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GP seven-day hubs refused indemnity for nurses

Medical defence organisations are refusing to offer indemnity to practice nurses working in hubs at weekends at GP Access Fund seven-day pilots, according to a GP who is now calling on NHS England to intervene.

Dr Patrick Geraghty, who helped set up a pilot in Leeds West and now works there, told Pulse that he has approached a number of medical organisations about indemnity for practice nurses but has hit a brick wall at every attempt.

As a result, the three hubs that operate at weekends in Leeds West do not employ any practice nurses.

Dr Geraghty said: ‘They (MDOs) don’t seem to have got their heads around hub working and nurses. So at the moment it is mainly being doctor-run, with healthcare assistants as well because they are covered by the doctors’ indemnity. And I don’t think this is just applicable to us, I think it’s a universal problem.’

The sticking point for the indemnity refusal is that practice nurses at the hubs might be seeing patients from other practices, but Dr Geraghty argued that the way the hubs are set up this does not become an issue.

He said: ‘This isn’t an out-of-hours service – this is extended access – so we all have access to the computer systems of all of the 15 practices. So we are working within their system as if we were a locum or a partner in the practices.'

He told Pulse that around a year ago NHS England top executives, including the chief executive Simon Stevens, listened to a presentation in which Leeds West staff explained the problem with indemnity and asked whether NHS England could look into it.

‘Nothing has happened though,’ said Dr Geraghty.

He is now calling on NHS England to step in and either put pressure on the MDOs to change their stance or for NHS England itself to offer indemnity cover. Because the inability to obtain indemnity for practice nurses also comes at a cost, stressed Dr Geraghty.

He said: 'Employing practice nurses could really help us because then naturally it would be more clinical time at a cheaper rate.'

In the meantime Dr Geraghty is still struggling to get indemnity, but he is now in talks with MPS, which is trying to find a solution.

MPS told Pulse that it is committed to offering flexible membership options and ensuring that it reflects the current and emerging patterns of primary care delivery in England and the rest of the UK, ‘including hubs and other more collaborative ways of working’.

Dr Nick Clements, head of risk and underwriting policy at MPS, said: ‘We can offer a number of indemnity options for nurses working in general practice, and we can discuss bespoke arrangements for hubs with multidisciplinary teams each operating in different ways – there is no one size fits all indemnity solution.’

But he added that it was important for MPS members to inform them if they were looking to use practice staff outside of normal practice arrangements – including where they plan to lend, borrow or share staff with other practices or organisations – to ensure adequate indemnity arrangements are in place.

Meanwhile, a spokesperson for the Medical and Dental Defence Union of Scotland (MDDUS) said: ‘We can confirm that we are able to provide indemnity for nurses working on seven-day pilots. This is available as an extension of our discount practice schemes.’

And Dr Sharmala Moodley, MDU deputy head of underwriting, said: ‘Well over 10,000 nurses are MDU members, the majority working in primary care. However, we can usually extend the benefits of MDU membership to nurses planning to take on additional roles outside the practice.

'This will sometimes attract an additional subscription depending on the nature of the arrangements and the specific role taken on.’

Pulse has approached NHS England for a response.

Readers' comments (18)

  • Does this mean that the MDOs are thinking that working at scale and decreasing the number of medics in the skill mix is inherently risky and will cost more and not be feasible without crown indemnity?Well who would have thought!

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  • The MDO system is a national disgrace that no-one is taking seriously. The NHS is utterly dependant on them to provide indemnity for basic service provision. The whole basis of the forward view is innovation and team working but there is no provision in legislation to provide the insurance required for us to deliver basic services. Patients are loosing out on essential care because it is now impossible to indemnify certain types of working patterns prop the NHS up. All this is going on whilst the claims bill rises and lawyers make more an more profit and MDOs trade from swanky London addresses. However did we allow things to get so out of control?

    This has to be at least as big as the BHS scandal and should be debated in parliament as a matter of priority because it's harming people right now. NHS workers should be covered by the NHS itself whatever their contract structure and claims should be capped before even more people loose out on urgent and emergency care.

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  • Not so hubtastic after all

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  • If people really don't want these to survive - this is the route to ensure the 7 day plans / mcp fail.

    it is very easy to build a risk model which paints a true picture of risks associated with 7 day hubs or E - gp which really ramp up indemnity.

    -to the point where it becomes unaffordable

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  • The indemnifiers have to ensure that the pot of money taken in each year balances the amount they are going to have to pay out eventually in legal costs and settlements. This involves a lot of guess work.

    The MDOs' other problem is that any loss of market share (due to raising premiums) leads to difficulty in covering their fixed costs (mainly staff).

    The UK MDOs are all non-profit making mutuals. We are all annoyed about rising subscriptions (premiums) - but if one of the MDOs goes bust, many GPs will go bust with it, when they become personally responsible for a legal settlement.

    Any novel ways of working in the NHS inevitably raise new risks that will be difficult to price. It is naive to assume that skill mix changes will lower the 'cost of risk per contact' - although they may lower the 'wage cost per contact'.

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  • Well I don't see what the fuss is all about. Doctors should be made to be responsible for all medical workers actions. They should also be charged more for this honour. They should pay in this way to fund the NHS as it is the right thing to do.
    Infact if anything goes wrong, doctors should take the complete rap for this.
    Oh wait.... they already do!!!!

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  • He said: 'Employing practice nurses could really help us because then naturally it would be more clinical time at a cheaper rate.'
    Dr Geraghty

    This is just insulting to our valuable nursing staff
    Nurses provide a thorough and valued clinical service different to a Doctor
    Within the boundaries of their clinical roles

    Nothing new or innovative about replacing doctors with nurses
    It looks good on paper and you apparently get more people seen
    But.... it is often a false economy as
    Patients may then have multiple appointments
    Complex case needs doc
    Strictly by the book practice.. untreated .. ongoing symptoms
    Incorrect diagnosis etc etc

    Who will be the scapegoat when their is a significant adverse event?
    The poor individuals
    In particular the last one to see the patient
    Pass the explosive parcel

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  • This could be a serious setback.
    The success of failure of hubs will rest on offering a number of services from one location, including (?district) nursing, specialist nursing and midwifery services( not indemnified by MDO) as well as GP services.

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  • If the government want these hubs they should indemnify them.

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  • Does a change in the semantics alter the risk level?

    Where does "extended hours" stop and "out of hours" begin?

    Should there be a distinction?

    Dr Geraghty argues that the collaboration of the 15 practices comprising the hub is to be viewed in an extended hours context. Will there not be patients attending these hubs who are new/not known to the attending clinician? If so, is this not the same inherent risk perception as an out of hours clinician who sees patients not previously known to him/her?

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