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Independents' Day

Practice pays more for nurse's indemnity costs than her salary

A practice was charged £3,900 to indemnify its advanced nurse practitioner - more than an entire month’s pre-tax wages, Pulse can reveal.

The ANP, who asked to remain anonymous, said that it would be equivalent to ‘paying to come into work’ if individuals take on the costs, and has called for pressure to be put on the defence organisations nationally.

It follows a series of reports around the cost of indemnity for practice staff, with Pulse revealing that one practice saw its ANP’s indemnity costs increase from £900 to £8,000, and that practices will be charged more than £2,400 to indemnify physician associates.

But this is the first example uncovered where the bill came to more than the practitioner’s salary.

The ANP told Pulse: ‘This year with the MDU I got a quote £8,995 for a full year, about two weeks before my indemnity was due up. So it didn’t give me any time to shop around with anybody else.’

She said this was a rise from around £1,500, which the practice was charged as part of a group indemnity scheme, so she informed the MDU that she had to leave at short notice and wanted to cut this down to one month. 

The MDU agreed, but sent her a final bill of £3,900 in a letter which also specified her monthly ‘gross non-indemnified income of £3,750’.

She added that she was effectively ‘paying to come into work’.

The ANP added: ‘So they’re charging me more than I’m being paid. That’s the price, not a quote. I rang them up and said look I’m not paying this, I’m not paying to go in to work.

‘Luckily the practice pay my indemnity for me but I wouldn’t come into work if I had to pay it myself. I don’t know what can be done; pressure needs to be put on nationally.’

Pulse has already reported that another advanced nurse practitioner, Rachel Drago in Weston Super Mare, saw her annual indemnity shoot up from £900 to £7,900. She was also indemnified by the MDU who declined to comment on individual cases.

The GPC has been coming under pressure to tackle indemnity issues in general practice, which have seen bills as much as £30,000 quoted for out of hours GPs.

Other GPs are already seeing their premiums increase as a result of routine extended hours work, with some estimates showing they have increased by a quarter in the past year.

The problems with extended routine access are likely to be a growing problem, as seven-day working is the backbone of Jeremy Hunt’s ‘new deal for general practice’. The new deal also calls for more alternative health professionals, such as physician associates – who Pulse has revealed will have indemnity fees of ‘around £2,400’.


Readers' comments (16)

  • I'm considering retiring at 55 because my pensionable income was 60k and this year I am paying 15k for indemnity from 8.3 k last year.
    I began with a premium of around 3800 in 2005. Pity, my salary instead of going up 5 times like my premium, is down today by 30% the beginning.
    Who are we working to feed?

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  • Ditch and switch? not possible and you would end up with no cover so can't work. lump it my friends. the end of general practice is near and it may not be becuase of the NHSE or mr. *unt in the end!

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  • when it takes 3 months to switch MDO it's impossible to get proper quotes and arrange cover appropriately.

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  • Does the government have shares in the medical insurance companies? Would be very interesting to know!
    Also why do I hear it is much cheaper to get insurance in other countries like Australia?

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  • Madness piled on madness

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  • Well as ANP's and Physician assistants consider themselves 'equivalent' to GP's then they should have expected these fees . It just goes to show how much risk is incurred in each GP consultation in primary care .if they want to take on equivalent type work they will also incur these risk - higher infact as they do not have the same intensive lengthy training needed to be a GP.

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  • Just Your Average Joe

    Stop the Ambulance chasers.

    Make it impossible to sue unless the corner rules the death was due to negligence or malpractice.

    All other cases of medical error or negligence are reviewed by an independent healthcare panel or experts with no lawyers involved - so no ridiculous fees.

    Costs for panel with be negligible compared to legal costs - and a fair pay out where required to cover caring costs for disability caused etc given with no cut to lawyers.

    Could be set up in months and the law could be changed to stop all legal process as above for anyone using the NHS as an amendment to the NHS Healthcare Bill.

