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GPs buried under trusts' workload dump

Physician associate indemnity ‘costs practices upwards of £2,400’

Physician associates are a ’useful addition’ to practices, but could cost upwards of £2,400 to indemnify, a GP has revealed.

Dr Patricia Wildbore, a GP in Warwickshire, told delegates at a Pulse Live event in Liverpool yesterday that the junior PA - one of two they employ - sees around 40 patients a day and ‘couldn’t do without them’.

However, the practice has said that it is paying £2,400 to indemnify the junior PA - and she warned that this could be more for future physician associates, who may take on more clinical responsibilities and receive higher salaries.

She told delegates that since they replaced a departing part-time doctor with a fulltime PA, the practice has bucked the trend of falling income, alongside improved patient satisfaction and access.

The Government this year announced that it was going to introduce 1,000 physician associates into general practice by 2020 in a bid to alleviate GPs’ workload.

In the short term, a programme has been set up to recruit 200 physician associates from the US on salaries of £50,000 a year to work in under-doctored areas.

However, GPs have raised the issue of how much the indemnity costs will come to, which will have to be borne by practices.

Dr Wildbore told delegates: ‘I often get asked about indemnity. It costs £2,400 a year for our junior PA.’

She added: ‘At the moment in the UK they’re paid between £20,000 and £40,000, but if people are putting out adverts for £50,000 for a PA, that’s going to change. A salaried doctor doesn’t get much more than that. 

Dr Wildbore also said that the locum insurance for the PA costs around £1,000 to £1,500 and isage and sex dependent. 

She told Pulse that their junior PA was seeing around 40 patients a day, and any absences had a serious knock on effect that needed covering.

The practice has boosted income by having more ‘feet on the ground’, which has led to ’improving QOF attainment because we’re less stretched… and it also means we can do other things like increasing the number of research projects we run at the surgery.

The senior PA at the practice is a partner now, and has far greater experience than the majority of PAs who will be employed, Dr Wildbore said. He pays around £4,700 a year in indemnity costs but he is an ‘exceptional case’, she added.

It comes after Pulse reported that medical defence organisations increased the indemnity fees of an advanced nurse practitioner (ANP) from less than £900 to £7,995 in one year, even though she had no complaints made against her.

Readers' comments (18)

  • Im an Advanced Nurse Practitioner. MDU are trying to charge me £3900 for one month!!! thats more than my salary!

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  • Many practices cover their salaried GPs' indemnity insurance (or a proportion of it), and their nurse practitioners. This is a business cost that has to be included in the business case when assessing whether or not a new type of clinician role is right for our practice. It could still be a better option than carrying a vacancy or paying a GP locum! Personally I think practices, particularly larger ones, benefit from having a range of different types of clinician, and patients benefit too. Many problems don't need to be seen by a GP- but then practices may need to give their GPs longer appointment times if their surgeries are predominantly more complex issues. It's not an easy balancing act, to be sure.

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  • I pay for all my indemnity as a salaried GP. why can't they pay theirs?..

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  • MDDUS do cover for Physician Associates at £1,129 for one year!

    Often PAs will cover the cost themselves, but if not - not a huge expenditure for Practices to cover.

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  • Within a year it will 4800 and then the geometrical progression will bankrupt all who dive into Cameron's cobweb looking to save some measly bucks.

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  • I wonder what commercial insurance companies will charge for PA indemnity. Any one knows?

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  • 40 patients a day seems a lot for a junior PA to see safely.

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  • PAs are the way forward.It's huge waste of taxpayer's money to have doctors deal with the worried well.They should all be hospital based dealing with proper pathology.It's great that Jeremy Hunt has understood this and will make GPs extinct.

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  • Anonymous | GP Partner30 Sep 2015 2:29pm

    Or perhaps we need to look at the the otherway round and government needs to reduce attendance of worried well? Advertising to see their GP (or any other NHS body) for trivial self limiting illness is not affordable!

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  • We tried all of the medical defence organisations and felt that we were being over-charged, so we've gone to a boutique insurance specialist (actually they mainly insure oil rigs and other unique structures) and they are providing ANP and CPN insurance averaging £800-£1500 per prescriber. Wonder if they can cover Medical? Message me if you want to know more (GP federation, 15 ANPs and 4 CPNs so far and growing)

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  • 2:29pm says GPs see too many worried well. Makes you wonder what a GP's job is? It's to listen to all of those people who desperately need someone to listen to them, sort out the real problems from the perceived, and to stop anxiety turning into serious mental illness or serious physical illness. Someone has to do it (and they have to be pretty expert) or our hospitals would become overwhelmed. Don't underestimate the value of listening!

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  • drop in the ocean

    GPs are on the way out - no point training for it.

    Physician associates are indispensable and the future. Not bad 2 years training, 55k a year, low indemnity costs, no clinical responsibility, supervised. Why run up a six figure debt for less (net pay) and more stress and responsibility. May as well stop training GPs.

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  • @2:29. You really must be trolling.

    If you are actually a GP and you see many worried well then you need to rethink your job or actually go and work in hospital like you suggested.
    I see at least 40 patients face to face daily and I get likely 1-2 worried well patients a week. Do not kid yourself.
    Secondly, you are likely ignorant about a clinically and cost effective healthcare system. Any healthcare system without a properly functioning primary care system is very expensive and inefficient. You think GPs should be in hospitals? You are a disgrace if you are a GP

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  • How can the junior PA be seeing 40 patients per day and only pay 2400 MDU? It doesn't compute , unless he is just doing 1-2 sessions per week surely ? I wonder what type of patients he is seeing and what problems are being dealt with . I would be concerned that a junior PA ( considering the limited duration and intensity of their training) is able to safely see 40 undifferentiated GP cases per day safely . This would be taxing even for an experienced GP . All very bizarre .

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  • We were asked to pay 8000 by MDU for ANP. They are high risk. You can't afford to pay PAs and ANP 50k then NI then pension then 8k MDU.....

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  • The PA is a partner? Do these GPs have no self respect?

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  • I'm a PA GP indemnity only costs that much if you go with the most expensive provider...which you wouldn't..

    Also 40 patients a day is a joke. NO PA would be happy with that, that's abuse. Im sure that PA will find a much better job soon.

    Also as per usual a few other facts here are wrong e.g. The GP salaries for PAs etc...

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  • I woudl also like to point out the 50k stuff is a bit irrelevant; it is a project, short-term, trying to bring about 200 v experienced US PAs into UK, and so having to compete with their salaries over there.
    Vast majority of PAs (who remember have science degree as wel as 2 full-tiime years of PA education) are on about 30k

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