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One in four out-of-hours GPs stop doing shifts due to indemnity costs

Exclusive Around 25% of out-of-hours GPs quit providing urgent care sessions because of rising indemnity fees, a new survey has revealed.

The survey of 395 out-of-hours GPs, carried out by a GP Survival member, found that 100 have stopped providing out-of-hour sessions completely while a further 20% said they dropped one to two sessions a month.

It also found that 18% of partners had dropped one to two in-hours session a month due to indemnity costs.

The survey follows a number of concerns around indemnity for out-of-hours GPs, which culminated in NHS England implementing a short-term scheme over winter to pay for their indemnity costs which has since been discontinued.

The GPC has said that this survey provides more evidence that the NHS must do more to find solutions for rising indemnity costs.

The survey was shared by Blackburn GP Dr Preeti Shukla with other GPs in Blackburn, Oldham and Bournemouth in March via email, online forums and social media.

In a letter for Pulse last month, Dr Shukla spoke about how increased indemnity fees forced her to quit out of hours work last August, as it was no longer financially viable for her to continue.

Dr Shukla said about the survey: ‘Everywhere you read, we’re being told there is a workforce crisis. But we’re not utilising the workforce that is actually ready to work but can’t.’

The problem with out-of-hour indemnity fees

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In January, Pulse revealed that indemnity fees were ‘spiralling out of control’, rising by an average of 25.5% in 2015, according to an analysis of responses from over 900 UK GPs.

This was particularly acute for out-of-hours doctors, with one GP claiming that they had experienced a £30,000 increase in their costs this year.

As a result, NHS England implemented a £2m temporary scheme in which GPs signing up for extra out-of-hours shifts this winter were be able to have their medical indemnity costs covered.

Pulse revealed that 550 GPs made use of the scheme, totalling 14,264 extra shifts. However, the scheme was discontinued as planned in March.

 Responding to Dr Shukla’s survey, the Medical Defence Union (MDU) said: ‘We recognise the effect that large claims are having on the affordability of indemnity in certain areas. However, we have no choice but to set subscriptions at a level that is sufficient to fund future claims and legal costs that we expect to arise from the year in question.’

The Medical Protection Society (MPS) said that it recognises the concerns over the cost of professional protection, adding that this is a ‘challenging time’.

NHS England implemented a temporary £2 million scheme from December 2015 to March 2016, which resulted in 500 GPs taking on 15,000 extra out-of-hours shifts this winter.

Dr Charlotte Jones, the GPC’s lead on urgent care said: ‘We continue to urge NHS England to put in place solutions for rising indemnity costs and have given them solutions to consider.’

Survey results in full

How many out of hours sessions have you dropped in a month due to a rise in indemnity?

Stopped doing out of hours work: 100 (25%)

Didn’t drop any sessions: 151 (38%)

Dropped 1-2 sessions: 77 (19%)

Dropped 2-4 sessions: 37 (9%)

Dropped more than 4 sessions: 12 (3%)

Other: 18 (5%)

Total answers: 395

 

How many in-hours locum sessions have you dropped in a month due to a rise in indemnity?

Stopped doing locum sessions: 42 (10%)

Didn’t drop any sessions: 213 (52%)

Dropped 1-2 sessions: 89 (22%)

Dropped 2-4 sessions: 40 (10%)

Dropped more than 4 sessions: 18 (4%)

Other: 4 (1%)

Total answers: 406

 

If salaried, how many sessions have you dropped in a month due to a rise in indemnity?

Stopped work: 4 (2%)

Didn’t drop any sessions: 167 (75%)

Dropped 1-2 sessions: 25 (11%)

Dropped 2-4 sessions: 11 (5%)

Dropped more than 4 sessions: 7 (3%)

Other: 8 (4%)

Total answers: 222

 

If you are a partner, how many sessions have you dropped in a month due to a rise in indemnity?

Stopped working/retired: 2 (less than 1%)

Didn’t drop any sessions: 238 (69%)

Dropped 1-2 sessions: 63 (18%)

Dropped 2-4 sessions: 13 (4%)

Dropped more than 4 sessions: 13 (4%)

Other: 14 (4%)

Total answers: 343

 

The survey was launched in March 2016 by Dr Preeti Shukla collating responses using the SurveyMonkey tool. The survey was shared with GPs in Blackburn, Oldham and Bournemouth via email, on online forums and social media.

 

 

 

 

Readers' comments (13)

  • OOH work at the moment is stupidly high risk.

    Why anyone does it at current rates is beyond me - taking on that risk for a corporate provider.

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  • You do have to slightly mad now to do ooh work. Rising indemnity, complaints and litigation, risk of burnout with the day job. I would rather have untrained people stick needles in my eye than do ooh.

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  • I love doing out of hours work but indemnity is a bit pricey . Sorry this is written in crayon but i'm not allowed sharp objects in here.

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  • OOH work = a game of chicken with the GMC.

    Minimal short term gain for maximum jeopardy. Wouldn't even consider it for less than £500 per hour.

    It wasn't always like this. What a mess. 14 months and I'm done at 50. I'm opening a seaside art gallery. There's more to life than this.

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  • Whichever company provides OOH care should have a corporate cover for all their healthcare workers.

    However ideally crown indemnity should cover all OOH - and a change to the NHS charter - to stop all idemnity claims from ambulance chasing lawyers.

    Have a panel of trained independent healthcare staff look at claims and throw out the ones where there is no real harm, and pay a reasonable compensation for those with long term harm/care needs, and all cheaper as no lawyers fees.

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  • Increasing defence Union fees made me reducing OOH shifts to 1-2 per month.

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  • The shame of it is, GP OOHs care must be so much more cost-efficient than A+E care where the junior doctors will investigate and refer at great expense. NHS has to pick up the indeminity tab, or GPs aren't going to do it.

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  • Will the profession survive litigation ?

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  • "The GPC has said that this survey provides more evidence that the NHS must do more to find solutions for rising indemnity costs".
    No organisation is better at missing the point, and getting the wrong end of the stick
    Of course Medical Indemnity is an extremely opaque subject, rather like the secrecy surrounding the setting of bonuses, by an endowment company
    It is not clear whether the rising costs reflect rising numbers of claims, the severity of the medical harm suffered, or a rise in compensation awarded.
    Many years ago the BMA was known to blacklist health authorities who employed medical staff on inappropriate contracts
    If out of hours providers are providing services which the mdu can show are clinically unsafe the gpc should be doing more than asking other people to find solutions

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  • Locums charge £90-100 per our in my surgery but I work at weekend in OOH at £70 per hour and paying extra to defence union but I am still doing OOH!
    Not sure how long my love for NHS and pateints wil last?

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