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GPs buried under trusts' workload dump

Indemnity rises could stop me from working

From Dr Preeti Shukla, Blackburn

Indemnity had been one of the burning topics of discussion in the GP survival forum over the past year. But its significance didn’t hit me until I got my MDO renewal quote in August.

I read the quote then read it again unable to believe it was right. It changed August from my birthday month to horror month.

Finally, I composed myself and rang my defence union to query the mammoth rise in fees when my circumstances had not changed. My defence organisation explained they are expecting a 10% rise every year as litigation culture has hit us hard.

So it’s a double whammy for GPs with increased indemnity and litigation. It left me wondering when complaints, which used to be a learning tool, turned into weapons of warfare against GPs.

I had to drop out of hours (OOH) work as it was not financially viable. For me, as a single mum, it meant a few treats for my son had to go. In a wider view, the NHS lost a willing GP to indemnity, adding to the OOH crisis. This was not inflicted upon the NHS by my gender, no matter what some (Dominic Lawson) might say.

Among all the other factors which are crippling general practice, rising indemnity is the one which can effectively stop me from working.

The thought scares me so I distract myself and start building Lego with my son and hope we will have a solution soon. If not, I am doomed.

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Readers' comments (23)

  • Go abroad! Ditch this tsunami of rubbish here. Your son will have a better lifestyle and so will you.
    It is only the start of gp persecution.
    Patients do not really understand enough to care.
    You will have worked so hard all your life you deserve better. Although it may be hard to start with, once you have made that mental decision you will be almost there.
    Also what future has your son got in this country??? I am sure he will have a better one in Oz.
    Good luck!

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  • Indeed - I would like to do some OOH work, as I used to enjoy it. However, indemnity rises are now of such magnitude that OOH is financially viable only if one doe s alot of it, to the exclsuion of daytime GP, rather than a shift every couple of weeks as used to be the norm.

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  • I am under capacity time wise at the moment but maxed out on the hours covered under my indemnity until my cover renews later this month. Currently turning down 100s of sessions a week in this part of the U.K.

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  • OOH work is unsustainable in every aspect. Indemnity comes to about £35 per hour. Average locum rate for day time ranges from £ 80-90.There is travelling to pay, the nerves doctors use in dealing with unrealistic public expectation. Anything and everything that all other agencies including patient's own GP does not do, is demanded from OOH service.

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  • Indemnity and increasing litigation and that monster/ogre called GMC, with it fitness to practice letters will put paid to medicine in the UK, unless there are changes.
    The UK NHS pays out MORE than any other Western country in litigation. Theres 28 billion wailing litigation in the wings \. Lawyers making 75000, the claimant 1000 in recent case.
    If the law does not change,medicine will.

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  • Indemnity providers want to know of any complaints right at the initial stages.
    But then they increase your subscription using the excuse of "advice given" even where the complaints have been trivial and closed down quickly with no payouts whatsoever.

    This just beggars belief. You are doomed if you ask doomed if you don't.

    If we can't even take advice or ask them to proof read a complaint answer then what's the point in paying thousands of pounds every year.

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  • I agree with other comments ..
    You should go abroad where your son will have better life .
    Working condition here are getting worse day by day with unreasonable demands from patient and government and on top of that this high cost of indemnity .
    I have worked in NHS over 40 yrs and have seen many changes , some good and some bad but never as bad as this ..
    Thinking to finish soon

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  • Ruined UK profession born out of jealousy for what you do and your place in society.
    Reevaluate.

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  • Well done for highlighting a massive obstacle for doctors to work in and out of hours. It is a huge deterrent to retiring doctors to stay on and if the Government are serious about finding 5000 more doctors they'll have to address this.

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  • Crown indemnity must come in for in and out of hours work otherwise GP is not feasible in the long term.

    At the moment we are paying about 1 month worth of our salaries for MDU/MPS fees.

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  • Here in the United States I frequently hear from friends and patients that all the US healthcare system needs to do is to model itself after the British system and everything will hunky-dory. I tell them to check into how our British GP colleagues are being brutalized then they'll think twice.

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  • I would love to move back to Australia where I enjoyed 7 years of working as a GP. I'm a single mum due to domestic abuse and cannot return to Australia as my ex has 50% custody and I HAVE to live near to him. Being a single mum, and the stress that it involves is increasingly not compatible with being a GP.

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  • There is only one answer to this; Crown Indemnity for all NHS work. We can then purchase indemnity for other non related NHS works and representations before regulatory bodies.

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  • Exactly- rise in indemnity is one of the reasons for me to stop doing OOH shifts.

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  • I am not sure if our gp colleagues know about another provider MDDUS based in Scotland provides you the cover at less then two third of the cost from MDU and MPS. However you need to apply to them about 10 weeks before your renewal of subscription in order to get all processed in time. We need to look around for cheaper options as well. I was not aware of this option until recently. I switched over to them successfully.

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  • Crown indemnity and ceiling on compensation are two most workable solution to the problem but needs lot of political will to change the law which is beyond our capacity.while BMA should fight for this cause we can also look around in the market for better options.

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  • agreed - i've dropped ooh work as well due to indemnity costs.

    it doesn't make sense - the government wants 7 day working and weekends treated as a normal week but the defense unions want to charge more for weekend work? with capping of locum rates to come - working OOH makes no sense unless your indemnity is covered.

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  • The problem is the exponential rise in payouts due to litigation. GPs used to be relatively free of litigation, but that was when there was a very personal relationship between patient and doctor and there was adequate time to devote to the patients. Whether it is the Defence Organisations or The Crown that provides indemnity it still has to be paid for! If it was Crown Indemnity this would come out of the NHS budget.
    We really should be pushing for an end to the adversarial nature of medical negligence and introduction of no fault compensation. This would encourage mistakes to be acknowledged sooner. In addition it is a false economy to put doctors under so much pressure when the NHS ultimately has to pay for their mistakes - whether it is in monetary terms or the fact that GPs won't work.

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  • This idea probably won't go down well with politicians.

    The UK public gets free health care. (which is a really amazingly good thing). Why not form a contract with the public that in exchange for free health care you will not be able to litigate against the NHS system. Obviously this needs a bit thinking about and perhaps retain compensation for real loss, but most legal case I suspect there is no real harm done and money is the motivating factor.

    I read somewhere that one of the quickest ways to an early retirement is to be in receipt of employment or medical compensation. People sometimes can become millionaires overnight by this method. It wrong, lawyers are bleeding the system

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  • Indemnity fees are tax deductible aren't they?

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  • The answer is so bleedin' obvious . Out of Hours companies pay for the indemnity. Of course they won't because it affects their profits. Nobody taking any shifts for 2 months might focus their minds on finding a solution .

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  • I do mostly out of hours. My indemnity cost for a month is £1500 but this is the amount of out of hours earnings I make in a week so it's manageable. You just have to do enough shifts to make it worthwhile.

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  • I challenge the MDO's to prove that OOH care is more 'high risk' as it is a perception rather than fact in my opinion. The OOH organisation that I work for has not had a claim brought to them apart from a case dating back to 2011. We are on the face of it dealing with mainly coughs and cold in an environment where you have 20 minute appointments. Add in summary care records means more information is available than before. Finally, the safety netting aspect in OOH is much tighter. So therefore - where is the risk???

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