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GPs able to negotiate lower out-of-hours indemnity costs after groundbreaking risk-sharing pilot

Exclusive GPs have been able to negotiate lower indemnity costs for out-of-hours work due to a new risk-sharing pilot scheme in Wales that the GPC says should be adopted by other NHS organisations.

The pilot has seen ministers in Wales extending the ‘risk pool’ that covers the costs of clinical complaints against doctors directly employed by health boards, to cover all out-of-hours work.

The Welsh GPC said the scheme, which will be reviewed over the next few weeks by the Welsh Government, has shown that the risk-sharing arrangements help alleviate problems with recruiting GPs for out-of-hours shifts.

The scheme was set up last September after the GPC lobbied for a scheme to tackle the crisis in out-of-hours recruitment. The GPC said at the time that it had been contacted by a number of out-of-hours GPs who said increases to their indemnity fees were putting them off taking up extra shifts.

GPC negotiators told Pulse that the pilot has been effective in increasing the number of GPs willing to do out-of-hours work and that it should be continued past 31 March this year, when it comes up for review.

The recruitment of out-of-hours GPs has become a big issue across the UK, with Pulse recently reporting that CCG leaders have had to provide extra funding to help recruit GPs, while the Scottish Government agreed to a 30% uplift in locums’ wages to support out-of-hours recruitment.

Welsh GPC chair Dr Charlotte Jones told Pulse the innovative scheme in Wales had worked.

She said: ‘The advent of the risk pool has shown there has been an increase in the number of GPs willing to do out-of-hours work, but there is an indication that it was removed, then GPs will stop doing it again… it certainly has helped with recruitment into shifts.’

‘I do know there have been incidences where some doctors have been able to negotiate lower fees.’

But she warned that GPs should not forego indemnity fees completely. She said: ‘The risk pool indemnity does not cover GPs against any criminal or regulatory hearing, so we would still strongly advise GPs to have additional indemnity to cover them against those sort of aspects of the claim.’

The Welsh Government said it would consider making the scheme permanent if it proves a success.

A spokesperson said: ‘During 2013/14, the Welsh Risk Pool Advisory Board determined to provide temporary cover for GP out-of-hours activity to 31 March 2014 whilst a review of the GP indemnity situation for out of hours across local health boards is undertaken.’ 

‘When the review is complete, the Advisory Board will determine whether to amend the scope of Risk Pool indemnification in future for GP out-of-hours arrangements.’

GPC deputy chair Dr Richard Vautrey said the scheme was a ‘good idea’ that others should look at.

He said: ‘Yes this is a good idea that other out-of-hours organisations should seriously look at adopting. Many GPs are now being discouraged from working in out-of-hours settings because of the huge increase in indemnity fees and unless something is done urgently there is a possibility that this could put some organisations ability to maintain services at risk.’

Medical defence organisations said they were looking at the scheme closely, but could not confirm that these arrangements would lead to a reduction in fees.

A spokesperson for the MDU said: ‘We are monitoring the situation in Wales but cannot comment further at this stage.’

A spokesperson for the MDDUS said: ‘MDDUS is aware of the Welsh Government’s thinking regarding out-of-hours services, but it would not be appropriate to comment at this time.’


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Readers' comments (5)

  • As in the USA, there are certain specialties where the defense fees have become too prohibitive. I suspect General practice is heading the same way. As usual too little will be done and it'll be done too late

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  • GPs urgently need an arrangement similar to trust indemnity. Medical insurance fees are rapidly becoming unsustainable due to the unrestricted growth of the medico-legal industry. Moving the costs to the government would concentrate minds on the need to get a grip on these costs.

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  • Edoardo Cervoni

    Behind any crisis there is an opportunity. An opportunity for a change. Increasing indemnity costs and litigations are a widespread phenomenon in USA and Europe. Not only. Malpractice lawsuits have high visibility, particularly those resulting in large awards. To make matters worse, a lawsuit for a large amount of money constitutes front page news, whereas a physician's exoneration in a lawsuit is often a back page entry.
    Malpractice most often takes place when "bad outcomes" are combined with "bad feelings." But nowadays litigation has become a common response to bad outcome in general. All doctors-even those who practice good medicine are therrefore vulnerable to litigation. Although many physicians continue to believe that litigation is something that happens "to the others," most are keenly aware of the risks.
    Fact is that defensive medicine is becoming more and more common. I do not think this is good for doctors, for patients, and for the government. In fact, perhaps it would be the general population and the public healthcare systems to pay the highest fees. This is why, I believe, government should step in. Besides the rising costs, one of the major effects is a distinctly defensive approach to practice, with the patients seen as adversaries long before any hint of litigation supervenes. Frequent attention in the media to the issue of malpractice may increase the level of paranoia among practitioners, in which doctor-patient relationships become doctor-customer relations or-at worst-defendant-litigant relations; and medical services are viewed as some kind of product with concomitant warranties and guarantees. Defensive practice may also usurp the clinical judgment of practitioners, and doctors may lose enthusiasm for attending to the needs of patients because of a perceived loss of autonomous control over the interaction. Doctors will avoid high risk areas of practice (general practice, obstetrics, orthopedics, and emergency medicine) or may leave the field of medicine entirely. we already know that Emergency rooms are difficult to staff, and insurance companies are accused of profiteering.

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  • Vinci Ho

    The Welsh GPC said the scheme, which will be reviewed over the next few weeks by the Welsh Government, has shown that the risk-sharing arrangements help alleviate problems with recruiting GPs for out-of-hours shifts.

    Editor , have you got some concrete evidence or statistics to support this claim?

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  • 70 sausages an hour, 40 percent tax, hence 40 an hour, 5 patients in an hour, comes to 8 for taking out of hour risk, why bother, sit at home and read vile DM comments

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