Today a GP can expect to pay around twice for their medical defence organisation (MDO) membership compared with five years ago. In addition, practice nurses now have to buy their own indemnity, the cost of which has also increased dramatically. And while new types of clinical practitioners have arrived to help reduce workload on GPs, the MDOs are struggling to price indemnity cover for the whole practice.
Here are some tips to get the best deal on your indemnity.
1. Consider a whole surgery policy
Whole surgery policies typically indemnify the surgery or surgeries as one entity, including all clinicians and administrative staff. They can cover staff such as nurse practitioners (with or without prescriptive authority), triage nurses, practice nurses, emergency care practitioners, physician associates, phlebotomists, HCAs, pharmacists, call handlers, admin or clerical staff and therapists.
At present most GPs retain their own MDO cover but increasingly the whole surgery policies are being extended to include GPs working in the practice. The obvious attraction of the whole surgery policy is that it is cheaper than individuals purchasing stand-alone cover, but there are other benefits.
For example, it avoids potential gaps or conflicts in cover where a patient has been seen by several clinicians who are insured by different MDOs or insurers. Also, other insurance products can be included (for example public liability and employers liability, GMC and Cyber cover) meaning that cover is seamless, appropriate and adequate. The surgery and all clinicians and staff have 24/7 access to legal and medicolegal advice and a whole surgery policy is easy to apply, understand and adjust as the business model evolves.
2. Economies of scale can work in your favour
Whole practice indemnity tends to be cheaper because insurance works on scale and risk management. If a number of GPs, clinicians, nurses and support staff are buying insurance collectively then they achieve an economy of scale. Combine this with a well run practice or group of practices and insurers achieve a level of comfort that they are insuring a well-managed risk. If multiple surgeries form a federation and employ common best practices then significant discounts can be obtained compared to single surgery policies or individual clinician cover.
3. Be aware of the security of the insurers
Cost and consistency of cover are both important but so is the security of the insurers being used. Most GPs will have heard or have personal experience of the St Paul situation where, 20 years ago, one large American insurer took a sizeable share of GP insurance then withdrew from the market. Today a number of commercial insurers are offering cover but it pays to understand who they are, what their security is like and what services they have on offer. An experienced broker can explain all of this.
4. Fill the form out correctly
Make sure that you complete a specialist proposal form. This will collect all the information required and will save you time. Disclose all material facts – all the things that may affect the insurers’ decision, such as any claims against the practice or the individual clinicians, the activities carried out within the practice and the checks in place to ensure clinicians are correctly registered.
5. Make sure you get an appropriate indemnity limit and understand the policy
Purchase an adequate and appropriate limit of indemnity – £10m is recommended but you should check the relevant contract requirement. Be aware if there is a policy excess and what this applies to. Policies are available without an excess but you may benefit in premium terms from receiving a quote with one. £5,000 is a typical excess.
6. Be aware of the support services
Look carefully at the support services such as the medicolegal advice and risk management services to improve patient care. Check whether GMC and other regulatory representation cover is available.
Kevin Culliney is head of healthcare at global insurer Lockton
