of the locum (but its request to do so must be determined as quickly as possible by the PCT), including agreement as to the amount that is to be paid for the locum cover;
2. the locum must not be a partner or shareholder in the contractor, or already an employee of the contractor, unless the performer on leave is a job-sharer;
3. the contractor must, on request, provide the PCT with written records demonstrating the actual cost to it of the locum cover; and
4. once the locum arrangements are in place, the contractor must inform the PCT–

1. if there is to be any change to the locum arrangements, or
2. if, for any other reason, there is to be a change to the contractor’s arrangements for performing the duties of the performer on leave,

at which point the PCT is to determine whether it still considers the locum cover necessary.

12.10 If any of these conditions are breached, the PCT may, in appropriate circumstances, withhold payment of any sum in respect of locum cover otherwise payable under this Section.

If you have any suggestions about how we can improve this section email them to contact@bristolgpsolutions.org.uk