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Independents' Day

GP indemnity fees spiral out of control with 26% rise last year

Exclusive ‘Out-of-control’ GP indemnity costs have increased by more than a quarter in a year, show the results of a Pulse survey.

Indemnity fees rose by an average of 25.5% in the past 12 months leading up to November last year, according to an analysis of responses from more than 900 UK GPs.

But the increase could be even higher, as a large number of GPs said their fees had decreased because they had had to reduce the number of shifts they worked.

More than one in 10 respondents said their fees had more than doubled, and more than a quarter saw hikes in excess of 40% in the past year.

Medical defence organisations (MDOs) said that the figures were not representative, and they were seeing rises of around 10%. 

However, these figures currently represent the best estimate so far of the rising burden of legal indemnity, as medical defence bodies have refused to provide comparable figures to Pulse.

Dr Zishan Syed, a GP partner in West Kent said his indemnity costs have increased by 60% in the past 12 months and said the MDOs needed to do more to challenge individuals who engage in campaigns of vexatious complaints against clinicians.

He added: ’Furthermore, the fact that they pick and choose what case to defend can leave a GP who has paid year after year of fees in the lurch with no defence.’

Dr Graham Scott, a GP locum in Warrington, said his fees had more than doubled, adding: ’‘I think that it is out of control and unfair. It needs serious regulation.’

Dr Ishwar Bhatia, a GP locum in Ipswich and East Suffolk, said: ’Compared to sessions worked, the amount has increased to double. A regular four sessions in surgery cost £5,100, and out of hours is more.’

Several GPs commented it was ’not worth increasing hours of work’ as the cost of indemnity was so high and they felt helpless to question fee rises.

A GP who did not want to be named said: ’There are no clear understandable rules for charges and because I don’t know how they work it out, I don’t have evidence for whether the charges are correct or not. I can’t complain as it is compulsory and we can’t work without indemnity.’

However, another GP who also wanted to remain anonymous, who saw a 20% increase in fees in the past year, said: ’When you’ve been through a complaint you realise how worthwhile it is, the support you get.’

The Medical Defence Union disputed the survey findings, claiming that average member subscription increases were lower, at around 10% a year. A spokesperson said: ’Long term, GP claims inflation has been running at over 10% year on year. Inevitably, this affects the subscriptions we need to collect to ensure our members’ peace of mind. Average subscription increases for our members reflect these trends rather than the figures your survey found.’

MDDUS also said most of its increases were smaller than 25%. A spokesperson said: ’MDDUS were able to limit subscription increases for the vast majority of our GP members to well below 20% this year. The numbers seeing increases at the level you quote were small – far smaller than the number of our Scottish members whose subscriptions were held stable.’

NHS England recently said it would reimburse GPs who take on extra out-of-hours shifts over winter under a temporary £2m scheme. A Pulse survey last year revealed that a year earlier half of GPs were already turning down out-of-hours shifts because the cover is too expensive.

The last LMCs Conference voted in favour of a motion for all GP indemnity costs to be covered all year round and the Government has looked into capping legal costs for small value claims.

How much have your indemnity fees changed in the past 12 months?

Increased by 100%: 3%

Increased by 80%: 3%

Increased by 60%: 5%

Increased by 40%: 14%

Increased by 20%: 28%

Increased by 10%: 15%

Stayed the same: 8%

Decreased by 10%: 1%

Decreased by 20%: 1%

Decreased by 40%: 0.5%

Decreased by 60%: 0.5%

Decreased by 80%: 0%

Don’t know: 190 21%

Total number of respondents: 922

The survey was launched on 26 October 2015, collating responses using the SurveyMonkey tool. The 20 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. A total of 922 GPs answered this question.

Readers' comments (41)

  • And we are waiting for 4% glorious package.As you can see medical inflation is much much more that the corrupt governments official level.The elephant in the room has come to trample on us.

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  • Fees may be going up because NHS indemnity for hospital doctors has robbed defence unions of a profitable financial stream.
    They are paying a great deal for staff costs-So the GPs have to pay more to make up the difference.Just a thought?

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  • I have just completed the I&R scheme. I was covered by the MDU. Now I'm salaried doing 8 sessions a week. The quote they gave me equated to £300 a week. That's just bread and butter surgeries. No Skype consultations, minor surgeries or OOH etc. Never had a complaint against me. Before my career break I'd used this companies cover for 11 years. Not any more.

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  • Pulse really need to do proper surveys otherwise we might imagine they are just interested in headlines

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  • My fee has gone up almost 30% this year with no change in work

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  • Peter Swinyard

    A survey carried out by the Family Doctor Association on behalf of NHS England (who couldn't get the information out of the MDOs) showed similar findings - although when analysed by statisticians showed 14% true rise but some cases up to 30%. Also some doctors have had to stop practicing if they have fallen out of the mutuals' grasp and are on the commercial market. Worst I have heard of to date is £27000 per year PLUS a £250,000 excess on each claim (ie we don't want your business - and he has a good claims record)

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  • We've gone up over 60%. Session ranges have changed to cover less, i.e. instead of 7-10 sessions, its now 8.6-10. This is putting the "banding" up on their charges. It's a ridiculous amount to pay!

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  • Whilst I agree there needs to be more transparency about how the MDOs work out the fees they charge, I think we need to reserve the "regulating" for the fatcat ambulance-chasing lawyers and vexatious patients who make stupid claims on "no win no fee". Sometimes things do go wrong, and people have a genuine case, but they are in a minority if you ask me, and we all know one when we we see it...

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  • My indemnity fees eat up around 20% of my take home pay. No other profession subjected to this super-tax

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  • Just Your Average Joe

    Simple - ban all ambulance chasing lawyers.

    If you use the NHS you can't sue.

    If something seriously goes wrong an independent panel of sensible relevant professionals and patient representatives looks at the incident and harm done - and pays appropriate costs to care for the patient harmed.

    Perhaps payments out will still be high for the most serious cases - ie baby needing permanent care, but all the legal costs will be stripped out, as well as the fishing expeditions and false claims.

    DOH extends crown indemnity to all NHS care.

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  • Fantastic!... Who is listening and who cares? This is a polite way of saying "LEAVE THE NHS NOW" or be prepared to pay the price!

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  • " 2 extra days per week - 40 % increase in work load . Yes but you,ll be tired therefore 80% rise in indemnity .

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  • Roll on crown indemnity.

    Or give us the same protection as judges!

    Really odd given medical care and preventative medicine has never been done better and we have guidelines and protocols for everything.Or is this the real problem?

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  • I think 1.53 is very pessimistic . You will probably only have to work on 1 extra day so it will be just an extra 40% . Come on you miseries try and look on the bright side . If you're chewin' on a bit of lifes gristle-give a little whistle.

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  • Peter Swinyard

    There are so many confounding factors which have led to the exponential growth in indemnity fees. One of the main problems is the method of calculation of damages. Under the other piece of 1948 legislation was a method of calculating harms which made provision for the entirety of care for those harmed in medical negligence to be provided privately. This is absurd and those affected must receive their care on the NHS. Likewise, all the damages are paid as a lump sum up front - which has to account especially in younger people for a very long lifetime of care. If money were provided on a monthly or annual basis, this would also greatly reduce costs.
    The way in which legal costs are calculated and the way in which defendants cannot reclaim the cost of their defence when they win a case also mounts up the costs against the interests of the NHS.
    It is a complete mess and at least NHSE are awake to the need to sort it out - the first glimmerings being subsidy of defence for those working out of hours last Christmas. More to follow, I hope.

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  • As many GPs consider working 6 sessions to be full time work; the Medical Defence Organisations could have made a justifiable adjustment to their fees where now one has to pay the same amount of money for 6 sessions.

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  • There is a simpler way - if you accuse a doctor - and he defends himself successfully you pay his legal fees and the time he spends defending himself. GMC fitness to practice referrals would plummet, CQC and the like will go bankrupt. Only legitimate clear cut complaints will be investigated and treated with respect - not all these cases/complaints that shouldn't be mentioned talk less of having thousands of pounds thrown at it before seen not to have any merits. Finally - patients needs to start bearing the charge of these legal action - you make a complaint - against a doctor -you get a lawyer - he/she gets a lawyer - the complaint found not to be valid - you pay for the time he responds to the complaint and the time he spends on the complaints. Until this is done - your entire earnings will be spent pandering to political correctness and patient stupidity.

