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Independents' Day

GP practices will get 52p per patient to cover rising costs of indemnity

Every GP practice in England will receive 52p per registered patient to offset the average increase to the cost of medical indemnity this year.

In an update on the GP contract announcements last week, NHS England said that the £30 million fund will be divided based on the size of a practice's registered list at a rate of 51.6p per patient.

GP leaders told Pulse that negotiations to decide whether this would be best paid as a one-off lump sum in early April, or incrementally across the year, were still underway.

In a letter to regional NHS England primary care leads and CCGs, NHS England director of commissioning Rosamond Roughton said: ‘Payments for indemnity costs... will be made based on registered patients at 51.6p per patient.’

This is part of an overall 3.3% funding uplift that amounts to £238.7 million in the 2017/18 GMS contract, and includes full reimbursement of CQC fees and the dropping of the unplanned admissions DES.

GPC chair Dr Chaand Nagpaul said that practices would ultimately have the discretion over how the funding was divided between doctors working for the practice.

He said: ‘We’re in discussions about the best way to have it paid. You’ve been given the amount and distributing it will be up to individual practice discretion, anyone in a practice – including locums – will have to factor in a rise.’

According to Dr Nagpaul, it would be impossible to be ‘prescriptive’ about a methodology where some GPs may have seen significant increases related to out out-of-hours, or GPwSI, work, which this payment is not intended to cover.

He said: ‘It’s important not to make this more bureaucratic than necessary, this covers the average rises in indemnity costs which have been projected from MDO feedback.

‘One needs to ensure the distribution of the money is fair within practices. Guidance will follow, but it will never be able to be too prescriptive because of the variation in circumstances of individual doctors.’

Practices will be given a share of £30m worth of funding to cover indemnity costs over the next two years - as pledged in the GP Forward View.

Mitigating the rise to indemnity costs

The £60m funding injection to offset indemnity inflation - first trailed in the GP Forward View - is part of a ‘two-pronged’ strategy to tackle rising indemnity costs, focusing on immediate support and a longer-term approach to reduce costs for GPs.

The longer-term approach will see NHS England working alongside the Department of Health, GPs, indemnity providers and the NHS Litigation Authority to bring about ‘fundamental reform’ of the current system.

This includes proposals to cap the fees lawyers are able to charge in low-value compensation claims.

NHS England is also repeating the £2m winter indemnity scheme for out-of-hours GPs this year, having successfully trialled reimbursements for indemnity hikes last winter.

Indemnity providers say inflation to indemnity costs is linked to steep rises in legal claims against GPs, amid a growing trend for increased litigation.

Readers' comments (23)

  • What about Locums???

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  • For locums NHSE has said you "retain the flexibility to raise your rates to cover any indemnity rises"

    If you work regularly for a practice you could have a discussion with them perhaps

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  • Ivan Benett

    This payment will go straight into the Practices profits and bypass salaried, locum or any independent practitioner working with the practice. Partners, as usual, will walk away with the gain and half of it will go back to the exchequer in tax

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  • I thought the problem with escalating costs was the increasing number of large million pound plus settlements that are predicted to come down the litigation pipeline over the next 2-3 years. Having a cap on lawyer fees will have no effect on these costs, now or in the future.

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  • Locums - increase fees
    Salaried - well those that have it paid by practice are fine, others negogiate a pay rise...or leave
    Partners - lose money as 2k aint much for us

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  • As a 4 session Salaried GP (working below national sessional average rate due to practice finances)-I already work from Jan 1st until April 15th UNPAID out of NET pay (not taxed pay- but take home pay) to just practice as a GP in this country in order to pay for indemnity fees, GMC, RCGP, to read the BMJ online ( too expensive to join BMA as well) and for one update course a year. This does not include car or phone use either or the late evenings finishing paperwork, coming in on days off or courses/meetings on days off- this would push it back yet further.
    I realise I could stop the RCGP, BMJ and not go on an update to reduce costs-but is this the level of professionalism our leaders really want in our profession?

    Whilst this is a welcome development it just scratches the surface of the problem - this is just a total of 4 sessions a week indemnity for 1 GP for a year in a practice of 11500 patients and refunded out of money that is already being taking away from practices ( e.g. PMS or MPIG or loss of seniority payments). How can it even be shared out equitably?

    All professional expenses for salaried staff (GPs and nurses) must be made to be practice/NHS expenses and therefore tax allowable and this needs to happen urgently to stop the exodus to locum status. It will need to be fully funded as practices are financially breaking already-it can't be done just bit by bit like this.

    Whilst I'd love to be a partner the current financial uncertainty and GP practice liabilities especially in our area prohibit this. So as salaried GP's we are also doing our bit to help our partner colleagues but everyone needs stand up and to take note of this.

    MP's claim expenses and get reimbursed as do most other salaried occupations. I imagine that CCG staff and NHS England staff do too. If you want to keep a salaried workforce this needs to be addressed urgently. If you want GP partners then you need to do more to stabilise practice funding than this- cutting with one hand and giving back less with another but dressing it up as new money. Locums are very valuable but we need people to realise why we are being driven to work as locums and why this is destabilising General Practice so rapidly.

    When the media write headlines about average GP salaries we need to go straight back to them with a realistic idea of the fees we have to pay to practice as GP's out of our salary then they can stop comparing our salaries as being greater than MP's and remove a major barrier to finally getting some proper financial investment back into primary care. And them tell them many GP's aren't even getting the AVERAGE GP salary- and probably most of these will be women.

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  • Pushing more money at the MDOs does little to attack the root cause of the problem. It's like giving out insulin to the morbidly obese, it just causes growth of an already bloated system. We need proper reform of negligence laws and serious regulation of legal firms, not sticking plasters.

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  • Not being funny (as Darling Denice says in Private Eye) but in my practice the salaried docs have their indemnity paid as part of the package so will benefit. No partners strolling off with anything except for the usual burdens of woe and care. Our local OOH provider now pays for indemnity and discussions are going on in the SW region to get some pooled cover for federation/working at scale. That said, I still pay 50% more than I did 5 years ago and this needs a proper, national sorting out. I am pleased to see a cap on claimants' legal fees (which often are multiples of any payout) is beng considered but I'll believe it when I see it, Parliament being largely full of lawyers.

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  • 52p per patient. so about 7 grand for us. 7 grand?! Whats that going to do!??!

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  • 52ppp is a joke considering it's going up £100s each year for GPs. All NHS indemnity should be reimbursed infull as per our hospital colleagues

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