State-backed indemnity – 
what it means for sessional GPs

There's still some uncertainty about the new state-backed indemnity scheme for England and Wales, and Rachel Birch from the MPS has the answers.

What is state-backed indemnity?

The state-backed scheme will provide GPs with indemnity for clinical negligence claims, arising from work undertaken under NHS-contracted primary medical services. This will be a similar arrangement to the claims indemnity that is provided to NHS hospital doctors.

The scheme will come into force in England and Wales on 1 April 2019; if you're a GP locum in Wales, you must register on the All Wales Locum Register in order to benefit from the state-backed indemnity scheme.

The health departments in Scotland and Northern Ireland have not yet announced whether they will introduce similar arrangements as those proposed for England and Wales.

What will the scheme cover?

The BMA has advised that partners, salaried, locum and out-of-hours GPs will be covered by the scheme for NHS-commissioned work. All members of the practice team, including those supervised by GPs (eg: nurse practitioners, paramedics) will be covered by the scheme.

The state-backed indemnity scheme won’t protect sessional GPs in these situations. It is for this reason that salaried and locum GPs will need protection above and beyond the state-backed indemnity scheme.

This week the General Practitioners Committee (GPC) published the GP contract agreement for 2019/2020, providing further information on the scheme. The scheme will be run by NHS Resolution, and will cover clinical negligence for all GPs and staff working in NHS GP providers, both in and out of hours, for NHS work.

What won’t the scheme cover?

Salaried and locum GPs will still need to ensure they have adequate indemnity arrangements for claims arising from any non-NHS services they help provide. Examples may include providing travel vaccinations, writing medical reports, doing insurance work, undertaking private medical examinations or doing medicolegal work.
A state-backed indemnity scheme won’t provide support for matters such as complaints, General Medical Council investigations, Coroner’s inquests, disciplinary matters, criminal or any other legal proceedings that GPs may be subject to.

Why sessional GPs still need their medical defence organisation.

It is an unfortunate fact of the modern medical working life that professional risks are real. It is said that a full-time GP may nowadays expect to receive two clinical negligence claims over a typical career.

Medical Protection figures show that they can also expect to receive nine complaints or professional challenges during that same time period. In fact, from October 2017 to September 2018, Medical Protection helped a third of all their UK-based GP members with over 6,000 such cases.

Facing an investigation or complaint can be a distressing experience professionally, emotionally and financially. Criminal investigations are incredibly daunting and could even put your liberty at risk. A Coroner’s inquest into your practice after the death of a patient could mean you need to produce evidence in court to justify your actions; opening you up to a searching cross-examination or criticism. Facing a GMC investigation could end your career, while a patient complaint to the ombudsman could quickly escalate into something more serious.

The state-backed indemnity scheme won’t protect sessional GPs in these situations. It is for this reason that salaried and locum GPs will need protection above and beyond the state-backed indemnity scheme.

Sessional GPs should maintain their membership with their medical defence organisation (MDO), so that they can continue to request support for such situations. Many sessional GPs may also need a small amount of claims protection (for their non NHS-work).

What can sessional GPs expect from their medical defence organisation?

The support of their MDO is vital in many situations such as those above, where a GP’s ability to continue working and making a living may be affected.

It’s a common misconception that bad things happen to bad people and if you’re a good GP everyone else will see it that way. Unfortunately that’s not always the case, and even when no medical mistake has been made, a complaint or allegation could still be made - driven by a misconstrued interaction, poor communication or an emotional volatile situation.

Complaints and claims are rarely expected, and often come out of the blue. Many can be easily rectified with the right advice and support, and although few escalate in ways that can threaten a doctor’s professional livelihood or even their liberty.

GPs deal with such a diverse range of patients and ailments that they cannot expect to make the right diagnosis every time. Even if you are sure you’ve done nothing wrong, once a complaint is made or a GMC investigation starts, there is always a sense that the doctor needs to prove their innocence, and that’s hard to do alone.

Receiving a complaint to the GMC is always stressful, and if the case proceeds to a Fitness to Practice Hearing it will also be very costly and require specialist representation.

The MDO is there to protect its GP members financially and emotionally, while providing them with the best expert and legal representation. GPs without legal representation fair particularly badly. The vast majority of GPs (84%) erased from the register as a result of a Medical Tribunal hearing had no legal representation, whereas nearly all GPs (91%) who do not receive a sanction had legal representation.

Having an expert at the end of the phone to help with practical and ethical dilemmas can make all the difference when GPs find themselves in a vulnerable or distressing situation; having someone there to support them can provide huge reassurance.

In certain situations, the MDO’s press office can provide invaluable media advice. In addition, there is always the range of education, workshops, journals and risk management tools available.

What should sessional GPs do now?

It is important that sessional GPs ensure that they will still have appropriate cover after 1 April 2019. The cost of this will be significantly less than current subscriptions.

First published in The Sessional GP magazine February 10th 2019

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