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CAMHS won't see you now

Time to stop the indemnity circus

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Paying indemnity fees is a necessary evil for GPs, and I have never known a time when they’ve been popular. But the situation has become a circus.

Many GPs tell me they are giving up working in out-of-hours and other settings because the premiums are so high. And who can blame them? A recent survey by the Family Doctor Association revealed that GP indemnity costs have increased by 25% in just one year. Pulse recently reported that one out-of-hours GP was quoted annual premiums of up to £30,000 by a medical defence organisation (MDO).

This isn’t an isolated case. This year’s LMCs Conference heard the cost of out-of-hours cover for some is £35 per hour. And it is not just GPs. One practice recently saw fees for its advanced nurse practitioner rise from £900 to £8,000 in 12 months, despite the nurse facing no complaints during the year.

Premiums will only rise further as practices struggle to recruit GPs and employ staff such as pharmacists and physician associates. The NHS is desperate for practices to take on more specialist care to save cash, but that will mean more hikes in premiums.

And don’t get me started on plans for seven-day working (which are already leading to increases in indemnity costs) and the use of technology, such as Skype consultations, to manage demand.

This problem will not go away. But there is a big transparency problem with the MDOs. In the past, the big three have been able to give Pulse at least a ballpark figure of their annual rise for the average GP. Now, though, they provide no figures at all, merely saying they are based on an individual’s risk.

Pulse asked recently how much it would cost a practice to indemnify a physician associate but got no clear answer from the MDU, MPS or MDDUS. I have some sympathy for them as we live in an increasingly litigious culture, but in what other industry would this lack of transparency be tolerated? I can think of a certain meerkat that would be appalled at how these firms are behaving.

The truth is the system is bust. State intervention is needed to enable GPs to work across different settings and take on greater risk, at a price they can afford. If the health service wants GPs to work more flexibly it will have to find an affordable mechanism to enable them to do so.

In this respect, Wales is leading the way. It has included all GPs in its NHS ‘risk pool’ for out-of-hours. This has significantly cut fees and while there are things it does not cover – disciplinary hearings and criminal proceedings, for example – at least it is a model that has been shown to work.

LMC leaders recently voted to look at whether a crown indemnity scheme for all practices could work in England, and I understand NHS England is considering what it can do nationally. Whether managers can be trusted to choose a scheme that is effective, rather than cheap, is another matter. But I urge them to think imaginatively and quickly.

Any crown scheme needs to be comprehensive enough to make a real difference to indemnity costs. Other mechanisms, such as reimbursing fees for non-routine activity by GPs should also be considered, and confusion over how to indemnify new grades of practice staff needs to be cleared up.

The curtain needs to come down on the indemnity circus, and soon.

Nigel Praities is editor of Pulse

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Readers' comments (13)

  • Thanks for stating our point of view. Certainly, if crown indemnity can be provided for hospital staff why can't we in general practice be given the same facility. I agree, we are supposed to be 'independent' or self-employed but this 'so-called independence' is actually a joke because we don't have a say in anything we do.

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  • If GP's stopped OOH for 1 month then HMG would rapidly step in . Of course they won't. GP's cannot even come together over this simple protest. It wouldn't need to involve all OOH docs just enough to make it hurt and then it wouldn't need a month -1 week could make them see sense.

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  • GPs aren't being remunerated for their skills, their costs and the risks they are being asked to undertake.

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  • I'm pretty sure hospitals pay for crown indemnity. There's a Quango who risk assesses trusts and charges accordingly. Not sure things are straight forward. Unfortunately.

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  • GPs also need to be aware that cover is also highly discretionary. So, you may pay a fortune for cover- but the company can decide, if the doctor's actions are really bad that they will not cover. As we have found out, if this happens to one of your employees, you will be "vicariously liable"- and the MDO's don't cover this. GP partners are therefore very precariously exposed. This has got to be sorted out

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  • @9.42. Totally agree. This needs to be addressed re: "discretionary" powers. Where's the transparency.
    Editor could you also resuscitate the issue of doctors who had been declined indemnity, by the MDOs after being restored to the register, or following a period of suspension? This needs to be addressed urgently as well, in view of changes to the law making indemnity cover mandatory to practice.

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  • It was becoming like the States, where a few doctors practice without insurance. However recent regulations here have made it illegal to practice without indemnity.

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  • We are in a situation where GPs are required by the government to buy an insurance policy (for that is what it is) to protect them from attack by another branch of government. The fees are supposedly set by actuarial calculation, but we don't actually see how this is calculated. The money then passes via one of these three agencies to an unaccountable group of legal types through opaque channels through a series of 'settlements' that are never subject to public scrutiny and make their calculations based on the provision of care outside of the NHS as if it didn't exist! Move along ladies and gentleman - no corruption to see here, oh no nothing at all...

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  • @ 2.07pm

    Spot on Mike!

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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.

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

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