Medical defence organisations are refusing to offer indemnity to practice nurses working in hubs at weekends at GP Access Fund seven-day pilots, according to a GP who is now calling on NHS England to intervene.
Dr Patrick Geraghty, who helped set up a pilot in Leeds West and now works there, told Pulse that he has approached a number of medical organisations about indemnity for practice nurses but has hit a brick wall at every attempt.
As a result, the three hubs that operate at weekends in Leeds West do not employ any practice nurses.
Dr Geraghty said: ‘They (MDOs) don’t seem to have got their heads around hub working and nurses. So at the moment it is mainly being doctor-run, with healthcare assistants as well because they are covered by the doctors’ indemnity. And I don’t think this is just applicable to us, I think it’s a universal problem.’
The sticking point for the indemnity refusal is that practice nurses at the hubs might be seeing patients from other practices, but Dr Geraghty argued that the way the hubs are set up this does not become an issue.
He said: ‘This isn’t an out-of-hours service – this is extended access – so we all have access to the computer systems of all of the 15 practices. So we are working within their system as if we were a locum or a partner in the practices.’
He told Pulse that around a year ago NHS England top executives, including the chief executive Simon Stevens, listened to a presentation in which Leeds West staff explained the problem with indemnity and asked whether NHS England could look into it.
‘Nothing has happened though,’ said Dr Geraghty.
He is now calling on NHS England to step in and either put pressure on the MDOs to change their stance or for NHS England itself to offer indemnity cover. Because the inability to obtain indemnity for practice nurses also comes at a cost, stressed Dr Geraghty.
He said: ‘Employing practice nurses could really help us because then naturally it would be more clinical time at a cheaper rate.’
In the meantime Dr Geraghty is still struggling to get indemnity, but he is now in talks with MPS, which is trying to find a solution.
MPS told Pulse that it is committed to offering flexible membership options and ensuring that it reflects the current and emerging patterns of primary care delivery in England and the rest of the UK, ‘including hubs and other more collaborative ways of working’.
Dr Nick Clements, head of risk and underwriting policy at MPS, said: ‘We can offer a number of indemnity options for nurses working in general practice, and we can discuss bespoke arrangements for hubs with multidisciplinary teams each operating in different ways – there is no one size fits all indemnity solution.’
But he added that it was important for MPS members to inform them if they were looking to use practice staff outside of normal practice arrangements – including where they plan to lend, borrow or share staff with other practices or organisations – to ensure adequate indemnity arrangements are in place.
Meanwhile, a spokesperson for the Medical and Dental Defence Union of Scotland (MDDUS) said: ‘We can confirm that we are able to provide indemnity for nurses working on seven-day pilots. This is available as an extension of our discount practice schemes.’
And Dr Sharmala Moodley, MDU deputy head of underwriting, said: ‘Well over 10,000 nurses are MDU members, the majority working in primary care. However, we can usually extend the benefits of MDU membership to nurses planning to take on additional roles outside the practice.
‘This will sometimes attract an additional subscription depending on the nature of the arrangements and the specific role taken on.’
Pulse has approached NHS England for a response.