GPs face sharp increases in defence premiums after being dumped with responsibility to cover nurses working at their practices by the Royal College of Nursing (RCN), which has controversially decided to stop providing indemnity for its members in primary care on cost grounds.
The move, scheduled from January 2012, has sparked fears GPs could face bills for millions of pounds of extra cover, with the GPC urging them to check indemnities to ensure they are covered for the actions of practice nurses in extended roles such as prescribing.
Medical defence bodies are seeking urgent talks with the RCN to ‘ensure there are no gaps’ in GPs’ professional cover following the decision. The Medical Protection Society warned the move could see GPs’ premiums rising, a concern echoed by accountants and the GPC.
The Medical Defence Union said it would encourage nurses in extended roles to take out their own cover. But in a further controversy, the RCN told its members: ‘It is clearly unacceptable for a GP to require a member to pay for personal cover, just as we wouldn’t expect the NHS to require a nurse to pay for personal cover.’
In briefing notes on the change, the RCN described its current duty to provide indemnity to practice nurses as ‘an unacceptable financial burden’. Read the full letter here.
It added: ‘The number of cases involving RCN members in general practice is small (around 40 to 50 a year) but the costs are high – around £5m, amounting to 90% of the costs of the indemnity scheme.’ It said it needed to control those costs ‘so subscription fees remain affordable to all members’.
Dr Iain Barclay, head of medical risk and underwriting at the MPS, said while GP members ‘will not have to increase their own cover’, they ‘must ensure all staff, including nurses, have adequate and appropriate indemnity in place’.
Dr Barclay added: ‘[We] will continue to look at how we can best meet the indemnity needs of GP members and their staff. There are different ways this can be done, but indemnity for any liabilities comes at a price.’
The GPC advised practices to check their indemnity arrangements to ensure ‘work carried out by practice nurses is appropriately covered’.
GPC deputy chair Dr Richard Vautrey said: ‘GPs’ individual indemnities would cover them to some degree. But the worry is whether that is sufficient for nurses in extended roles. GPs need to check their cover with defence bodies. They might need to take out practice indemnity, and there are cost implications to that. This could be a big problem for some practices.’
Bob Senior, director of medical services at accountancy firm RSM Tenon, said: ‘The cost is well below £1,000 for a nurse, but if a GP has to pay that on top of the typical £5-6,000 a year for themselves, it’s quite a big percentage increase.’
In a further statement, the Royal College of Nursing’s legal director Chris Cox said: ‘Any work undertaken by an employed nurse in the practice setting should be covered by the employer through practice group indemnity. The RCN has informed relevant stakeholders, such as the BMA, who have advised their GP members of this change.’
‘To single out employed RCN members for different treatment compared with non-RCN and other practice staff dilutes the principle of vicarious liability, which legally all employers must accept for all the staff they employ.’