Guide: Workforce/HR/Employment law Primary Care Networks

Managing the cost of PCN staff absences

How can PCNs financially plan for when network staff go on sick leave and their workload needs to be covered? Financial advisor Simon Appleyard shares his tips 

Competition for talent at PCN-level is heating up. Networks have increasingly been moving from a contractor model to a value-based model, focused on attracting, and crucially, retaining the right staff.  

Offering the right level of pay and benefits can be a key differentiator in attracting new hires. However, benefits such as enhanced sick pay also create financial liabilities for practices and networks – liabilities that they will need to plan for and manage.  

The challenge ahead – arranging cover for PCN staff on sick leave 

PCNs have money available to help increase their collective workforce through funding streams such as the Additional Roles Reimbursement Scheme (ARRS). 

As networks have developed, they are using these to hire the very best staff they can – supporting delivery of the highest quality patient care, but often simultaneously increasing their overall staffing costs against what is ultimately a capped NHS budget.  

The challenge comes when members of PCN staff, whether roles funded by the ARRS or otherwise, are unable to work because of illness, and practices or the network need to arrange to cover their responsibilities.  

Where this happens, management teams across the network have two options: they can either hire in temporary cover or ask other members’ practice staff to step in. Both options have considerable drawbacks.  For some networks, staffing costs will be tight, with very limited headroom within budgets to cover the cost of hiring replacements (that pressure will be even greater during periods or seasons when multiple members of staff are likely to be absent all at once). If money for hiring in temporary staff ends up coming from a practice or partnership’s own pocket, it reduces profitability, and potentially reduces the budget available for other business costs. 

On the other hand, if a practice tries to fill an absence by having another team member cover, it immediately puts additional pressure on capacity, and could still result in needing to hire extra resources to help with workload. Where a GP, for example, needs to step in to cover another serving in a PCN clinical director role, this could mean hiring a locum to help meet the doctor’s contracted number of sessions – another cost that the practice, and network, needs to manage. 

How can PCNs manage this financial risk?  

The first step is to have a thorough and up-to-date view – at both practice and PCN-level – as to the full financial liability that hiring new staff will pose.  

This will allow practices to adequately anticipate and plan for instances where staff are ill or on leave, helping them make the most of staff funding available, while minimising the risk of being caught out financially.  

In a PCN setting, these discussions should include conversations about which practice, whether the lead or otherwise, is responsible for which shared network employees in cases of absence. 

Considerations like this can be set out in a PCN’s network agreement. Doing so will give clarity to all involved and help the network better plan for any financial or operational hits.   

Practices could also consider insuring the risk. This can mitigate against the financial risk of staff illness.  

One of our solutions makes regular benefit payments to a network if a member of the plan is unable to work because of illness or incapacitation – protecting against the need for network members to fund any cost of hiring replacements, or paying for extra staff hours, themselves.   

Whichever way you choose to manage the risk, seeking support from a financial adviser who understands the challenges your practice and network faces will be invaluable.  

They can help build factors such as staffing risk into network agreements and identify what financial products, like insurance, are right for your specific circumstances.  

Key points:  

  •  Offering the right level of pay and benefits – including sick pay – is a key differentiator for practices and networks looking to attract staff in a competitive environment. However, it increases their financial liabilities. 
  •   A major challenge is the cost of providing temporary cover when PCN staff are off sick. There might not be enough budget available to replace absent staff, while arranging cover from within the existing workforce can increase capacity pressure. 
  •   Plan for the financial/operational hit. Practices and networks need to develop a full and up-to-date view of the full financial liability that hiring new staff poses. They also need to determine factors which practice is responsible for which shared network employees in cases of absence. 
  • Consider what financial products may offer solutions.  

  Simon Appleyard is senior area manager at Wesleyan, the specialist financial services mutual for GPs  

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