Locum Cover Insurance for GP Partners: What the SFE Pays, and the Gaps

The short answer

For GMS practices in England, the Statement of Financial Entitlements (SFE) obliges NHS England to pay towards the cost of covering a GP who is on parental leave or sick leave. The 2026/27 maximums are:

In every case the payment is the lower of the invoiced cost and the weekly maximum. It is not reduced because the absent GP works part-time.

Locum cover insurance is what practices buy for the rest: the first two weeks of sickness, the half-rate period, anything beyond 52 weeks, and the gap between a locum's real cost and the weekly maximum.

Who and what qualifies

The absent doctor must be a GP performer: a partner, or a GP employed by the practice. The cover can be:

• an external locum, or a salaried GP on a fixed-term contract, or
• a GP who is already a partner in, or employed by, the practice, as long as they are not full time.

The practice must not already be claiming another SFE cover payment for the same GP.

Parental leave (SFE section 9). The leave must be for more than one week, and the GP must be entitled to it under statute, the partnership agreement, or their contract of employment. For an employed GP, the contract must entitle them to their full salary from the practice during the leave. NHS England's policy protocol pays for weeks 1 to 26; the BMA notes that the SFE itself sets no time limit and expects payments to follow the length of the leave.

Sickness (SFE section 10). If the absent GP is an employee, the practice must be required to pay them statutory sick pay or their full salary. Where the absence follows an accident and the practice can claim compensation from whoever caused it, NHS England may lend the cost of cover instead, repayable from the compensation. A single-handed GP who is off sick "should normally" be considered to need cover.

When NHS England may say cover is not needed. For both kinds of leave the Directions say cover should not normally be considered necessary if the absent GP's right to return has been extinguished, or if the practice has already taken on a new partner or employee to do their work and is not carrying a vacancy they will fill on return.

Sickness: the two weeks, and the 52-week look-back

No reimbursement is paid for the first two weeks of each period of absence. After that, the entitlement for a particular GP is 26 weeks at the full amount NHS England has agreed, then 26 weeks at half of it.

Those 52 weeks are not fresh for every illness. On the first day of a new absence, any weeks paid for the same GP in the previous 52 weeks are added together and taken off the entitlement, full-rate weeks first. The Directions give the example: if cover was paid for 32 of the previous 52 weeks, what remains is 20 weeks, at half rate.

The BMA's guidance describes the deduction as weeks claimed earlier in the same financial year. The Directions' wording, a look-back over the previous 52 weeks from the first day of absence, is the one that applies.

How to claim

Claims go to the practice's commissioner, for costs actually incurred.

Parental leave. Claim at a frequency agreed with the commissioner, or failing that within 14 days of the end of the month the costs were incurred; the payment falls due 14 days after the claim. The practice supplies:

• maternity: the certificate of expected confinement used for statutory maternity pay, or a private certificate with the same information
• paternity: a letter from the GP confirming prospective fatherhood and the expected date
• neonatal care: a letter from the GP with the dates and duration of the leave
• adoption: a letter from the GP with the date and the main carer, countersigned by the adoption agency
• shared parental leave: the eligibility certificate, or a letter from the GP countersigned by the practice

Sickness. The conditions are stricter:

• the practice must get NHS England's prior agreement to engaging the cover, including the amount, and NHS England must decide "as quickly as possible"
• medical certificates for each period of absence must be sent without delay
• claims are made at the end of each month, and paid on the day the practice's next global sum payment falls due
• the practice must say at once if it stops paying an employed GP statutory sick pay
• the absent GP must not act in a way that is prejudicial to their recovery, or do clinical work for anyone else, except under medical direction and with NHS England's approval

For both, the practice must keep records of the actual cost to show on request, and must tell NHS England about any change to the cover arrangements. Breaching the conditions lets NHS England withhold payment.

Where NHS England can pay more, or less

Section 22 of the SFE lets NHS England pay for cover where it is not obliged to, and to top up a payment at the maximum. It must keep a protocol, agreed as far as possible with the BMA's GP Committee, on how it uses that discretion, including:

• cover for a GP on long-term sickness after the 52 weeks run out. The Department's expectation is that this would not exceed the half rate, or what the NHS Pension Scheme would pay on ill-health retirement, whichever is lower
• cover provided by nurses or other health professionals
• payments to a partner or employee who covers for an absent colleague
• cases where it is likely to pay less than the maximum, the SFE's own example being cover for a GP who normally works three days a week

Section 10 also asks NHS England to consider discretionary help where sickness rates in an area are unusually high, and for rural practices where a GP returning from sick leave cannot take on their full list straight away because of home visit distances.

There are separate SFE payments for covering a GP suspended from the performers list (section 11) and for prolonged study leave.

