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Indemnity Cover (April 2019)
As an LMC we are getting lots of contact by GP, Nurses & Practice Managers who remain confused about state backed indemnity.
In the past GPs and other clinical staff working in general practice were required to have medical indemnity cover. This cover was largely provided by the three major providers, the Medical Protection Society (MPS), the Medical Defence Union (MDU) and the Medical and Dentist Union of Scotland (MDDUS).
From 1st April 2019, NHS Resolution will be operating a new state-backed indemnity scheme for general practice in England called the Clinical Negligence Scheme for General Practice (CNSGP) and everyone working in general practice will be automatically covered in relation to NHS services.
No payments are required to benefit from the indemnity provided under the scheme and there is no formal membership or other registration requirements for either individuals or practices/organisations.
The indemnity provided under the scheme continues to apply where a GP or other person is no longer practicing or working in general practice at the time a claim is made (which can be many months, sometimes years, after the clinically negligent act or omission occurred).
The new scheme mirrors arrangements in NHS Trusts to bring significant benefits to general practice staff. NHS Resolution can already exercise discretion in relation to that scheme but rarely, if ever, does so. NHS Resolution will work hand in hand with those who find themselves the subject of a claim and only settle cases where compensation is due, while defending the rest. CNSGP is a comprehensive scheme available to all GPs whether in GMS, PMS, APMS and other settings and GPs should be confident they are fully covered just as clinicians in secondary care are
Full details of the scheme, which is being run by NHS resolution, can be found on their website at: https://resolution.nhs.uk/services/claims-management/clinical-claims/clinical-negligence-scheme-for-general-practice/.
If you are carrying out an activity that consists of, or is in connection with, the provision of primary medical services under a GMS, PMS or APMS contract, any clinical negligence liability incurred by you which arises from that activity is covered under the scheme.
If you are carrying out an activity that is not being delivered under the above contracts, you will be covered by the scheme if the answer to all the following questions is affirmative:
- Are you carrying out an activity that consists of, or is in connection with, the provision of NHS services?
- Are those NHS services being provided by, or under a contract with, a person or organisation whose principal activities are to provide primary medical services (i.e. the NHS services are provided as part of general practice)?
- Is the activity in question connected to the diagnosis, care or treatment of a patient?
Who is covered?
- General Medical Services (GMS)/Personal Medical Services (PMS)/Alternative Provider Medical Services (APMS) contract-holders;
- GPs and other healthcare professionals (e.g. pharmacists, nurses, physiotherapists);
- All GP practice employees (including management, reception and administrative staff);
- Locums and self-employed workers;
The BMA have issued the following statement :-
Following further discussions on some of the finer definitions of the scope of CNSGP, we are pleased to announce that it has been agreed with DHSC and NHS Resolution that the compiling of safeguarding reports for NHS patients will now be included within scope. It was initially thought that as these reports can be chargeable under collaborative fees arrangements they should be deemed to be private work and therefore out of scope. However, lobbying from the BMA extended an alternative view of these statutory reports as being reimbursed by the system rather than a private service to patients. This perspective has been accepted by DHSC and NHSR and therefore actions originating from the completion of safeguarding reports after 1st April 2019 will be covered by CNSGP.
What activities are not covered by CNSGP?
CNSGP does not cover all general practice activities.
In addition to retaining the management of existing claims, and being involved in any run off cover, MDOs or other indemnity providers will continue to provide members with advice and support on all non-NHS claims issues. For example, the following circumstances will not fall within CNSGP and so will be dealt with by your MDO or other provider:
- Non-NHS work;
- NHS Dentistry;
- Community pharmacy;
- NHS Optometry;
- Complaints (unless there is also a claim for compensation arising out of alleged clinical negligence);
- Inquests (unless there is also a claim for compensation arising out of alleged clinical negligence);
- Regulatory and disciplinary proceedings;
- Employment and contractual disputes;
- Non-clinical liabilities such as defamation.
You will need to maintain membership with an MDO or other indemnity provider in respect of activities and services not covered by CNSGP.
So CNSGP will cover any clinical negligence liability incurred by your practice team which arises from services delivered on the NHS but it won’t provide the additional advice and guidance/support that the MDOs detail above. It is this that the MDOs are charging you for.
The MDOs have taken a view on assessing risk of a GP needing to use their services based on the types of NHS work that they are undertaking and set their new premiums accordingly. Some MDOs appear to deem minor surgery, implants , out of hours work etc as an additional risk and so are charging a premium on top of their standard rate. Other MDOs are taking a different view. GPs may wish to shop around.
Other Healthcare Professionals (ANPs, Nurses, HCAs, Paramedics etc)
We would encourage practices to clarify with their MDO what cover is included for ancillary staff that is not provided by the CNSGP. It may be necessary for these individuals (ANP, Nurses, HCAs Paramedic's etc) to obtain cover for professional representation and additional indemnity cover for any private work they are undertaking on behalf of the practice.
Medical Defence Union
The MDU changed it cover last year from an occurrence based cover to claims based cover. This reduced the cost of cover by up to 50%. An Occurrence policy protects you from any covered incident that “occurs” during the policy period, regardless of when a claim is filed. Claims-made policies provide coverage for claims only when BOTH the alleged incident AND the resulting claim happen during the period the policy is in force.
As an LMC we had stated that MDU members would need to purchase 'run off cover' as they have changed from an occurrence based cover to a claims based cover.
The MDU have now clarified that run off is payable in the following circumstances:
if you leave the MDU before the state-backed indemnity scheme is introduced
if the state-backed indemnity scheme is introduced without picking up historic liabilities and you were to leave the MDU before the normal retirement age for your NHS pension scheme.
Otherwise there would be no need for you to purchase run off from us.
Medical Protection Society
(the following statement was written by Dr Mark Sanford-Wood the GPC lead for Indemnity)
The structure offered by the MPS falls into 2 categories:
Professional Protection(GMC representation, complaints advice etc) and
Claims Protection(cover for private work).
Under Professional Protection the website asks if you do any of the following higher risk activities and the answer in many cases will be yes.
This will add about £150 per year to the Professional Protection premium. However when it comes to Claims Protection the question is subtly different and asks if you require MPS indemnity for any of the higher risk activities. Given that CNSGP covers these as long as they are delivered for the NHS the answer in most cases should be no. This seems counter-intuitive to many and answering yes to this question has the effect of producing premiums often over £2,000. This question should be answered in the affirmative only if those activities will be carried out privately.
For most normal GPs the levels of private earning per doctor spread across all doctors in a practice will be considerably under £2,500 per year and the price range for both professional representation and private cover combined should be under £1,000 per year regardless of the MDO you join. It is only where GPs are doing significant amounts of private work requiring private indemnity outside of the CNSGP that costs should be significant.
MDU https://www.themdu.com/ .
NHS Resolution https://resolution.nhs.uk/
Mark Sandford-Wood's Blog - well worth reading click here
RCN Indemnity Scheme - https://www.rcn.org.uk/indemnity