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  • Mine has gone up by 28% with no explanation. I am in the lowest risk bracket with no private practice and no treatment of patients ( I am a tribunal doctor)

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  • What can we learn from this story?
    Withdrawal of labour leads to action. GP's turned down work and suddenly the DoH found 2 million quid. If we all refused to pay indemnity they would have to pay it for us.

    It is a seller's market. We have the power. We just need the determination to seize it and make our lives better.

    Until GP's are released from the shackles of their contract they cannot make the sort of mass protests that would achieve some sort of fairness and equity.
    We must liberate ourselves from these constraints.

    Ditch the contract comrades.

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  • In every other industry extra costs are passed to the end service user, except for the messed up world of NHS subcontracting.

    I really despair that we GPs dont have the resolve to put an end to this rubbish -boiled frogs indeed.

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  • Took Early Retirement

    No fault system like NZ? However, that would disadvantage lawyers and an awful lot of MPs are....lawyers in their "spare" time.

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  • Seems like a oligopoly situation to me with a very opache system of charging. I wonder what the Competition and Markets Authority view is?
    Perhaps the BMA GPC could do some work on this, that is if they are not too busy making patients their first priority.

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  • Tony Gu is so so right.
    We Dumkoff GPs have a Contract that mops up all extra work [ when JDs go on strike or A+Es close or whatever]; all extra costs [ Defence, heating .lighting,staff wages or whatever]
    Normal Contractors pass these costs on to the consumer.
    But the GPC [ like its esteemed leader] is so concerned about the patient that they forget the GPs they represent.
    I sincerely hope that MDU, CQC, GMC will kill off the complete nightmare that GP land has become.
    And, the dumbest thing is, we are so needed.
    And the DOH cannot see that.

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  • Charge appropriate high sums for insurance and other reports, four figures.

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  • Doctors are treated like surfs or slaves now, with only a pretence of freedom.
    Why are we forced to give our hard earned cash to litigation costs anyway? If we cannot work in a free system how can we pass the indemnity costs on. At this rate, we will not only be paying to work but for paying for a whole growing legal industry and insurance industry and also patients who want extra money.
    We also are paying directly for a whole mass of other organisations the bloated medical colleges, the gmc and other problem organisation such as cqc (who should have all been sent up in the first space rocket)
    Why bother working here in the uk in the NHS, why should we work to support all these parasitic industries in addition to working untold extra UNPAID hours to make up the staff shortages in the NHS.
    This is disgusting and immoral. We need to stand up for our rights as otherwise we cannot support ourselves or our families in any way.
    I have walked and I am SO much happier. Reaĺly! It is a hard step to make and it is very emotional to make changes like this as being a doctor is fundamental to our very identity as we have spent our lives getting to where we are.
    But the world is continually changing and to survive and thrive you need to stand back, see a situation as it is and believe your instincts and act on them.
    Incidently in the time it has taken to write this, there have been two adverts on the tv trying to get people with injuries to go to their legal firms for free to see whether they can get compensation, no win no fee.....

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  • Tony Gu,you've taken the words out of my mouth.When I mentioned to a non doctor about all this the reply was "you're paid enough". GPs just don't seem to earn the public's sympathy.In their minds we're failed hospital doctors who are overpaid for what we do.

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  • Hello Madam, I'm Dr Jones, and for the first three minutes of your allotted ten, I work for the Medical Defence Union. Now, what's on this list of yours? A new mole or two yes, and there's the mandatory trip through your fibromyalgia/ibs/depression medications I see, dry eyes this week, there's a new one, oh and these last two are a novelty aren't they? Plantar Fascia hurting, which in no way is related to the last item on your list, your desire to lose a stone of the twenty you hurl about the place. Sure, yes, Little Tyrone can have some Calpol to help wash down his Concerta. And sure, your January audit of the bathroom cabinet means you're in dire need of some Gaviscon, Ventolin and Ibugel while we are at it. Tired all the time you say? You should try this side of the desk love.

