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GPs go forth

NHS indemnity is welcome, but the burden of compensation remains

Dr Michael Devlin, head of professional standards and liaison at the Medical Defence Union (MDU), explains the problem of growing liabilities for NHS clinical negligence claims in England remains, despite GPs no longer paying for their own indemnity

On 1st April 2019, a collective sigh of relief was breathed in GP surgeries, as a state-backed indemnity scheme for existing clinical negligence claims liabilities was rolled out in England and Wales.

It followed years of unsustainable inflation in clinical negligence awards that in turn led to increasingly unaffordable indemnity subscriptions. The new schemes are welcome, but it’s important to recognise that they don’t address the underlying causes of the burgeoning compensation awards in clinical negligence claims.

NHS Resolution, the body which provides indemnity schemes to NHS trusts in England, and which now includes GPs, reported total estimated liabilities of over £83 billion in its latest annual report. This figure comprises claims paid in the year to April 2019; those settled in the past but where regular future payments will be made; and those where actuaries estimate the value of future claims that have not yet been made relating to past incidents.

These are real figures with a significant impact – NHS money which would ideally go straight to patient care will have to fund compensation awards instead.

The particularly worrying thing is that the £83 billion figure will grow each year, and substantially. Claims inflation is running at almost 10% per year, which suggests that by 2026 total liabilities could amount to £165 billion. To give that figure some context, the running costs for the NHS in England in 2018/19 was £129 billion.

Patients must be compensated for the cost of having all future care provided privately

The massive bill is principally a reflection of the high costs of future care in cases where the patient is seriously damaged and not a reflection of the standard of care. A GMC report in 2018 described health and social care being at a ‘critical juncture’, but doctors were ’still delivering good care in very trying circumstances’.

And GPs are at the forefront of providing good care: despite delivering 1.22 million appointments per day last year, in often challenging conditions, Pulse reported that 96% of patients report confidence in their GP.

The absence of an empirical link between clinical standards and the spiralling increase in the cost of claims is important to emphasise. It’s right to relentlessly pursue the highest standards in patient safety and the new national patient safety syllabus aims to achieve just that. But it’s wrong to assume that advances in patient safety will lead to significant savings in the amount paid out each year in clinical negligence claims.

Control of compensation costs is needed, but that requires legal reform. For example, a 1948 law forces judges to ignore the availability of NHS care when assessing damages.

Patients must be compensated for the cost of having all future care provided privately. If defendants such as NHS Resolution and the MDU were allowed to pay the NHS to look after patients damaged by negligence, they would still get the care they needed and others would also benefit from the boost to NHS funding. Reform of that particular law is long overdue.

Your voice is important and if you’re interested in calling for the types of changes that we say are needed, get involved

Dr Michael Devlin is head of professional standards and liaison at the MDU, and a former GP

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Readers' comments (13)

  • I'm sorry but how can a health care system cause harm? I'm sorry your cancer was diagnosed late but unfortunately you're not the only person demanding cancer care. I'm sorry your wait for an inpatient bed meant spending time in a corridor but you're not the only person putting pressure on bed managers. I'm sorry your GP appointment is not for months but a growing population is outweighing ability to provide care.

    The fact is HMG can only do so much to improve the NHS. It cannot conscript people into nursing or doctoring. It cannot magic money out of thin air to build more hospitals.

    The only entitlement to care we all have is the fact that we pay taxes for it. If it weren't for that simple fact you aren't entitled to diddly squat.

    (Please keep in mind your taxes go towards other struggling sectors such as the police force)

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  • The only way a system like the NHS can survive is either strict discipline of care provision, population control or forming a true communist society.

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  • The only way to reduce our individual risk is see less patients. No one will help you because you were too busy.

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