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BMA pushes for indemnity discount for GPs working out of hours

Exclusive The BMA is to meet with medical defence organisations after reports that ‘steep rises’ in indemnity fees are putting GPs off working out-of-hours shifts.

The move comes after some GPs reported some medical defence bodies demanding rises of up to a third in fees, with one locum provider saying this penalises those who only wish to take on a small number of shifts.

But the medical defence bodies said that they had to collect sufficient income from fees to cover their costs, and that some of their largest payouts were for GPs doing out-of-hours shifts.

The BMA’s intervention comes at the same time as GPs are bracing themselves to take on responsibility for the out-of-hours care of patients under controversial Government plans.

Pulse revealed earlier this year that in-hours subscriptions rose four times the rate of inflation in 2013, but one GP contacted us saying they had an increase in medical defence fees from the Medical Protection Society of 33%.

The MPS confirmed that figure was correct, but stressed that this was based on 14 sessions a week with a significant proportion out of hours and declined to give any figures on the average rise for GPs working out-of-hours shifts.

A salaried GP who works two out-of-hours shifts a week told Pulse they had a 15% fee hike in their MDU subscription from 1 April. The Medical Defence Union refused to confirm if the figures were representative of the average increase in fees.

The MDDUS said it had increased its fees by 10% across the board.

A BMA spokesperson said: ‘Many GPs across the UK are facing steep rises in their medical indemnity costs, especially those who are undertaking occasional or out of hours shifts.’

‘The BMA will be raising this issue directly with the [MDOs]. We are particularly keen to discuss whether there are potential reforms to the current fee system that could alleviate some of the pressure on those undertaking occasional and out-of-hours shifts.’

But MDU professional services director Dr Matthew Lee said GP subs took into account the different type of work GPs do, but that those only working one or two sessions out of hours per week would not typically see fees rise as a result.

He said: ‘Those with significantly greater involvement in out-of-hours work, or who work primarily out-of-hours, are exposed to an increased risk of facing complaints and claims and this is reflected in our calculation of their individual subscription.’

He added: ‘Some of the largest claims we have settled have stemmed from care provided, or in some cases not provided, by GPs working out of hours.’

Dr Stephanie Bown, director of policy and communications at the Medical Protection Society told Pulse they would be ‘happy’ to meet the BMA on the issue.

Dr David Bailey, a GPC negotiator and chair of GPC Wales, said they were looking at subsidising or getting ‘group bookings’ for GPs facing increased fees from ‘just doing a little bit of out of hours’.

He said: ‘They are financial organisations, so it is a question of whether or not we can come to something which works for both sides.

‘But what we can’t have is a situation where if you want to go and do just one or two out-of-hours session the entire fees for doing that get eaten up in increased insurance costs. That simply doesn’t work as it means out of hours is not an attractive prospect.’

Dr Sarabjit Singh Chandan, an out-of-hours locum GP who also runs his own 450-member locum agency in the Midlands region, commented: ‘Locum rates are higher than they should be for out of hours. The rates are not fair because most MDOs don’t distinguish between what out-of-hours work you do, between triage and face-to-face contact.

‘I think those doctors that work mainly out of hours are committed to doing so but the [deciding factor] for a GP to take on just a few shifts out of hours would probably depend on what the provider paid.’