GP practices in England were paid more than £20m last year for locums to cover sickness and maternity leave in their practices, HSJ has learnt.
The payments are made despite the fact that practices are regarded as private businesses and independent contractors to the NHS.
A senior source at the Department of Health said the payments were "completely anomalous". He said the DH was concerned the payments - made at the discretion of the primary care trusts - could be challenged under European law, which forbids governments from subsidising private companies.
HSJ submitted Freedom of Information Act requests to more than 30 PCTs, asking for details of payments for sickness and maternity leave cover made to GP practices in 2007-08. Half refused to release the information, saying third party commercial arrangements were exempt. Sixteen did release the information and revealed that they had paid practices almost£2.3m to cover the sickness and parental leave of their GP partners and staff.
The sums involved suggest that over a full year the 152 PCTs were likely to have paid out£20m-£25m to GP practices - figures confirmed by department and other sources. Approximately a fifth of this relates to sickness cover and the rest to parental leave. The largest payments to individual practices were made by Leeds, Salford and Mid Essex PCTs, with payments reaching£76,000 to a single practice.
TaxPayers' Alliance chief executive Matthew Elliott said: "This is yet another example of GPs securing some of the most lucrative perks in the country for no good reason. Any ordinary contractor would be expected to foot staffing bills themselves - that is a central plank of contracting out."
Earlier this year the National Audit Office found that under the new GP contract, GP practices were able to take 45 per cent of their income as profit, after staff wages and operating costs had been paid.
A DH spokeswoman said: "Reimbursement for sickness and maternity locum cover is part of the contract arrangements negotiated with the British Medical Association. However, the level of reimbursement is entirely discretionary. It is for PCTs to justify individual levels of reimbursement."
The maximum level of payment a PCT may make to a practice to cover parental leave is£1,500 a week. But BMA GPs committee deputy chairman Richard Vautrey said this would not provide suitable cover. Because PCTs could opt to pay much less, "the vast majority of practices get next to nothing", he added.
Bryan Heap, medical director of Norfolk PCT, which paid£205,000 for cover at 20 practices, said in practice the discretion PCTs could exercise was limited. "The 'discretion' element is only as to whether the PCT feels the practice can or can't operate according to its contractual requirements with a member of staff absent," he said.
Following HSJ's revelation of huge differences in funding per patient as a result of the minimum practice income guarantee (news, page 4, 27 March), health minister Ben Bradshaw has said the income guarantee is under review. In response to a parliamentary question this week, he said the payments would be the subject of "announcements" as part of junior health minister Lord Darzi's next stage review.
Top five largest practice payments
Locum payment (PCT)
£45,144 (Mid Essex)
£38,600 (Mid Essex)
Source: FOI request. Mid Essex PCT estimated payments for one year. Darlington and Salford payments for first nine months of 2007-08 only