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Independents' Day

Practice faced with £7,000 increase in nurse’s indemnity bill after almost ten-fold hike

Exclusive A practice has seen the indemnity fees for its advanced nurse practitioner rise by £7,000 in 12 months, despite having had no problems during the year, leaving it struggling to pay the fees.

The advanced nurse practitioner (ANP) was told by the Medical Defence Union that the fee had gone up to £7,995 for annual cover this year – the equivalent of four months’ salary – despite previously paying less than £900 last year for cover in the same job.

It comes as there have been fears about the costs of indemnity for other practice staff, such as ANPs and physician associates, with the Government promoting them as being the best way to fill gaps caused by the shortage of GPs.

The GPC said that the only way to stop escalating indemnity fees for all GPs and practice staff is for the Government to pay the costs or to cap legal costs.

Rachel Drago, an ANP at the Clarence Park Surgery in Weston Super Mare, said the practice had traditionally paid her fees but added that it simply could not afford the bill.

She said: ‘The practice would pay it tomorrow if they could. But we don’t have the money. We are a tiny practice.’

She said she was not given any prior warning of the increase in her subscription fee by the MDU. Instead, she received a bill for £7,100 the day after her indemnity cover was due for renewal – and was informed the MDU had already taken a first instalment of £795 via her existing direct debit agreement.

Mrs Drago – who has more than 10 years’ experience in general practice – said she was told the increased fee was based on her work in a ‘high-risk, non-indemnified environment’.

Mrs Drago said she had not been able to negotiate an alternative quote from the MDU and was still attempting to find cover elsewhere, but had been told ANPs would automatically be facing quotes in the region of £4,000 to £10,000 from any indemnity provider.

She told Pulse the fees hikes would see ANPs left with no choice but to consider leaving general practice altogether.

When I take into account all my other costs, it is barely worth me going to work

She said: ‘When I take into account all my other costs, it is barely worth me going to work. How many other professions have to give up four months’ salary to perform their job?’

Dr Peter Maksimczyk, a GP partner at the practice, said Mrs Drago had been an excellent ANP, and there had been no issues with her.

But he added: ‘We haven’t worked out who will pay it. It is the equivalent of a 20% salary increase.’

‘They’re bringing in physician associates - but who will pay for this?’

The ANP indemnity hike comes amid a crisis in indemnity for practices that has seen GPs given quotes as high as £30,000 for doing out-of-hours work, and will cast doubt on the government’s programme to bolster general practice by expanding roles of pharmacists, nurses and physician associates (PAs) employed within practices.

The MDU said in a statement: ‘We cannot comment on individual subscriptions but we would encourage any member with concerns about their individual membership to contact us to discuss the indemnity options available to them.’

Dr Richard Vautrey, deputy chair of the GPC, said the rising legal fees were a ‘rate-limiting factor’ for the government’s plans for expanding non-GP roles in practices, as well as other initiatives such as extended practice hours.

He added that either the government would have to find a solution, either by paying indemnity of GP staff ‘or by cutting the costs of indemnity’, which can only be done by legal reforms, ‘or capping legal costs, in the way other countries have done’.

Readers' comments (19)

  • Utterly outrageous!
    The most qualified nurses will be looking for jobs down under soon.
    Soon we will all be paying to work!

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  • Took Early Retirement

    I thought the name sounded familiar

    not that long ago, her practice couldn't do without her!
    Well, no offence to you Rachel; I bet you do a good job. This is just the reality of nurses taking a bigger clinical role:- risk goes with that, so up go the premiums. By the way, the practice probably CAN afford, it, but it will mean a pay cut for the GP partners there.

    What a mess, eh?

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  • Your anger is directed at the wrong enemy.

    Accepting actuaries will get it wrong, the risk they identify is real. The fees in primary reflect the risk.

    What is wrong is that increasing risky practice - phone and web based consults are subsidized by the whole of primary care.

    Also high levels of risk should carry greater reward - i.e primary care dr's should be paid accordingly - that is the major issue.

    The good part of this is that it will stop the use of independent ANP's - which has been a fudge.
    It allows the real issue of primary care pay or government taking the risk to be addressed.

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  • 7.53pm

    Rachel and the partners are as one on this issue. Sarcastic remarks about her value to the practice are unhelpful. As it happens, she is the best of the ANPs and we won't lose her!
    The main issue is that if PAs, ANPs, paramedics and others are brought in to primary care, and riskier ways of practice (telemedicine , Skype, etc) increase then clinical risk increases, but partners cannot bear the full cost as it will , no doubt, increase year on year, at the same time as having a pay cut for 8 successive years, with more cuts to come.
    It doesn't help to take a pot shot at one another, an d yeah, I know I'm taking a pot shot at you.

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  • From a practical perspective, why do people expect any different? Seeing undifferentiated patients is difficult and high risk. Why would someone with a narrower training be lower risk?

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  • I was wondering the other day why this hadn't happened before TBH. indemnity should only be 5% of salary so saleries must double.
    Sounds like a strike is brewing anyway and I for one will be happy to deal with only urgent matters indefinitely until funding rises dramatically for all and I hope others will join in if this is on the cards.

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  • Took Early Retirement

    Er... it wasn't sarcastic, if you mean me. She is of value, clearly, but as another poster has pointed out- actuaries don't get it wrong- usually. I agree there is a common enemy. No one in practice wants to take that enemy on.

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  • I have been trying to flag this for months . I am a Nurse Partner and pay my own cover and this is one thing that has forced me to reconsider my position . All companies may vary slightly but will follow suit . Now indemnity is in the code of conduct it is vital that all Nurses check their level of cover is adequate for the work they do especially if covered by a group policy .

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  • The problem remains that GPs are 'step-partners' of the NHS. We have the obligations but unequal rights as compared to our colleagues in Secondary Care.
    So, while indemnity cover is provided for colleagues in hospitals, we continue to be weighed down by various overheads - indemnity costs, wage increases for staff, increasing costs of electricity, consumables and other mundane necessities essential to run Practices.
    You really need a good speculum to look into the policies of Mr *unt and but no awards for guessing his intentions.

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  • " indemnity should only be 5% of salary so saleries must double."

    Indemnity costs should be based on risk. If nurses want to take on riskier activities like seeing anything that walks through the door they should take the responsibilities that go with this. It doesn't make sense that a GP has to pay £7000 and that an ANP seeing effectively the same caseload has to pay £700.

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