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GPs facing escalating indemnity costs for seven-day working, claims GPC

Exclusive GPs are being billed inflated indemnity costs to extend their cover for seven-day working as they are based on out-of-hours premiums, the GPC has claimed.

The GPC said some GPs are being charged higher fees for covering the extra sessions because medical defence organisations were basing the costs on risk algorithms developed for urgent out-of-hours work – even though the work involved delivering predominantly routine, non-emergency care.

Medical defence organisations insisted they did not necessarily class the extra sessions as out-of-hours work, but consider fees on a case-by-case basis.

It comes as the GPC is beginning work on looking at indemnity fees and how they can be reduced for GPs. Pulse has previously reported that out-of-hours GPs have been quoted premiums of up to £30,000.

But the GPC has said that the medical defence organisations are lumping routine weekend working in with out-of-hours care when calculating risks in many instances.

Dr Dean Marshall, a lead negotiator for the GPC on contracts and regulation, told Pulse: ‘Because people are now say, doing Saturday morning surgeries in a network, the defence bodies don’t have any historical risk data so what they do is basically say that’s the same as out-of-hours. And it’s not – often you will be sitting seeing booked patients.’

The GPC is in talks with the defence bodies to try to resolve the issue, Dr Marshall said, but he warned GPs to be ‘absolutely clear’ in the meantime what the work they are doing involves before getting cover.

He said: ‘What we’ve been saying to the medical defence organisations is they need to look at the way they assess risk. We’re not criticising them, but we they need to be absolutely sure that their assessment of the risk is based on an understanding of what the GPs are actually doing.’

The extra costs for extended hours add to the growing crisis in securing indemnity cover, which has led to GP leaders warning that some out-of-hours services could be left completely unmanned and this year’s LMCs conference voting to consider a move to crown indemnity.

The GPC is planning a symposium in mid-September, bringing together the medical defence bodies, NHS England and the NHS Litigation Authority, in an attempt to resolve some of the problems.

However, Dr Marshall warned the latest issues could ultimately make the Government’s plans for extending working hours unviable.   

Dr Marshall said: ‘There is a fair amount of money being thrown at it just now, but once that money is stopped people will realise it may not be viable because of the additional costs.’

Medical defence bodies insisted that they did not uniformly apply ‘out-of-hours rates’ to extended hours work and considered each GPs’ case individually.

Dr Iain Barclay, head of medical risk and underwriting at the Medical Protection Society, said: ‘Membership subscriptions are set fairly to reflect the level of risk experienced by each area of practice. The subscription rate for GPs are each considered on their own merit and MPS does not apply “out-of-hours” rates to all GPs working “extended hours”.’

A spokesperson for the MDDUS said: ‘We are pleased to reassure our members that work undertaken in “extended hours”, where a GP is providing predominantly non-emergency care and has access to full patient records, will be treated the same as sessions undertaken within the normal working week for MDDUS subscription purposes.’

The spokesperson added: ‘We would assess the risk on a case-by-case basis and provide an individual subscription for the GP concerned.’

The Medical Defence Union issued the following statement: ‘We tailor our subscriptions to our individual member’s needs. If members have any queries about their subscriptions we would encourage them to contact us.’

Readers' comments (24)

  • Fascinating reasoning behind all this. One of the main reasons behind the setting of fees for Out of Hours work has been the inherent risk of not knowing the patient and not having full access to the records. Many of the 7 day week pilots are shared ones based on sharing of records and I guessing from this , the indemnifiers will not be putting OOH rates onto those doctors even though they may not be from the same practice. How is it then in areas where there is full sharing of records indemnifiers are classing that as out of hours work despite the 'inherent risk' being diminished through full access to patient records?

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  • The problem is that GPs are now doing so many different types of work outside of standard day time hours that the boundaries between them are becoming increasingly blurred and of course we change roles frequently. This is really risky for GPs because if you get the details wrong, you could potentially find yourself without cover. The MDO system lacks transparency and looks dodgier by the minute. There is only one solution to this and that is for the government to provide crown indemnity for all GPs.

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  • the fact you can't even be on the performers list without extra indemnity cover now means that its essential and should be provided by the NHS/Crown.

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  • The traditional MDO's are exploiting the fact that you can't be on the Performers list without Indemnity. They are declining indemnity for GPs who had GMC issues, even after being cleared. The GMC may allow a GP back to practice but some of the MDOs never forgive. Indeed they are proving more ruthless than the regulators. The BMA has been aware of this for more than 3 years and nothing has been done.
    Very soon, it is the MDOs that will have a final say on a GP practicing or not and not the GMC. The GMC does forgive and allow GPs a second chance, some MDOs never forgive. We have read several such reports in the Pulse. What is the GPC doing about that?

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  • soon it will be impossible for some GP's to work if they are paying over 40% tax, 30% pension, and 20% of their income in indemnity fees. The take home income will be not worth the risks involved with the job. This might be the final nail in the coffin for ooh care anyway. Bring on the noctors and physicians assistants to take this on their shoulders without doctor cover. good luck.

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  • These are huge firms operating out of fancy offices. Make no mistake, clinical negligence is a large and exploitative industry which is using the MDO system as a front to pump money into its coffers. This needs investigating by the National Crime Agency.

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  • BMA should consider setting up indemnity services. It's not just ooh. Even the current fee for GPs doing normal 8-9 sessions/week is unjustifiable.

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  • http://companycheck.co.uk/company/00036142

    https://s3-eu-west-1.amazonaws.com/document-api-images-prod/docs/FJPk8i_ZgsOsF9DL7AwcPqBTIzNnnbez8KihcaWWcxU/application-pdf?AWSAccessKeyId=ASIAI675GHSVZWKZRNAA&Expires=1438857950&Signature=8HSuOYf5Csv3AZSF%2B56EtPKEMgQ%3D&x-amz-security-token=AQoDYXdzECsa0AM3piCm00j7c6%2FPDcW6hvnm9LpSqNaV9JDm1Of5hmZ5fEb72ccOBZpt7MGjLFRvq1TlnnFvg8LiiB%2FrvWLmqBb9AAvyJop4I5RDQQ9XFUtnxs2D4YwaMEhzS%2FkGbYP0mEbebTMR9qvWv5znWaoXm%2Fj%2F8%2Fsx7NA1RCqRdaBxmKlb0Epf3SyCKU5KCk1%2Bc0nsy36PBcRxpkYJMxcjyr0Q6Y7yb59ztqulkrrI5R0RNWQJyfUtUqhDTarzdNmJO0J9PvqEXSlY%2FwuHK6upU2H3Gw59tNlfgEyxXFf0aVSEftx8XEgYSffgWIuQ7ShplPQQufbLUny%2B2YGo7%2FvGYejKpL4VSKZ6OvkZjtDOH7lzzfk5g0w%2Fgb01dMIOfMHyEcnt6bsonqkJnCnabebLTOMZQbYGDFH69XrToKKK6z%2FMmc5PDJMbhZi%2FoXe0Ngjrxbqiy32wS%2B92%2FzAzUosfGL%2Fh5XUFi7y3MP%2FS2HwH%2B7teFiqH2Og3BqZvNomJx3keOwWlvAjDS5LCSsyizMHUtMvZZHHhnC%2BaWoGXfLfiURaRfVE0kULiolBOes7wGbleH6K2A9qVIgp2ov8xtjC%2BlmKNFzpIOWO5M2M5WP6uW87LKjJ3PyDr04yuBQ%3D%3D

    - anonmyous salaried!!

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  • This does not solely apply to GPs. A Nurse Practitioner has just had her renewal information for normal weekday working hours, and the amount has risen from just under £700 to just under £7000!

    Obviously we are challenging this, but have had to begin a payment plan to enable the NP to continue to work in the Practice. Having five NPs in the Practice, this has huge cost implications and despite being a group scheme, there has been no discussion/information shared with the Practice. The MD organisation will only speak to the member.

    All practices be aware - a very concerned Practice Manager

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  • The only person gaining in this NHS wipe out of of our GP population is lawyers.The patients according to Prof Brian Jarman and Michael Hands in BMJ2012;345:e2839 and BMJ2013;346f209 only suffer.The medical directors and other managers should be taken to task for hurting patient care.The GPs should be supported by the Government against NHS excesses.Most lawyers after their persecution cannot afford the lawyers or the journey and stay at HQ of GMC Manchester.
    I

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  • Anon salaried - wish I could get into this ?!

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  • The government indirectly get tax from the law firms so all is plain. The same NHS patient requiring us to fork indemnity while at the AE door its hunky dorey.

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  • You're attacking the wrong people. MDO's use actuaries to give an real assessment of risk.

    What we pay is probably fair value.
    The mistake is that we undercharge for our expertise, and crown indemnity is so protective.

    If this trend of NP's and PA's needing high cost indemnity continues it will destroy any benefit to have them.

    Again this is where the market speaks clearly, the correct response is not to be frightened by it but respond appropriately.

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  • This article is not strictly true as MDDUS treats 7 day working with notes as ordinary sessions not OOH

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  • W are Independent Contractors, so it is upto GPC to negotiate a fair rate. If they cannot, they should ballot for resignation from the NHS. Otherwise, there will be no gPs of any sort left.

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  • HMS NHS the modern Titanic is sunk,
    Due to its swollen heavily paid bureaucrats,
    Whose only work was to at GPs work to sulk
    Refer them to GMCMPTS who unquestioningly of NHS Claims,
    Tortured the GPs with disdain.
    Caused them to immigrate or resign.
    When GP Manpower was depleted The NHS sighed and cried,
    Call in half trained GPs them to replenish.
    The Lawyers all took their incomes with relish.
    The poor GP was treated in a way devilish.
    BMA and Defence bodies their roles relinquished.
    What boots it with incessant care to tend the homely slighted trade(GP),
    And Strictly meditate the thankless muse (GMC,NHS).
    Were it not better as others use,
    To sport with amaryllis in The shade or with the tangles of Naera’s hair.
    Fame is the spur that the noble spirit (Dedication to peoples health)doth crave,
    That Last Infirmity of the Noble Mind,
    Too scorn Delight and live laborious days

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  • this will be the final nail on the head - why?

    1. if my recollection is correct many leaders including Prof Keogh want to dispense with extra weekend and OOH supplements for weekend or OOH work i.e. treat it as a normal working day 9 to 5. This will result in a pay cut for many NHS staff. In addition they will want all of us to do a rota to cover unsociable hours. The logic is that previously unsociable hours will be viewed as normal hours.

    2. the reduction in pay will be crippling to many who work in London and through in cessation of supplements to trainee GP's will mean that being a GP will be unaffordable to trainees,

    3. locum agencies etc already view pay rates for weekend in hours work as the same rate throughput the week but hours after a certain time are paid as OOH at about £100 an hour. I've seen no rise in my rates for 5 years.

    4. Defence unions view weekend work and OOH as high risk and charge a lot for it, Although I can do OOH work it wasn't cost effective due to the defense rates. That's a locum - if I was a partner I would be stuffed.

    This could be the final nail in the coffin as ;

    income falling
    pension contributions up (15%)
    defense fees for OOH (15%)

    was you add it up - GP pay will be less than a tradesman take home pay. so youngsters are better off being a plumber, builder, electrician, beautician etc ....

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  • My Plumber Rates

    Charges are per hour with a one hour minimum charge and thereafter in 30 minute units. Some work can be carried out on Estimate.

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    Plumbing

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    8am – 5.30pm
    5.30pm – 12am – £95.00
    Saturday
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    8am – 5.30pm
    5.30pm – 12am – £115.00
    Sunday
    £120.00
    8am – 5.30pm
    5.30pm – 12am – £150.00

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  • Drainage

    Monday – Friday
    £95.00
    8am – 5.30pm
    5.30pm – 12am – £100.00
    Saturday
    £100.00
    8am – 5.30pm
    5.30pm – 12am – £150.00
    Sunday
    £150.00
    8am – 5.30pm
    5.30pm – 12am – £170.00

    Handyman

    Monday – Friday
    £70.00
    8am – 5.30pm
    5.30pm – 12am – £95.00
    Saturday
    £95.00
    8am – 5.30pm
    5.30pm – 12am – £110.00
    Sunday
    £115.00
    8am – 5.30pm
    5.30pm – 12am – £145.00

    Anyone else think all those years of University and training may have been wasted??????

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  • "Anonymous | GP Partner | 07 August 2015 2:44am

    Anyone else think all those years of University and training may have been wasted??????"

    And the crucial difference between you and your plumber is - he isn't in bed with the Government.

    For gawd's sake GPs, go private and set a fee that makes people realise your worth and value you. Escape the Soviet NHS. It's entirely in your own hands. If you stay NHS then shut up and stop complaining, it's your own fault.

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  • The government wants us all to be salaried to drive down our pay. What better way than to make the job of a partner unsustainable by letting indemnity fees rise. Partnership days are numbered. We are all Cecil the lion.

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  • 07 August 2015 9:25am

    there are many of us who want to do just that but the profession is run by champagne socialists and the more progressive GPs are not united.

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  • 10:36am

    except Cecil was popular and had friends.

    we (GPs) are despised by the left (guardian readers) and the right (daily mail readers). why ?

    the left want us to be good comrades and work for free 24/7 for the social good and despise the fact that we want time to have a family, sleep etc.

    the right hate us for wanting a high salary on the public purse and propping up a closed (to competition) expensive public service.

    it's time we started looking after ourselves.

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  • a cynic might say that the MDO's have seen an opportunity to increase fees and that GPs will tell the DOH that they cant do extended hours within the existing pay structure. The DOH will pay (they want the extended hours so much) and the MDO's will get their fees !!

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