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Independents' Day

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)

  • 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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  • "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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