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GPs reap significant savings as trust indemnifies out-of-hours work

Exclusive Swathes of GPs in one area of England have seen their indemnity costs fall after the local ambulance trust agreed to take on the liability for their out-of-hours work, Pulse has learned.

South Western Ambulance Service NHS Foundation Trust, which provides GP out-of-hours services across Dorset, said it decided to indemnify the work of 150 GPs on its roster via the NHS Litigation Authority in a bid to fill shifts.

One local GP has told Pulse that their premium has decreased by £1,600 since the changes came into effect in April, making the GPs ‘bank employees’ of the trust.

The trust decided to cover its GPs’ indemnity after tax reforms were put in place by the Government in March.

The reforms, which made it the responsibility of public bodies to determine the employment status of those working for them, also changed how employment status is decided.

After seeking legal advice from PriceWaterhouseCoopers, the trust said it decided that their out-of-hours GPs were employed by the trust rather than self-employed, which they had previously been.

This comes as indemnity premiums continue to rise – especially out of hours – with GPs demanding that the Government reimburse their fees in full.

An out-of-hours GP working for the trust, who said she needed to remain anonymous for contractual reasons, described the new employment situation as ‘a good deal all round’, adding that it has ‘paved the way for other employers to go down this route’.

Although each GP negotiates their own indemnity premium with their medical defence organisation based on individual circumstances, she said that her annual premium decreased by £1,600 as a direct result of the trust’s decision.

Dr Simon Scott-Hayward, a GP and associate medical director for the ambulance trust, said the decision had been in ‘the best interest of the trust’. 

He said: ‘What we have seen is indemnity fees rising fairly steeply and as a provider of out-of-hours services we have seen indemnity fees, and the system that sits behind it, being an increasing barrier to people working and doing additional work. 

‘We have been trying to work out a solution to indemnity cover for the last couple of years and this has been a lever to enable us to do that.’

He added that having GPs work under a bank contract enables the trust to pay into their NHS pension scheme as well as offering indemnity under the trust.

It comes as NHS England has covered GP out-of-hours indemnity costs the past two winters to boost uptake of shifts. And in Wales, GPs have been able to negotiate lower indemnity costs after the Government extended the ‘risk pool’ for for doctors directly employed by health boards to also include out of hours.

Mitigating the rising cost of GP indemnity

Every GP practice in England is receiving 52p per registered patient to offset the average increase to the cost of medical indemnity this year. The £60m Government programme to reimburse rising expenses come as GPs had recently seen their premiums increase by as much as a quarter year-on-year.

But at last month’s LMCs Conference GPs declared the measure insufficient, passing a motion demanding the Government begins to reimburse GP indemnity fees in full.

The problem, which the Government has acknowledged requires a more long-term solution, has been ever more evident for out-of-hours premiums, where the risk of litigation is generally deemed to be higher. And, as extensively highlighted by Pulse, this is putting increased pressure on out-of-hours providers attempting to fill GP shifts.

The medical defence organisations say the increased premiums are in direct response to rising costs of payouts and increased rates of litigation brought against GPs. They have further warned that the Government’s decision earlier this year to reduce discount rates will mean that payouts will rise by millions.

Note: This article was updated at 12.20 on 7 June to reflect that this is not the only hospital trust that runs GP out-of-hours services.