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Stevens: Crown indemnity may not be the right solution for GPs

Exclusive NHS England’s chief executive has cast doubt on how useful crown indemnity will be for GPs, suggesting that it may not reduce costs for practices.

In an exclusive interview with Pulse, Simon Stevens reiterated that he wanted to relieve the pressure of soaring indemnity costs from practices, but pointed out that GPs would still have to pay premiums to the NHS Litigation Authority.

The recently released General Practice Forward View promised a consultation with the profession on ‘potential solutions’ to the soaring cost of medical cover. But it seemed to confuse crown indemnity with ‘crown immunity’, claiming that such a scheme would ‘mean it is not possible to sue for damages’.

Lawyers told Pulse that these were two different types of scheme. When asked by Pulse to clarify NHS England’s position, Mr Stevens said: ‘The idea of [patients not being able to] sue wouldn’t be viable. 

‘Crown indemnity would just mean the NHS Litigation Authority, rather than defence organisations or commercial insurers, charging premiums to practices.

‘We have been talking with the FDA, GPC and others about this, together with the defence organisations. We’ve got a number of tangible propositions we want to consult on. But, for me, the fundamental point is there’s absolutely no reason in principle why GPs should personally be on the hook for rising indemnity costs in a way that hospital doctors aren’t.’

The GP Forward View said that NHS England had ‘to date, not seen evidence’ that including practices in the Clinical Negligence Scheme operated by NHS Trusts would bring down costs for GPs. Indemnity costs are a major barrier to the development of primary care to take on more secondary care services, as envisioned in the Five Year Forward View blueprint for the health service.

Other solutions mooted by GP leaders have included direct reimbursement of indemnity costs.

Jack Stephenson, a solicitor at Harrison Dury, said: ‘It would appear that [NHS England] has mixed up crown indemnity with crown immunity. The latter is a legal doctrine by which the state cannot commit a legal wrong and is immune from civil suit or criminal prosecution. If GPs had crown immunity, this would indeed mean that they could not be sued for clinical negligence.’

An NHS England spokesperson insisted it was not a mistake, but that the GP Forward View’s statement on crown indemnity ‘could have been clearer’.

A recent Pulse survey, of more than 900 GPs, showed that GPs paid an extra26% more on average in indemnity fees last year, although the figure could be higher as many said they had cut shifts in response.

Tackling the indemnity issue

The GP Forward View said NHS England proposals, to be put forward in full by July, will include looking at: