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Independents' Day

Almost half of GPs turn down out-of-hours work due to medical protection fees

Almost half of GPs have turned down out-of-hours work as a result of medical indemnity cover, a new report has revealed.

In a report funded by CareUK, both private and not-for-profit GP providers of out-of-hours care have called for medical indemnity providers to charge more reasonable premiums after a survey of 1,000 GPs revealed that 46% of GPs had been put off out-of-hours work as a result of high costs of medical protection fees.

The report - Urgent and important: the future of urgent care in a 24/7 NHS - also revealed that 59% of GPs felt that out-of-hours services were not a high enough priority for the NHS.

The authors say out-of-hours GP services have ended up being marginalised over the past decade, through NHS reorganisations and GP contract changes, leading to a ‘chronic shortage’ of staff.

It also calls for an end to perverse incentives in contracting and tariffs that the authors say currently inhibit working between GPs and A&E emergency services.

The findings come after complaints from GPs about big hikes in medical indemnity fees to cover urgent care provision, which led the BMA to lobby medical defence organisations to offer discounts to GPs working out of hours.

A groundbreaking risk-sharing scheme set up to tackle the problem in Wales led to an increase in GPs willing to take on out-of-hours work, but the arrangement has yet to be adopted elsewhere.

The report states: ‘The commission expressed concern that indemnity providers are focused on mitigating against the risk of a single, rare case that will have significant financial consequences. The result is soaring costs of indemnity in out of hours, which has led to many healthcare professionals stepping back as the work offers low financial incentive.’

It recommends: ‘Medical indemnity providers should take into account the quality and performance record of the provider when looking to associate levels of risk for the provider workforce.’

The report was produced by a commission led by the former Department of Health national clinical director for primary care Professor David Colin-Thome, and including Dr Agnelo Fernandez, the RCGP’s lead on urgent and emergency care, Dr Simon Abrams, chair of Urgent Care UK, and Dr Fay Wilson, former GPC member and chief executive of the BADGER out-of-hours consortium.

Dr Rob Hendry, medical director at the Medical Protection Society (MPS), said: ‘In MPS’s experience the nature of the case mix presented in out-of-hours is more likely to give rise to higher cost claims. As a not-for-profit organisation, we must ensure that we collect sufficient subscriptions to be in a position to meet the future costs of defending claims against members.

‘Because the provision of out-of-hours services is crucial, MPS believes that Government should undertake a full review to consider what barriers stand in the way of uptake of out-of-hours’ work by GPs and what policy proposals might tackle these issues.’


Readers' comments (12)

  • The way forward is that NHS England offer full indemnity cover for OOH work as an incentive for GPs as the charges are so high that it simply is too punitive to work.

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  • crown indemnity for all otherwise watch this and other service become purely non doctor services. Much as we care for patients, we are not going to pay out of our pocket to care them.

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  • No, I turn down OOH work because it sucks.

    Extra evening or weekend work when I've already done 9 exhausting sessions in the week as well as rota'd Saturday surgeries, terrible pay and a cattle market mentality seeing hundreds of dirty snivelly babies from other practices.

    Also, getting car sick being driven around nasty drug infested council estates and stray dogs in bad weather.

    Any more reasons not to do OOH work?

    I wonder whether some of my OOH loving colleagues just like driving around in a car that says 'Doctor' on it!

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  • ......Abstraction, what are they talking about ! How can I do OOH work if I use the Saturdays and Sundays to catch up with work having down 12 hours daily form Monday to Friday :)

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  • i stopped for exactly this reason - was doing 4 OOH shifts a month - but MSU wanted an extra £3500 annually for the privalege of me working harder
    ....Chasing my tail - so I stopped.
    Would start again tomorrow though - IF I was idemnified. Don't understand why crown indemnity can't apply here, or perhaps a collective national scheme - Would solve recruitment problems overnight.

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  • Indemnity, 12+ hours in own practice, weekend work in own practice, tax disincentives, increased medical risk and hassle, visiting crap nursing homes on long bank holidays...
    What's not to like?

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  • I turned down OOh for follwing reasons:
    1.lack of compassion by providers
    2. 111 totally ineffective- gps still end up haveing a large volume to triage
    3. GPs asked to triage-visit-do F2F assesments
    4.denial culture- from providers that staffing levels are adequate
    5. its is not all OOH issues- local GPs are not fulfilling their GMS obligations- we see pts telling us that the practice cannot offer to see them and told if no better to attend 111, which always means pt is seen in OOH.
    6. yes - ooh is high risk and hnce to attract experience GPs- teher needs to be crown indemnity or providers must provide this.
    Wel I am leaving to greener pastures- good luck to those staying!!!

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  • My indemnity increases by £3000 to do OOH. On top of that my employer failed to mention a complaint had taken to solicitors. 3 months later I was sent the paperwork! (all dopped now). This is why I stopped OOH, actually quiet enjoyed the job itself

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  • It's simply too risky to see patients who aren't known to you any more. I've heard some really nasty stories about complaints that arose from OOH work. The risk of litigation is simply terrifying.

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  • In response to colleague 10.58.
    I absolutely agree that it is not only OOH.We see far more in hours GMS work not done ny local GPs. Patients are simply told call 111. I see patients coming at midnight asking for referals to secondary care because their gp does not want to increase his ref rate, we see 3rd trimaster pregnant women with PV bleeding ( why can they not go to preg assesment unit), we see very sick children who the gp should have refered to paeds early on.
    Yes, I agree it is a high risk work, but poor primary care services is the reason for making OOH unmanagable.
    I have to mentioned care homes, end of life care, palliative care.

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