Dilemma: Lapsed indemnity
A member of staff has missed the registration deadline for their medico-legal subscription and faces a temporary ban from work as they are not covered to practice. What should you do?
Dr Stephen Bassett : Keep calm in a crisis
As ever in a crisis, keep calm. Focus on solutions not problems, and certainly not on personalities - there will be time for a post-mortem later but for now deal with the living. You may be sufficiently well-organised to have made Key Person insurance arrangements; some policies allow cover for the unavailability of mission-critical staff for most reasons.
Even with this, you may struggle to cover specific workflows at short notice, and again, leaving the scalpel aside until the post-mortem, it may be better to absorb extra work in a systematic and predictable way using staff you know will be present, paying extra for extra work.
If you are still struggling, waiting room messages, leaflets and personal apologies to those inconvenienced will help keep them onside - most people respond sympathetically to signposting of workload stresses if done positively and proactively.
Now, the scalpel… You will need to find out whether your colleague exhibits similar disorganisation in wider domains and suggest one of the many excellent personal productivity texts such as “Getting Things Done” by David Allen and “How to be a Productivity Ninja” by Graham Allcott.
Finally, examine yourself; are your systems and processes overloading your colleagues and partly responsible for this crisis?
Dr Stephen Bassett is a GP, a barrister, GPC member and a member of the BMA´s medico-legal committee
Dr Edward Farnan: Ramifications vary according to which staff member it is
It is a potentially serious scenario for any team member to allow their professional indemnity to lapse. It may affect the whole practice; the staff member concerned may not be able to work until the situation is resolved and alternative cover may need to be arranged.
The ramifications vary according to who the staff member is. For GPs and nurses, it is an ethical requirement to ensure adequate insurance or professional indemnity is in place. Without indemnity, they may be exposed in the event of a claim. As a result, patients may need to be seen by another appropriate professional until the GP or nurse has reinstated their professional indemnity.
If the staff member is a practice manager or another non-clinical team member, they may be able to rely on their employing GP’s vicarious liability. This means that employers are likely to be held liable for the acts and omissions of an employee should a claim arise. However, the GP partners may decide to allow the staff member to continue working, as long as the indemnity is reinstated as soon as possible.
To avoid this problem arising, some practices have a method for checking that all team members are adequately indemnified and continuously registered with their regulating body. For example, the practice manager could put renewal dates in the diary and request copies of latest certificates. Your medical defence organisation can advise if you are worried about a lapse in your professional indemnity or that of a staff member.
Dr Edward Farnan is a medico-legal adviser at the MDU
Tania Francis: Encourage staff to renew by direct debit
Defence organisations provide indemnity/insurance for clinical negligence claims, as well as some other issues. If a colleague or member of staff has not paid their annual subscription to their defence organisation, they may not be indemnified/insured to carry out clinical work. The position will depend on the member of staff’s role and their employment position. A doctor (whether a partner or salaried GP) will require their own defence organisation cover in order to be able to work. An employee, such as a nurse, may not require their own cover – they may be covered by your/the practice’s policy. A member of staff who has a purely non-clinical role (such as a receptionist) will not require cover for clinical negligence claims at all.
From a practical point of view, the steps to be taken are to ensure that the member of staff ceases work if necessary (subject to the above), or is restricted to non-clinical duties if that will suffice, until their cover has been reinstated. You should insist on seeing proof of this before allowing the member of staff back to their normal duties. You may also wish to encourage staff to renew their cover by direct debit, so that the risk of such lapses are minimised in future. You should make a note of the renewal date for each member of staff and ask to see evidence of renewal every year on that date. It is important to avoid having an un-indemnified member of staff, which might result in civil liability or a breach of CQC requirements.
Tania Francis is a partner in health and social care law firm Hempsons