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GPs buried under trusts' workload dump

GP’s indemnity fees doubled to over £1k after state-backed scheme launch

A GP has seen his indemnity premiums rise by almost £600 per month after it emerged his prison work may not be covered under the state-backed indemnity scheme.

The new NHS indemnity scheme for GPs in England, introduced from 1 April, covers claims for NHS work and means GPs no longer have to pay fees to a medical defence organisation for this area of activity.

GPs are expected to continue membership with their MDO for any other claims, including those related to private employment.

But despite expecting his MDO fees to reduce significantly - to £67 - because he was no longer paying for NHS cover, prison GP Dr Gerry Bulger instead saw his premiums for indemnity cover double, to more than £1,200 per month.

This was after he was forced to declare all his income from work in prisons as private to secure indemnity cover, because his MDO, the Medical Protection Society, could not confirm to him which exact prisons are left out of the state-backed scheme.

NHS Resolution, which runs the new scheme, and the BMA - which negotiated the indemnity deal - confirmed GPs providing NHS services under GMS, PMS and APMS contracts in prison in England are included, but those working under other contracts 'may not necessarily be covered'.

The BMA said it was down to 'individual GPs' to 'ensure they have appropriate cover in place', but Dr Bulger said doctors have no way of telling which contracts prisons operate within - and similarly, the prisons he works for 'have no idea either'.

Dr Bulger told Pulse: 'Some GPs providing primary care services for NHS patients may not be covered after all by the new NHS indemnity scheme for GPs and not know it. They will have to fund their indemnity as “private” with their defence union, which is an expensive option.

'If all my income from prisons had now to be called private, it rises to £1,253.14 a month. But [for] which prisons do I need to pay this premium?'

Before the Clinical Negligence Scheme for General Practice (CNSGP) came in on 1 April, Dr Bulger was paying around £650 per month to MPS for his prison work.

His fees then fell to £67 a month because he assumed he only had to pay the minimum cover for private work. However, Dr Bulger's quoted premium then went on to almost double from the original price when he realised his prison work was at risk of not being included in the NHS package.

Dr Bulger added: 'Doctors have no idea as to what internal NHS contract wording is so we have no idea if we are covered. The prisons I work for have no idea either.'

He argued people in prisons were receiving NHS services and that GPs providing that care should see all of that work included in the indemnity scheme.

He said: 'These are all NHS patients in prisons getting NHS funded one way or another, getting primary care from GPs using the same NHS clinical system. It is a scandal, and no logic whatsoever, that some prisons are covered and others are not, depending on the contractual arrangements within the NHS.'

A BMA spokesperson confirmed: ‘GPs providing NHS services under GMS/PMS/APMS contracts in prison in England will be covered by the state indemnity scheme; those working under other contracts may not necessarily be covered.

'Individual GPs need to ensure they have appropriate cover in place. Some GPs may need to continue to purchase their own cover. The BMA has been clear in our advice on this from the outset.’

According to NHS Resolution guidance, which highlights activities covered by the CNSGP, GP work in secure environments that are 'delivered under the GMS, PMS or APMS contract or subcontract are covered'.

An NHS Resolution spokesperson added: ‘GPs providing their services in a secure environment where NHS England does not commission primary medical services under a primary care contract, as defined above, will not be covered under CNSGP for any clinical negligence liability that arises after 1 April 2019. In this case, they will need to obtain cover from an MDO or other indemnity providers.’

MPS medical director Dr Rob Hendry said: 'Medical Protection Society urges members to contact the member services team directly so that we can better understand their past and current subscription needs. 

'If the member has paid for claims protection for prison work but they have since found out that their prison contract is covered under CNSGP, then Medical Protection Society can adjust their membership accordingly and we would provide them with a refund.

'Prisons are a complex environment to practise medicine in and it is well recognised that prisoners are a vulnerable patient group. Not only do they suffer from higher rates of mental and physical health problems compared with the general population, but the nature of their detained status presents a unique range of challenges. It is important that doctors working in prisons ensure they are adequately indemnified.'

NHS England has been approached for comment.

This comes as recent guidance stated GPs who have clinical negligence claims made against them could see their information passed on to the GMC or NHS England, which was not required before the state-backed scheme came in.

Previously in March, it was revealed that GP indemnity claims would be under the 'discretion' of NHS Resolution on behalf of the health secretary.

Readers' comments (11)

  • You're also not covered for criminal charges under state indemnity so any potential Dr Bag's out there (which is everyone). Get private indemnity cover!!

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  • *Dr BG's

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  • My MPS fees may no make sense to full time GPs. I am part-time in London prisons, and my other NHS GP work is in Scotland as two week locums, where MPS fees are cheap anyway and now comes with a separate certificate and premium.

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  • Are there any out of hours services that do not have "Schedule L" in effect APMS contracts? They too would not be covered

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  • I asked NHS Resolutions what would happen if I made a claim working at any prison, or needed help, next week. The first thing NHS Resolutions will do is look at the trail of contracts to see if Schedule 2L of the NHS Standard Contract is there (in effect APMS). If not mentioned I would not be covered, so back to MPS, having paid the double premium for “private” work cover.

    GPs do not know the wording of contracts up the chain, so we remain at risk.

    The main contract will not necessary APMS/PMS at all. But depends if somewhere in the documentation there is a Schedule 2L of the NHS Standard Contract (each a “Primary Care Contract” in effect APMS) added on to the contract. That is all that is needed.

    NHS Trusts pay a premium each year for their CNST scheme, and the premium depends on their risk and claims rate. NHS Trusts could, if they wanted, include GPs, but you can see why they would rather not. The CNSGP scheme has NHS England pay a global premium. There is no group membership or risk premiums to pay. So it may be all that is needed if for all prison providers to look at their contracts, and add if not there, Schedule 2L of the NHS Standard Contract and we are covered after all!

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  • does he write NHS prescriptions in the prison? or private ones?

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  • GP in English write NHS prescriptions on System 1. They are NHS funded and is in similar manner to hospital scripting as issuing medications to the patient is recorded on the system. They are not FP10s. For a decade + there have been plans to make clinics in prison standard GP practices, but so far has proved too complex (as many extra services) to set up

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  • Why dont all the prison GPs either ask their employer to a) confirm the contract status at the prison so they dont need to pay b) pay the extra costs to the dr or c) find other work for a few months and let the managers sort it out.

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  • and yet still in Northern Ireland, we are paying full price Indemnity. No government, no state indemnity and soon....no doctors.

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  • Same issue for GPSI work, MDU and nhs resolutions had no idea

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