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English GPs move north of the border due to spiralling indemnity fees



Exclusive GPs in the English borders are crossing over to work exclusively in Scotland after identifying that indemnity costs are one third of what they would pay working full time in England.

The chief clinical officer of NHS Northumberland CCG told Pulse that several senior GPs who have switched to locum work after a career in English general practice have said working south of the border ‘makes no financial sense’ due to flaws in the indemnity system.

Indemnity providers told Pulse that a GP practising in England is three times more likely to face a clinical negligence claim than and the value of the claim is likely to be higher as well.

A GPC negotiator has also said that he has seen his indemnity quote by 500% when moving from Scotland to England.

Local leaders said that the situation is compounding workforce issues in a region already facing ‘alarming’ fill rates to GP training posts.

Pulse reported last year that some doctors quoted £30,000 for annual cover including out-of-hours, with GPs reporting an average fee increase of 25% last year.

NHS England said in its General Practice Forward View that it would tackle rising indemnity fees, having launched a risk sharing pilot for out-of-hours last year.

But NHS Northumberland CCG chief clinical officer Dr Alistair Blair told Pulse that the current system is ‘penalising’ small rural practices in Northumberland who are of a ‘really high standard’.

Dr Blair told Pulse he had used his own details to get quotes for annual cover doing ten sessions on either side of the border.

He said: ‘It’s about £7,000 to £8,000 for a full time ten-session GP [in Northumberland], and it’s £2,000 to £3,000 in Scotland. Those are big differences – £5,000 a year penalty to work in England rather than Scotland.’

He added: ’Recently, several GPs have retired and looked at doing locum work… Unfortunately they’re now saying “I know I’ve worked in England all my days but it makes no financial sense for me to work in England now, so I’m working in Scotland only.”’

‘We look at the very alarming fill rates locally, in the training scheme and we look at… the fact the fill rate in Scotland is greater than the fill rate in England. This is another factor which suggests GPs may preferentially work in the Scottish borders, rather than the English borders.’

An MDDUS spokesperson said that, while they were always looking at making their fees competitive: ‘GPs practising in England are up to three times more likely to have a claim than one practising in Scotland… not only are the number of claims higher in England, the value of these claims are also greater.

‘It is important to note that the distinction being made is between two different areas of legal jurisdiction, rather than a matter of simple geography.’

Dr Dean Marshall, a GPC negotiator, said at the LMCs Conference yesterday: ’I am soon to move to working in England from Scotland, and my indemnity fee has risen 500% for the same level of cover. That ca not be right. But it gives you an idea that the problems around the English legal system are significant, as I am no more risky working in England than I am in Scotland.’

Rising indemnity fees

simon stevens

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In January, Pulse revealed that indemnity fees were ‘spiralling out of control’, rising by an average of 25.5% in 2015, according to an analysis of responses from over 900 UK GPs.

This was particularly acute for out-of-hours doctors, with one GP claiming that they had experienced a £30,000 increase in their costs this year.

As a result, NHS England implemented a £2m temporary scheme in which GPs signing up for extra out-of-hours shifts this winter were be able to have their medical indemnity costs covered, which 550 GPs used, totalling 14,264 extra shifts.

The scheme was discontinued as planned in March but NHS England is looking of ways to reduce the indemnity burden on GPs, with chief executive Simon Stevens telling Pulse: ’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.’