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At the heart of general practice since 1960

Is the NHS serious about tackling GP indemnity costs?

Practices are set to be reimbursed, but will it be enough, asks Alex Matthews-King

The rampant costs of GP indemnity can no longer be ignored, and NHS England seems to have put its money where its mouth is.

In April 2017, practices can expect to receive a lump sum of around 50p per patient to cover the increase in the costs of indemnity fees, and a similar amount the following year too. NHS England has committed £30m for each of the next two years in what appears to be a tacit acknowledgement that successive pay awards have not covered soaring fees.

GP leaders have welcomed the move, but some concerns remain. First, that the extra cash won’t be enough to take the pressure off GPs, and second, that the funding will not trickle down to locum GPs who pay their own indemnity costs.

The new funding was promised in the GP Forward View in April. NHS England chief executive Simon Stevens told Pulse: ‘There’s absolutely no reason in principle why GPs should personally be on the hook for rising costs in a way that hospital doctors aren’t.’

NHS England has now said the funding will equate to some £3,500 to £4,000 annually for the average practice and will be divided among practices based on their unweighted patient list size.

Managers also said the scheme is a stop-gap while NHS England conducts a review on how to reduce fees in the long term.

indeminty infographic 580x894px

indeminty infographic 580x894px

Underestimation

NHS England conducted a survey of 4,500 GPs in June that showed the average spend on indemnity had risen from £5,200 in 2010 to £7,900 in 2016 – an annual increase of 7%. In the end, managers chose to believe the medical defence organisations (MDOs), who gave a 10% annual rate of increase; this equates to around £30m per year. But a Pulse survey of more than 900 GPs earlier this year suggests those figures significantly underestimate the real increases.

It found the average reported increase last year was 26%, with some individuals quoted as much as £30,000 for annual indemnity. A smaller survey by the Family Doctor Association put the annual increase at 25% (see graphic).

However, this year, the £30m provided does come on top of money pledged in this year’s funding uplift. The 3.2% increase in the global sum this year included £33m to account for the increase in indemnity expenses.

GPC deputy chair Dr Richard Vautrey said details of how practices would receive the money are still to be negotiated, but it is likely to be a top-up payment.

He added: ‘A problem with it going into the global sum is it’s then subjected to Carr-Hill variations, so some practices get less and others more depending on their population. Yet indemnity payments really aren’t dependent on population.’

NHS England has said practices will be expected to provide an ‘appropriate share of their payment to their salaried GPs and locum GPs’. But National Association of Sessional GPs chair Dr Richard Fieldhouse told Pulse: ‘It would be really nice for the 17,000 locums out there not to have to individually negotiate and barter with practices over getting their fair share of the rise.

‘Otherwise locums are going to be charging extra for it and that’s going to increase the employer’s contributions to the NHS superannuation scheme.’

It comes as Pulse revealed the top salaries at MDOs have increased by as much as 30% since 2012. The MDOs claim the figures include one-off payments.

NHS England has also said it plans to run its winter out-of-hours indemnity scheme again. Last year the scheme saw 500 extra GPs help deliver 14,000 more shifts. However, this only covers ‘additional’ shifts, not those normally undertaken by out-of-hours GPs.

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Readers' comments (12)

  • I have 2000 patients, and pay £8500 to the MDU. This extra 50p, after tax and superann, will be worth about £400 and will be divvied up by partnership share to my partners who have smaller lists than I. I will get about £250 of it
    The MDU tends to go up by £500 a year
    Sticking plaster? ITS NOT ENOUGH MONEY

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  • Er..No.

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  • It's not enough money and does nothing to address the real threat to GPs ie a sudden hike in fees renders them uninsurable.

    There are huge and systemic problems with the MDOs:

    1) By settling too many claims they encourage litigation
    2) By not making counter claims there is no risk to vexatious lawsuits
    3) There is no transparency in how fees are set - we cannot compare rates because the definition of a session varies and is not compatible with modern work practice ie remote working.
    4) By not being either a public body or insurer they are effectively unregulated - we cannot issue FOI requests for example.
    5) There are only 3 of them and negligible competition. This is a monopoly.
    6)It's not clear who's interests they are acting in - the legal system, their directors or their members.
    7)They rent swanky addresses and don't appear to be cutting costs.
    8) There are potential conflicts of interest if they represent 2 doctors in a claim
    9) It's not clear who is paying for what ie GPs seem to be propping up hospital sector risks through inflated fees.
    10) The fees have rendered some forms of GP work unviable by costs eg exclusive OOH
    11) A lot of their guidance is too vague to be of clear use in real world medicine. eg write better notes in 10-minute consultations.
    12) There is no obligation to indemnify a doctor.

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  • Today had my defence 2016-2017 renewal through - 15% increase on last years. (Last time I contacted my defence body was 10 years ago for advise about confidentiality and then I only got a woolly response).

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  • The DOH could easily fix this (we all know how) and create a nice legacy for himself.

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  • Apparently the country hasn't got enough money to pay for the health care of its people. You hear about the crisis of finance in the NHS on any radio station that has the news every day. Apparently the country is broke. Turn to a different chanel and you might get the sports news. The other day I heard Arsen Venga (sorry if that's spelt wrong) manager of arsenal, being interviewed saying there's more money in football these days than there's ever been. 'Every year' he says he amount of money avaliable to spend on transfers has gone up...this year they'll be spending close to a billion pounds on football players in the premier league. On top of that football players get paid hundreds of thousands every week for kicking a ball around. This is all paid for by television rights, much of which comes for subscribers to SKY tv and the like, from folk around the country keen to watch football,on TV. The country has no money?? I don't think so..we would rather spend it on our television subscriptions and on our mobile phones ...that would be a more honest analysis. It's about the country's priorities. Nothing else. We can afford our health care system...we are just wilfully blind to the fact.

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  • dont you think that people should pay a small money for seeing dr?
    for example £10
    or a yearly subscription of £20 a year?
    for example for a surgery with 10000 patients it will be £200,000 extra money
    people pay money on many things but nothing toward seeing a dr.
    this little money is nothing and is afordable for everbody and will reduce the no of unnessasary visits.
    yes we all pay tax but this is a contribution and tax pays for infrastructure of health system but people should pay like every body all over the world
    the unnessasary use of dr appointments for silly things are enormos and even people on benefit can afford it.

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  • so a single mum comes in with three children and £10 who is going to decide which one is seen.

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  • 08 Sep 2016 8:30am

    quite right - if only doctors worked 24/7 for free then the NHS could be saved but this lazy lot want things like time to sleep and money to pay for food and sleep. the younger generation are even more cheeky and want money to repay their student loans! The last thing we want is for the public/tax payer/patients to pay for their health care / NHS.

    thank goodness Jeremy is on the case

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  • @Mitra Mahdevi: You have a point. Incidentally, Marx is probably turning in his grave when he now realizes that UK has achieved the heights of communism he never dreamed of. And all because, UK politicians have only one aim - to appease the masses and get their votes. Nobody wants to discuss the harsh realities and financial constraints and make people aware of a ticking bomb that may jeopardize basic medical services in the very near future.Payment per visit like the Dental services is the only way out in the present situation. Putting things off doesn't make the problem go away.

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