    Burned out doesn't get close sometimes. So the prospect of working 2 months of every 12 to pay lawyers really is a kick in the guts. Still, 18 months only to go.....

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  • There's only one solution to this. Crown indemnity for all NHS work. The MDO's can still make a lot from private works, GMC representations etc etc. Why is the BMA not making a case for this pretty soon?

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  • To Anonymous | Other healthcare professional22 Jan 2016 8:32am

    Wow! From the heart and completely on the money!

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  • Can't keep absorbing these rises. Crown indemnity ain't going to happen. Only way forward is to bIte the bullet like the juniors did, anD ditch the contract. They need us more than we need them - start again with a clean slate.

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  • I've worked my arse off during these last few months for OOH and th government is paying. Out of th winter indemnity scheme it's just not viable to do much work

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  • Well the whole aim of hunt is to squeeze the doctors so much that the pips squeek. It would be interesting to see by current rises in fees etc... we have to pay, and rates of inflation for these 'extras' when the estimate date would be that we would be paying to go to work??? Cannot be long now....

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  • Has anyone else noticed a trend? Centrally managed FPS making cash flow erratic, expenses higher, profits down, spiraling MDO fees, seniority withering away, CQC costs to be paid for by increasing our fees, pension pot limits and probably tax relief to be cut for higher earners. No brake on workload. I reckon Mr Hunt wonders why so many of us are still here?

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  • 10 sessions= 15000
    1 session= 1500
    But if you reduced your sessions to 8, then you pay 14000
    A kid will tell you that if one session is 1500 then reducing two sessions will get it down to 12000.
    If your premium has been doubled from 8 to 15000 it is because you are 'high risk' - you confided that there was a complaint although nothing may have come out of it.
    Reducing 2 sessions make that risk still higher so now your premium per session works out to be 14000/8= 1750
    This is MPS maths because there is an illiterate Lord MP sitting in this stupid cartel

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  • I believe when Moses told pharoah to 'let my people go' be brought along some plagues to make a point. You should start planning them folks - if you want this tyrannt to relent.

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  • Una Coales. Retired NHS GP.

    I suggest you step up your plan B exit strategy.

    NHS consultants and Associate Specialists both get annual increases in their pay as well as discretionary financial rewards and the hospitals cover their indemnity, ie crown indemnity so they get to keep their 6 figure pay. No employees NI or employers NI to pay out of your pocket. No staff redundancies to pay out of your pocket.

    Only thing is Hunt is introducing shift work and in house on calls and scrapping hospital discretionary financial rewards which means consultants will go private and associate specialists will resign and locum.

    We have already heard that nurses bursaries will be scrapped and many hospitals are understaffed.

    Now that you know all arms of the NHS workforce are being attacked simultaneously, speed up your exit plan pronto.

    I have just heard that Australia may be increasing its immigration as it will need more farmers and farmhands. This means a need for more doctors as even with their own doctors, there will not be enough.

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  • Reduced from 8 to 5 sessions
    £5000 increase to £8500

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  • The options everyone over 50 retire.
    everyone below resign from partnerships and go salaried.
    traditional general practice has gone.
    55 and I am taking early retirement and SO relieved. Now feel so much better. The job is making us unwell and there is no occupational health service for us.

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  • I agree with a previous comment, that if you use the NHS you should not be allowed to sue. I think you should be able to complain about poor practice and expect a proper enquiry. If a doctor or practice has more than a certain level of complaints they should then be investigated to find out why- understaffed, ill, overworked .I think DR'S should be able to sue the NHSE if they mess up the medical system so badly in this country that we can no longer practice safely and it turns out this is why there was poor performance.

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  • Doctors are slaves to the public, NHS,GMC and to themselves.

    I do not feel proud to be a doctor.

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  • Despite being a doctor twice over, medical and academic, I rarely use these titles now as I don't want to be used or taken advantage of any more.

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