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  • Just Your Average Joe

    PS - Crown indemnity for all who work in the NHS and overall still saving costs of billions.

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  • Anonymous salaried GP at 9.55 .. I do NOT consider myself equivalent to a GP. I have a similar but also completely different skill set. I am also paid less than GP. I offer a supportive role to a failing health service into which junior Drs are not attracted due to pressure and pay. But can you anonymous salaried GP justify why I should give up over one third of my salary to do my job, do you have to do that ?
    You do mention qualifications... well I have over thirty years in health care, I have numerous academic and professional qualifications that I undertook for my own personal reasons and at my own expense for the majority of my studies.
    Lengthy training .. together dr and nurses undertake continuous learning. My pre reg training was four yrs ! Can we be reasonable and work together on this rather than the confrontation and Dr Nurse game that is still being played. We are on the same side after all.

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  • Salaried service here we come. BMA utterly blind sided on every front. Why don't we have any moles in the DH? Who has been asleep at the wheel?

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  • well said Rachel. I have completed a 4 year MSc programme to be an advanced nurse practitioner. I never profess to be better than a GP. Regardless of roles and salaries, as a GP would you pay over 100% of your salary to go to work???

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  • Peter Swinyard

    There is a real problem with the no-win no-fee arrangements in which fisahing expeditions are carried out in patients' notes to try to find problems.
    We must either go to no-fault government paid compensation for medical accidents as in the New Zealand model or to Crown Indemnity which is being scoped by NHSE. I think it unlikely that we will get direct reimbursement of our costs.
    Another problem is that the courts are awarding damages according to the cost of completely private care for continuing treatment after a successful claim rather than allowing for NHS care for the medical residua. This also needs to be corrected so that victims are properly compensated but need to use the NHS for their medical care, not funded for private treatment - also should be on an annual or monthly payment not a lump sum.

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  • Pulse headline writers - you ought to be ashamed of yourselves. The defence organisation's bill is for a year, the salary quoted is for a month! Greater accuracy required, please!

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  • This is completely accurate. This was my quote for 1 month. please re-read the article.

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  • I too had indemnity insurance quotes of £7000 when I started in my new role earlier this year but it was suddenly dropped back to £700 upon threat of the the entire practice taking their business elsewhere.
    I read the comments with fascination, knowing that as ANP's we are helping to to plug the gap in services that isn't being filled by new GP's. I don't think any ANP would claim to be doing the same as a GP and I'm certain that most of us have huge experience and have spent many years studying (generally at our own expense) to be able to provide the service that we do, which I feel Is a very valuable one in the current climate.
    But let's be very clear on the remuneration that we receive for this wealth of experience, hard work and responsibility (because we are accountable for our actions and the decisions we make in the management of risk). There are huge numbers of us who are being paid less than £20 an hour..... My plumber earns more than that! Yes I sometimes need to ask questions and yes sometimes I cannot deal with the problem in its entirety..... But mostly I can and I do. For instance, yesterday, whilst doing a locum shift at a walk in centre (a GP and myself on duty) we saw 188 patients between us and I had to ask my colleague's support read an ecg
    Not bad value I'd say considering the difference in the cost between us.
    So proportionately the cost of indemnity for a nurse practitioner is phenomenal when compared to the responsibility and their salary.
    It's very sad to read the attitude of resentment from GP's who are getting a great (and extremely cheap) helping hand in times that would otherwise see their profession entirely unmanageable.
    It would be oh so nice for once to hear support from GP colleagues for the role we do, the help and suppport we supply, for the patient satisfaction we provide and the money we save, rather than off the cuff remarks about our none existent aspirations to be a GP. It is worth mentioning that most ANP's have areas of ecperti
    The health service is changing whether any of us like it or not and we are part of that change..... Animosity towards colleagues who bring different skill sets and experience to the service isn't helpful.

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  • It is not surprising that ANPs should be charged this amount. There are some very good ANPs but I have come across extremely low quality ANPs who basically are not fit to practice!

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