The gap: a worked example

Made-up figures. A full-time partner is off sick for a year, and the practice books a locum for eight sessions a week at £450 a session: £3,600 a week. NHS England has agreed the cover and pays the maximum.

That shortfall falls on the partnership, and how it is shared is a matter for the partnership agreement, which also sets what an absent partner is paid. It is the sum locum cover insurance is designed to meet.

Locum cover insurance

Locum cover insurance (sometimes called practice expenses or locum and fixed overheads insurance) is bought by the practice and pays an agreed weekly benefit when an insured GP cannot work. The BMA's advice is that the national maximum "may not fully cover the cost of a locum", and that practices should review their cover and consider keeping enough to top up the national payments.

Questions worth putting to an insurer or broker, because policies differ:

• What weekly benefit for each GP, and does it match what cover would really cost?
• How long is the deferred period before it pays, and how long does it pay for? Does that line up with the SFE's two weeks, 26 weeks and 52 weeks?
• Does it pay the agreed benefit however the absence is covered, including by a partner or by not covering at all?
• Does it cover phased returns, salaried GPs as well as partners, and parental leave or pregnancy-related illness?
• Which conditions are excluded, and how are pre-existing conditions treated?

This guide does not recommend any insurer or policy.

Tax: premiums and payouts

HMRC's Business Income Manual treats this kind of policy differently from personal cover:

• Locum and fixed overheads policies. Premiums on policies that pay for a locum, or the practice's fixed overheads, while the policyholder is too ill to work are allowable deductions, and the benefits are trading receipts, taxable as part of practice profit (BIM45565). If a policy also covers personal costs such as medical treatment, the premium may have to be apportioned.
• A partner's own income protection. Premiums a partner pays for their own sickness cover are not deductible, and the benefits are not trading income and are generally tax-free (BIM45560).

How a payout then feeds into each partner's profit share, and into the Type 1 certificate, is a question for the practice's accountant.

PMS, APMS, and the rest of the UK

The SFE Directions apply to GMS contracts in England. PMS and APMS practices should check their own agreement for what it says about locum reimbursement. Wales, Scotland and Northern Ireland have their own arrangements, which this guide does not cover.

Frequently asked questions

Does NHS England pay for locum cover when a GP partner is off sick?

Under the GMS Statement of Financial Entitlements, yes, after the first two weeks of each absence: up to £2,151.96 a week in 2026/27 for 26 weeks, then half that for a further 26 weeks, or the invoiced cost if lower. The practice needs NHS England's agreement to the cover before it is engaged, and a medical certificate for each period of absence.

How much does NHS England pay for locum cover during maternity leave?

Up to £1,475.17 a week for the first two weeks it reimburses and up to £2,238.03 a week after that in 2026/27, or the invoiced cost if lower. The leave must be for more than one week, and the same applies to paternity, adoption, shared parental and neonatal care leave.

How does a GP practice claim for locum cover?

From its commissioner, with invoices for costs actually incurred. For parental leave, claims go in at a frequency agreed with the commissioner or within 14 days of the end of the month, with evidence such as the certificate of expected confinement. For sickness, the practice must agree the cover in advance, send medical certificates, and claim at the end of each month.

Is the reimbursement reduced for a part-time GP?

The Directions say payments are not to be pro-rated to the absent GP's working pattern; the practice receives the lower of the invoiced cost and the weekly maximum. Covering a part-time GP usually costs less, so the invoiced cost is often the figure paid.

Are locum insurance premiums tax deductible for a GP practice?

HMRC treat premiums on policies that pay for a locum or practice overheads while a partner is ill as allowable business expenses, and the benefits as taxable trading receipts. That is different from a partner's own income protection, where premiums are not deductible and benefits are generally tax-free.

Do GP practices need locum cover insurance?

It is not compulsory. The NHS reimbursement pays nothing for the first two weeks of sickness, only half after 26 weeks, nothing after 52, and never more than the weekly maximum, so the BMA recommends practices review their cover and consider keeping enough to top up the national payments.

Sources

Checked 6 November 2026. Where a primary source disagrees with anything here, the primary source wins.

• General Medical Services Statement of Financial Entitlements Directions 2026, GOV.UK, in force from 1 April 2026: section 9 (parental leave), section 10 (sickness), section 11 (suspended doctors) and section 22 (NHS England's discretion and the locum protocol)
• Locum GP cover for parental and sickness leave, BMA, updated 7 November 2025: parental leave duration, the advice on locum insurance, and phased returns
• Primary medical care policy and guidance manual, NHS England: the protocol for cover payments for parental and sickness leave
• BIM45565: insurance, locum and fixed overheads and BIM45560: own health policies, HMRC Business Income Manual

A note on advice

This guide is general information, not financial, tax, legal or insurance advice. For a claim, ask your commissioner; for cover, an independent broker; for the tax, the practice's accountant.