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GPC in urgent talks as indemnity makes general practice 'untenable' by autumn

The BMA is in urgent talks with the Government to introduce a ‘radically different system’ for indemnity ahead of expected increases this autumn that could make GP work ‘untenable’.

In one of his first interviews on being elected to chair the BMA GP Committee, Dr Richard Vautrey told Pulse that the increases in litigation costs for defence organisations this year were ‘significantly increased’ - which GPs will now begin to see. 

This is as a result of Government changes to the ‘discount rate’, the formula for calculating compensation pay outs for victims in personal injury suits, which had been frozen since 2001.

Medical defence organisations have raised concerns about the change in indemnity, and last week Pulse revealed that the DH was urgently reviewing the threat to GPs.

But Dr Vautrey said the GPC’s ‘fear is that [MDOs] can only hold off for so long’ before increasing costs and this likely to materialise in a matter of months when GPs start to get their annual letters to renew.

He told Pulse: ‘We need to ensure that every doctor - whether they are a contractor, salaried or a locum - any GP on the performers list needs confidence that they’ve got the indemnity to be able to work.

‘Whether in an out-of-hours setting, extended hours, in a practices doing locum sessions without the worry of indemnity costs.

‘We’ve made it very clear to the Department of Health, even in the last few days, that this has to happen quickly. Because there is a real risk that medical defence organisations will be forced to put up their rates to a level that will make it untenable for many GPs to work, or to do the number of sessions that they were able to do.’

He said it was welcome that the GPC had secured reimbursement for the inflationary rises in indemnity this year and last, but this will not cover for the latest increase.

Dr Vautrey added: ‘That cost pressure has yet to materialise and our fear is that they can only hold off for so long.

‘As indemnity renewals start to appear in GPs’ letter boxes in the coming months… there is a real risk that that’s the point where MDOs have to make the change and it will be significantly greater than the annual expected rise that we’ve seen in recent years.’

He explained that the GMS contract is supposed to cover GPs business expenses, of which indemnity is one, but even with the inflationary cover in recent years the contract has fallen behind the pace of rises.

Also in the interview Dr Vautrey set out:

  • That the GPC is prepared to take a formal ballot on industrial action as long as practices understand the consequences and show they are ‘prepared to do so in sufficient numbers’ – though he would not say what this threshold was.
  • That it will this year produce guidance on how practices can identify when they are working beyond safe limits and where to redirect patients when they go beyond this. But it says defining a national threshold of patient contacts which practices shouldn’t routinely go above could would be ‘simplistic’ and could be ‘counterproductive’.
  • That NHS England’s pace in delivering recurrent, and increased investment needs to increase significantly, and that he recognises the GPC hasn’t yet ‘managed to address the fundamental issues of the sustainability of workload management in practices that were promised in the Urgent Prescription.’

Readers' comments (20)

  • Too little too late. this problem has been ongoing for years. some of my colleagues are estimated to have to pay over 10K because of this litigation rubbish culture. come on bma. If you want NHS (which is the problem) why can't you ensure clinicians are adequately defended?

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  • 25% flat increase for me. No calls or complaints. Simply unsustainable

    I'm going to Australia soon and it's about 10% of the rate we pay here.

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  • In danger of becoming like the car insurance industry with MDO's lawyers , no win no fee solicitors and suing the NHS is my equivalent of the lottery ticket punters all doing rather nicely at the expense of the poor sods paying for the privilege of indemnity.
    Time to stop and adopt Australian or SAfrican approach to risk ASAP

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  • I only do few clinics a week . I will stop working because of cost of indemnity . any talk of increase will be detrimental to all semiretired and locums.
    industrial action if just a talk. gps have never gone on strike in past and will not do so now. they may prefer to leave country. Australia is full of British gps now . they may go to Canada or Newzeland.

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  • This has to be top of the agenda - stopping a lot of us doing more sessions

    Also makes a lot of people drop sessions as after tax and defence fees, more economical to work less

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  • Indemnity costs are stopping me work more. I'll say it again - Indemnity costs are stopping me work more.

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  • We've been asking for crown indemnity for years now and it's fallen on deaf ears. The government will only be incentivised for tort reform if the tax-payer is on the receiving end of the costs that politicians deliberately created. It's obvious that rising indemnity is being used against us to achieve the DOHs primary goal - destroy the NHS.

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  • UtterFool

    I've just asked to drop a session unless my employer can give me a significant pay rise, this is a direct result of my indemnity increase in June..which makes my current job untenable. If they don't pay adequately I'm leaving to become a Locum. Unless the help is very swift indeed I think it's too late, probably even working as a Locum. ..bland statements such as 'we are looking in to it ' , is, I fear, all we are going to get for the foreseeable.

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  • Medical Litigation is the next cash cow for the lawyers. All these companies that have been set up to deal with PPI will be looking for something else to do when PPI runs out in a year or two.

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  • Vinci Ho

    Richard , you will have to play with some political sound bites or slogans like ,' no crown idemnity , no more GPs', for instance.

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  • Patients sue GPs privately, engaging their own lawyers at their own expense. Compensation awards to successful claimants are also paid privately. If Government will not meet the escalating costs of medicolegal cover it would therefore seem reasonable for practices to be able to cover these costs by charging an excess, the cost of which would currently be less than £10 per individual annually.

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  • In a commercial environment, such extra or increasing business costs would be passed on to the consumer. We should insist on the ability to do the same. The government is ultimately the consumer, and our annual contract negotiations should realistically reflect the rising costs of operating as small businesses.

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  • can someone explain to me the argument AGAINST crown indemnity?

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  • Hi Watchdoc
    The argument against crown indemnity is that if you want to destroy the NHS as Jeremy and his chums do to then it is all going swimmingly.

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  • Having an indemnity surcharge would be a great way forward but it would require a GMS contract renegotiation. It could be added to the prescription charge for simple collection.

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  • The main reason against crown indemnity is the risk that GP's may earn more money.

    Many of the NHSE projects have an overwhelming unwritten rule. Money can be spent on any project regardless of the lack of evidence as long as it doesn't end up in frontline primary care.

    Many senior NHSE managers believe that GP's are on huge salaries ( yes most NHSE managers do not understand drawings/risk or partnership).
    That is the overwhelming aim - destroy GP's - if there is collateral damage so be it.

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  • The argument AGAINST crown immunity is simple...
    Back in the day GPs were proud of their independent contractor status, in other words proud of being OUTSIDE the NHS.
    Cocking a snook at the statist institution, it is no surprise that the state now argues GPs don't deserve a bar of state benefits

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  • Too little too late. I still do 2-3 session/week but I will stop when next MDO bill drops through the letterbox

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  • Council of Despair

    will pass on full increase to clients

    the blame will go 100% to the government.

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  • The argument against crown indemnity is that it still has to be paid by someone, and this pushes the cost back to DoH so they have to make cuts elsewhere to cover it.

    I would like to work just half a session extra, but the rise in indemnity (as it would cross a boundary) is prohibitive, so I don't. And that's also why I can't do any out of hours.

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