What is Medical Indemnity? #theGPcrisis

The rising costs of medical indemnity have been hitting the headlines recently, causing GPs to retire and do less out-of-hours work. A recent Medical Defence Union survey of over 900 GPs found a third were thinking of considering leaving the profession or retiring over the increased costs of indemnity caused by the rising cost of compensation payments.

What is medical indemnity? It is a specific subgroup of insurance, protecting medical professionals against malpractice. Where negligence is proven for incidents, accidents and mistakes, compensation is paid to the claimant.

Doctors who are employed by the NHS receive their indemnity through their employer; this is provided by the Clinical Negligence Scheme for Trusts. GP’s however are their own entity being self employed, and as they are not employed by the NHS they are not covered by the Clinical Negligence Scheme for Trusts. The rising cost of medical indemnity is also affecting hospital doctors who require additional medical indemnity cover to do specific procedures for the NHS and private work.

Medical defence bodies are non-profit organisations that provide 24hr support and medico-legal advice. Medical Defence Union (MDU), Medical Protection Society (MPS) and Medical and Dental Defence Union of Scotland (MDDUS) are all examples. They are mutual organisations, which means they are owned by their members.  The annual fees are based on amount and type of work of the member. There are some private schemes which would also provide cover.

July 2014: Health Care and Associated Professions (Indemnity Arrangements) Order 2014: all healthcare professionals are legally required to have adequate and appropriate insurance and indemnity to cover their practice in the UK.

The GMC states:

“Under the law, a doctor must have cover against liabilities that may be incurred in practising medicine having regard to the nature and extent of the risks. The type and level of insurance or indemnity a doctor requires depends on factors including where a doctor works, whether they are employed (and, if so by whom and for what services) or self-employed, and the nature of work they do.”

Damages awards are based upon the cost it would take for the patient to be in the position they were before the incident: these costs are based on private and not NHS costs.

N.B. Due to increasing demands on services more healthcare professionals work in practices, without necessarily being directly employed by them. There are concerns of the vicarious liability to the practice in these situations.

Why is the cost rising?

There is an increasing number and cost to cases being brought against GPs. This can make some work considerably more expensive and therefore not feasible. This includes out-of-hours work. This is particularly problematic as GP services are increasingly strained and under pressure to provide more out-of-hours services. ‘Some’ out-of-hours is covered with basic costs, but there is a sharp increase in cost by working more than one or two out-of-hours sessions a week. GPs are reportedly turning down more and more of this work because the indemnity costs are so prohibitive that it’s not worth their while. The costs have increased significantly due to an increase in claims against GPs working out of hours. Many practices report that they simply cannot afford to take on this work, due to indemnity costs. If you work across multiple sites, do forensic work, undertake private GP sessions, travel clinics or walk-in centre, or employ occupational health therapists, pharmacists and some other professionals your cost of indemnity increases. Any work in cosmetic surgery or sports medicine also incurs higher costs.

What is being done about it?

In GP Forward view £30 million was pledged between 2016/17 and 2017/18. There was also a GP winter indemnity scheme provided an extra £10 million (£5 million more than the previous year). In October 2017, the Health Secretary Jeremy Hunt announced a state-backed indemnity scheme to try and help resolve this problem. We are still waiting on further details about what this will entail…