Stopping nurse indemnity will cost GPs and practice staff, but may also end up hurting the RCN, says Dr Ben Wyatt.
The surprise announcement by the Royal College of Nursing that its indemnity cover for nurses working in general practice will stop from January 2012 has caused some ripples.
I understand from the RCN website that its indemnity cover is underwritten by an insurance company, so I can only assume that this decision was made on the grounds of commercial risk. However, this arbitrary move may cause nurses more problems than it might appear to solve.
The two main medical defence organisations offer indemnity arrangements for GPs with additional benefits for membership on a group basis. These benefits can include ‘free' cover for other health professionals – including practice nurses – but nurse prescribers and practitioners, working more independently, may not be covered on the same terms. Of course, ultimately there is no such thing as free cover, so GPs will end up paying for this facility in some form.
Such arrangements seem to have worked reasonably well so far, but this development may cause all parties involved to question the nature of their current arrangements.
Practice nurses not currently included in their GP employer's indemnity arrangements may press their practices to pay for their indemnity cover. This may be attractive to the medical defence bodies, as it might push group membership up the agenda and this brings economies of scale to both them and GPs.
But it may be unfortunate for smaller practices on those economies of scale. For those practices that do not make their cover a joint arrangement, they may have to answer the call to fund indemnity cover
for their employed nurses individually. At a time of falling net income, and despite an uplift of a massive 0.5% in overall funding, this negotiation might be less than mutually amicable.
Walking away
In any event, practice nurses might wish to carefully consider some wider implications of this change. If the GP employer is funding their cover, and the nurse has none of his or her own, can this always work?
Cover provided in this way would only cover work in the practice, and only within protocol. Any work outside the practice – for instance, locum work at another practice, Good Samaritan acts and so on – would not be included. Any deviation from protocol, for whatever reason, might not protected.
More importantly, in the unfortunate event of complaint or litigation, disciplinary proceeding (within the practice, or outside, for instance a hearing before the Nursing and Midwifery Council) or dispute, the interests of the practice and its medical defence body might not be the same as the individual nurses.
This is analogous to hospital doctors who are indemnified by their acute trust as employer. Hospital doctors are wise to still pay for their own indemnity in addition for just such situations. Having no personally funded indemnity or access to medicolegal advice leaves a practitioner potentially exposed.
So although practice nurses and nurse practitioners may enter negotiations with their employers about the funding of their cover, they might think twice about relinquishing the ownership completely and may wish to purchase their own cover separately. The RCN will lose the business to other providers, which seems a pity.
In fact, practice nurses may reconsider why they retain RCN membership at all, as although membership brings other benefits, I believe that many practice nurses will feel let down by their professional body and walk away from it.
I believe that the RCN may be about to inflict a pedal injury of its own making.
Dr Ben Wyatt is a GP in Sowerby Bridge, West Yorkshire
